BACKGROUND: Sugammadex reverses rocuronium-induced neuromuscular blockade quickly and effectively. Herein, we compared the efficacy of sugammadex and pyridostigmine in the reversal of rocuronium-induced light block or minimal block in pediatric patients scheduled for elective entropion surgery. METHODS: A prospective randomized study was conducted in 60 pediatric patients aged 2–11 years who were scheduled for entropion surgery under sevoflurane anesthesia. Neuromuscular blockade was achieved by administration of 0.6 mg/kg rocuronium and assessed using the train-of-four (TOF) technique. Patients were randomly assigned to 2 groups receiving either sugammadex 2 mg/kg or pyridostigmine 0.2 mg/kg and glycopyrrolate 0.01 mg/kg at the end of surgery. Primary outcomes were time from administration of reversal agents to TOF ratio 0.9 and TOF ratio 1.0. Time from the administration of reversal agents to extubation and postoperative adverse events were also recorded. RESULTS: There were no significant differences in the demographic variables. Time from the administration of reversal agents to TOF ratio 0.9 and TOF ratio 1.0 were significantly shorter in the sugammadex group than in the pyridostigmine plus glycopyrrolate group: 1.30 ± 0.84 vs. 3.53 ± 2.73 min (P < 0.001) and 2.75 ± 1.00 vs. 5.73 ± 2.83 min (P < 0.001), respectively. Extubation time was shorter in the sugammadex group. Adverse events, such as skin rash, nausea, vomiting, and postoperative residual neuromuscular blockade (airway obstruction), were not statistically different between the two groups. CONCLUSIONS: Sugammadex provided more rapid reversal of rocuronium-induced neuromuscular blockade in pediatric patients undergoing surgery than did pyridostigmine plus glycopyrrolate.
Anesthesia ; Delayed Emergence from Anesthesia ; Entropion ; Exanthema ; Glycopyrrolate ; Humans ; Nausea ; Neuromuscular Blockade ; Neuromuscular Monitoring ; Pediatrics ; Prospective Studies ; Pyridostigmine Bromide ; Vomiting

Subcutaneous emphysema is the accumulation of gas or air in loose subcutaneous connective tissue. The use of air-driven handpieces in dental procedures is a common iatrogenic cause of intraoral mucogingival barrier disruption by high-pressure air. This case report describes a 60-year-old woman who underwent prophylactic periodontal treatment with an air-abrasive device and subsequently developed severe bilateral subcutaneous emphysema, extending from the temporal region to the thoracic and mediastinal spaces. Subcutaneous emphysema was suspected based on clinical examination, and paranasal CT was performed for definitive diagnosis. Chest CT was conducted for further evaluation, followed by consultation with the Department of Thoracic Surgery.The patient was admitted for supportive care and prophylactic antibiotics. After 4 days of hospitalization, the symptoms had nearly resolved, and a follow-up paranasal CT showed significant air resorption. The patient was discharged without complications. Although generally benign and self-limiting, subcutaneous emphysema can lead to serious complications such as systemic infection, pneumothorax, and air embolism. This case highlights the importance of prompt diagnosis and appropriate management to prevent further complications.

Subcutaneous emphysema is the accumulation of gas or air in loose subcutaneous connective tissue. The use of air-driven handpieces in dental procedures is a common iatrogenic cause of intraoral mucogingival barrier disruption by high-pressure air. This case report describes a 60-year-old woman who underwent prophylactic periodontal treatment with an air-abrasive device and subsequently developed severe bilateral subcutaneous emphysema, extending from the temporal region to the thoracic and mediastinal spaces. Subcutaneous emphysema was suspected based on clinical examination, and paranasal CT was performed for definitive diagnosis. Chest CT was conducted for further evaluation, followed by consultation with the Department of Thoracic Surgery.The patient was admitted for supportive care and prophylactic antibiotics. After 4 days of hospitalization, the symptoms had nearly resolved, and a follow-up paranasal CT showed significant air resorption. The patient was discharged without complications. Although generally benign and self-limiting, subcutaneous emphysema can lead to serious complications such as systemic infection, pneumothorax, and air embolism. This case highlights the importance of prompt diagnosis and appropriate management to prevent further complications.

Subcutaneous emphysema is the accumulation of gas or air in loose subcutaneous connective tissue. The use of air-driven handpieces in dental procedures is a common iatrogenic cause of intraoral mucogingival barrier disruption by high-pressure air. This case report describes a 60-year-old woman who underwent prophylactic periodontal treatment with an air-abrasive device and subsequently developed severe bilateral subcutaneous emphysema, extending from the temporal region to the thoracic and mediastinal spaces. Subcutaneous emphysema was suspected based on clinical examination, and paranasal CT was performed for definitive diagnosis. Chest CT was conducted for further evaluation, followed by consultation with the Department of Thoracic Surgery.The patient was admitted for supportive care and prophylactic antibiotics. After 4 days of hospitalization, the symptoms had nearly resolved, and a follow-up paranasal CT showed significant air resorption. The patient was discharged without complications. Although generally benign and self-limiting, subcutaneous emphysema can lead to serious complications such as systemic infection, pneumothorax, and air embolism. This case highlights the importance of prompt diagnosis and appropriate management to prevent further complications.