الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Successful dialysis access necessitates superficial arterio-venous fistula placement to facilitate identification of anatomical landmarks for safe cannulation which mainly done under general anesthesia. Muscle relaxant used to induce paralysis to facilitate intubation.
Rocuronium non- depolarizing neuromuscular blocking agent with a rapid to intermediate onset depending on dose and intermediate duration. It acts by competing for cholinergic receptors. This action is antagonized by acetylcholinesterase inhibitors, such as neostigmine and edrophonium.
In patients with chronic renal failure, physiological and pharmacological factors alter the pharmacokinetics and pharmacodynamics of non-depolarizing neuromuscular blocking agents, making the recovery of the neuromuscular function relatively unpredictable.
Complete and rapid reversal of the effects of neuromuscular blocker drugs is a primary element of safety in anesthesia. Neuromuscular conduction that is not completely improved leads to post-operative residual curarization and the development of complications that are related to respiration.
In the presence of renal dysfunction, the clearance of neostigmine is reduced and the half-life is prolonged so that patients are exposed to enhanced cholinergic effects from the drug and as a consequence may suffer vomiting, bradycardia and bronchoconstriction.
Sugammadex reverses the neuromuscular block induced by aminosteroid drugs such as rocuronium by encapsulating the drug molecules. Studies show that in patients with chronic renal failure, sugammadex, at a dose of 2 mg/kg, effectively reverses a moderate NMB faster than neostigmine. Sugammadex is a safe agent with a low risk of serious side effects.
The aim of this work was to study the efficacy of sugammadex versus neostigmine for reversal of rocuronium-induced muscle relaxation in end stage renal disease patients undergoing general anesthesia.
The study was carried out on forty adult end stage renal failure patients ASA III-IV in Alexandria Main University Hospitals scheduled for elective arterio-venous shunt surgery under general anesthesia was participated in this study. All patients were received the same general anesthetic technique that was intravenous propofol (2.0 mg/kg) and first response to nerve stimulator to obtain supramaximal stimulus was tested, Oro-tracheal intubation was facilitated by rocuronium (0.6 mg/kg), anesthesia was maintained with isoflurane (1.2−1.5%) in 100% oxygen, muscle relaxation was maintained during operation using rocuronium (0.06 mg/kg) when train of four (TOF) reached a score of 1.
At the end of surgery and when second twitch was achieved on the TOF stimulation, patients who were randomly classified into two equal groups by the closed envelope method were received the coded intravenous:
group I: Patients were received sugammadex 2 mg/kg.
group II: Patients were received neostigmine 0.05 mg/kg together with atropine 0.02mg/kg.
Standard monitoring (ECG, mean arterial blood pressure, and heart rate) were recorded before induction of anesthesia. During anesthesia and after reversal administration these parameters were continuously monitored and recorded every 15 minutes intraoperatively and 2, 5 and 10 minutes after reversal administration. The duration of general anesthesia and total dose of rocuronium were recorded. TOF ratio 0.9 TOF% and recurrence at PACU were recorded. Any other complications were recorded.