Children undergoing isolated adenoidectomy may leave the post-anaesthesia care unit sooner when their neuromuscular block is reversed with sugammadex rather than relying on mivacurium alone, according to a propensity score-matched cohort study published in BMC Anesthesiology. The benefit, however, is modest in absolute terms and rests partly on a primary analysis whose headline result did not survive a stricter sensitivity test.
The study addressed a gap in the pediatric anaesthesia literature. Mivacurium and the combination of rocuronium followed by sugammadex reversal are both commonly used neuromuscular blocking regimens in pediatric otorhinolaryngological surgery, but existing comparative studies frequently pool isolated adenoidectomy together with adenotonsillectomy. That mixing introduces significant confounding, and dedicated head-to-head comparisons restricted to children undergoing isolated adenoidectomy alone have remained scarce. The researchers therefore compared postoperative recovery efficiency between the two regimens in children aged 3 to 12 years.
From 877 eligible children, the investigators analyzed 616 children, forming 308 matched pairs after 1:1 propensity-score matching. The primary endpoint was the time from cessation of the anesthetic maintenance agents to tracheal extubation. Secondary endpoints included the time from anesthetic cessation to discharge from the post-anaesthesia care unit, the quality of emergence, and postoperative pain scores.
On the primary endpoint, the median time from anesthetic discontinuation to extubation was 23 minutes in the rocuronium-sugammadex group versus 25 minutes in the mivacurium group, a Hodges-Lehmann pseudomedian difference of minus 2 minutes with a 95 percent confidence interval of minus 4.00 to minus 0.0001 minutes and a P value of 0.022. The authors note, however, that this modest between-group difference was not statistically significant in a paired sensitivity analysis, which returned a P value of 0.069. Readers should therefore treat the extubation-time finding as suggestive rather than firmly established.
The secondary endpoint told a more consistent story. The median interval from drug cessation to PACU discharge was shorter in the rocuronium-sugammadex group, at 38 minutes with an interquartile range of 30.00 to 48.00 minutes, than in the mivacurium group, at 42 minutes with an interquartile range of 34.00 to 51.00 minutes. The Hodges-Lehmann pseudomedian difference was minus 4.00 minutes, with a 95 percent confidence interval of minus 6.00 to minus 2.00 minutes and a P value below 0.001.
Recovery quality and comfort did not appear to be compromised. Steward emergence scores were comparable between the groups, with a P value of 0.416. Visual analogue scale pain scores did differ statistically, with a P value of 0.016, but the authors report that the absolute difference was minimal, meaning the statistical signal likely reflects little of practical clinical importance.
Subgroup analyses added nuance about who benefited most. A shorter extubation time was observed only in children who had received intraoperative midazolam. Shorter PACU discharge duration was also seen in that midazolam subgroup and in both age subgroups, but not in children who did not receive midazolam. Importantly, the authors caution that formal interaction analysis for this exploratory subgroup comparison did not demonstrate significant effect modification, so the apparent midazolam-related pattern should be interpreted cautiously.
The study’s conclusion frames the findings in terms of real-world clinical dosing conditions. The rocuronium-sugammadex regimen was associated with a modestly shorter extubation time in the primary analysis, though that finding was not confirmed in the paired sensitivity analysis, together with significantly reduced PACU discharge time and delayed discharge risk, without compromising postoperative recovery safety or comfort. The authors suggest that, taken together, this anesthetic strategy may help optimize patient turnover in high-volume pediatric day-surgery centers, where minutes saved per case can accumulate across a busy operating list.
As with any observational matched cohort study, the results describe associations under the dosing conditions actually used in practice rather than the effects of a randomized protocol, and the primary extubation result remains sensitive to the statistical method chosen. For anaesthesia teams weighing reversal strategies for children undergoing isolated adenoidectomy, the evidence points to a small but consistent advantage in PACU discharge time, with extubation benefits that are narrower, conditional, and still open to confirmation.
Subject of Research: Recovery efficiency after pediatric isolated adenoidectomy comparing rocuronium-sugammadex reversal with mivacurium
Article Title: Comparison of rocuronium‑sugammadex and mivacurium on recovery efficiency after pediatric isolated adenoidectomy: a propensity score‑matched cohort study
Article References: Zhou, L., Yuan, C., Wang, Y., & Hu, Z. (2026). Comparison of rocuronium‑sugammadex and mivacurium on recovery efficiency after pediatric isolated adenoidectomy: a propensity score‑matched cohort study. BMC Anesthesiology. https://doi.org/10.1186/s12871-026-04369-8
Image Credits: AI Generated
DOI: 10.1186/s12871-026-04369-8
Keywords: pediatric anesthesia, rocuronium, sugammadex, mivacurium, adenoidectomy, neuromuscular blockade, PACU discharge, extubation time, propensity score matching, day surgery, Comparison, recovery
News Source: Harold Sullivan. (October 28, 2026). Rocuronium-sugammadex modestly speeds recovery after pediatric adenoidectomy. Scienmag.
