Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting

Yağan, Özgür; Taş, Nilay; Mutlu, Tuğçe; Hancı, Volkan

doi:10.1016/j.bjane.2015.08.003

Cited by 24 publications

(30 citation statements)

References 24 publications

(32 reference statements)

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“…A meta‐analysis of 17 randomised trials involving 1553 patients reported that the relative risk of nausea after sugammadex was 0.94 (95%CI 0.79–1.13), and of vomiting 0.87 (95%CI 0.67–1.17 . Since this systematic review, several small studies have suggested that PONV may be transiently reduced in the first hour or so after reversal with sugammadex, although not subsequently . This positive finding is consistent with previous data but the quality of evidence is low, because all studies have been either retrospective cohort studies or small clinical trials with poor bias control such as inadequate blinding or power, or only positive findings for a secondary outcome.…”

Section: Introductionsupporting

confidence: 86%

“…Yagan et al conducted a randomised trial in a mixed surgical population, and found that those patients receiving sugammadex had a lower incidence of PONV in the first postoperative hour (but not across 24 h), and required less treatment on the first postoperative day. Their patient groups were not matched for PONV risk (which may have confounded the results) and the dose of neostigmine used was larger than in our study . Geldner et al reported no significant difference in PONV, but acknowledged that their randomised controlled trial was underpowered to evaluate this outcome .…”

Section: Discussionmentioning

confidence: 70%

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Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial

et al. 2017

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Sugammadex more rapidly and reliably reverses rocuronium-induced neuromuscular block compared with neostigmine, but it is not known if subsequent patient outcomes, including nausea, vomiting and other aspects of recovery are modified. In this study, we compared the recovery characteristics of sugammadex and neostigmine/glycopyrrolate following reversal of neuromuscular block. This was a single-centre, randomised, blinded, parallel-group clinical trial in women undergoing elective day-surgical laparoscopic gynaecological surgery, with a standardised general anaesthesia regimen that included rocuronium. Neuromuscular block was reversed with either sugammadex 2 mg.kg or neostigmine 40 μg.kg and glycopyrrolate 400 μg. The primary outcome was the incidence of nausea and vomiting during the first six postoperative hours. Secondary outcomes included other measures of postoperative recovery such as patient symptoms and recovery scores. Three-hundred and four women were analysed by intention-to-treat (sugammadex n = 151, neostigmine n = 153), which included four major protocol violations. There was no significant difference between sugammadex and neostigmine groups in the incidence of early nausea and vomiting (49.0% vs. 51.0%, respectively; OR 0.92, 95%CI 0.59-1.45; p = 0.731). Double vision (11.5% vs. 20.0%; p = 0.044) and dry mouth (71.6% vs. 85.5%; p = 0.003) were less common after sugammadex. Sedation scores at 2 h were also lower after sugammadex (median (IQR [range]) 0 (0-3 [0-10]) vs. 2 (0-4.[0-10]); p = 0.021). Twenty-four-hour recovery scores were not significantly different between groups. Reversal with sugammadex in this patient population did not reduce postoperative nausea or vomiting compared with neostigmine/glycopyrrolate.

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Section: Introductionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 70%

Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial

et al. 2017

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“…Most unwanted effects were bradycardia, increased sputum, dry mouth, headache, nausea, and vomiting. The proportion of patients suffering from these unwanted effects was similar to other studies [23], [24]. There is still no evidence in the literature to blame headache and nausea for using sugammadex or neostigmine as well because there were many affected factors.…”

Section: Discussionsupporting

confidence: 83%

Reversal of Deep Effect of Rocuronium by Sugammadex or Neostigmine after Abdominal Laparoscopic Surgery: A Single Center Experience in Vietnam

Dong

Giang

Cường

et al. 2020

Open Access Maced J Med Sci

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BACKGROUND: Using sugammadex allows to quickly reverse deep neuromuscular blockade with rocuronium in laparoscopic surgery, which results in great benefits during and after surgery by minimizing the problem of postoperative residual curarization. AIM: The aims of this study are comparing the efficacy of reversing neuromuscular blockade between sugammadex and neostigmine and evaluating its unwanted effects after laparoscopic abdominal surgery. METHODS: Subject of this prospective clinical comparative trial was patients who underwent abdominal laparoscopic surgery at 103 Military Hospital from October 2017 to October 2018. Eighty-four patients suffering from abdominal laparoscopic surgery under deep neuromuscular blockade were enrolled and divided randomly into two groups with 42 patients in each: Group N used neostigmine for neuromuscular blockade reversal and Group S applied sugammadex. At the end of surgery, neuromuscular blockade was reversed with either sugammadex or neostigmine. RESULTS: The reversal time to achieve train-of-four ratio >0.9 in the sugammadex group was 2.42 ± 0.58 min, which was shorter than in the neostigmine group (11.83 ± 2.19 min) (p < 0.05). The time until extubation in the sugammadex group was 3.69 ± 0.67 min, which was shorter than in the neostigmine group 11.90 ± 2.22 min (p < 0.05). Reversal with sugammadex resulted in statistical significance of less sputum production (0% vs. 11.9%), dry mouth (0% vs. 28.57%), headache (2.38% vs. 7.14%), and nausea (4.76% vs. 14.28%) compared with neostigmine. However, 26.19% of patients in the neostigmine group presented bradycardia, whereas the concurrent administration of atropine in the neostigmine group resulted in increased heart rate. CONCLUSION: Sugammadex reversed neuromuscular blockade more rapidly and effectively than neostigmine in abdominal laparoscopic surgeries. The unwanted effects of sugammadex group were fewer than neostigmine group.

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“…[7,21] An advantage of sugammadex for PONV has also been reported by several studies. [8,22,23] Cholinergic effects from the use of cholinesterase inhibitors can cause a decrease in oesophageal tone, and an increase in secretion and intestinal movement that might be associated with the increased PONV. However, due to the fear of these potential side effects, anticholinergic agents have been used to compensate for these unwanted cholinergic effects.…”

Section: Discussionmentioning

confidence: 99%

“…[5,6] Besides the fast reversibility of NM blockade, advantageous effects of this agent on recovery components after anaesthesia such as consciousness, nausea/vomiting, or physiologic factors have been reported. [7][8][9] Nonetheless, controversial results on the superiority of sugammadex over conventional NM blockade reversal agents have been reported. [10,11] The Post-operative Quality Recovery Scale (PQRS) assesses the quality of postoperative recovery over time using six domains of recovery.…”

Section: Introductionmentioning

confidence: 99%

Influence of Reversal with Sugammadex or Neostigmine on Post-Operative Quality of Recovery Following a Single Bolus Dose of Rocuronium: A Prospective, Randomised, Double-Blinded, Controlled Study

Bai¹,

Lee²,

Ss³

et al. 2018

Preprint

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There is a lack of data comparing sugammadex with anticholinesterase for the quality of anaesthesia recovery, especially following a single bolus dose of rocuronium. Thus, we evaluated the influence of reversal with sugammadex or neostigmine on post-operative quality of recovery by using the Post-operative Quality Recovery Scale (PQRS). A total of 86 patients undergoing trans-pars plana vitrectomy (TPPV) under general anaesthesia were intubated following a single bolus dose of rocuronium (0.6 mg/kg). At the end of surgery, patients were received either neostigmine or sugammadex. The quality of recovery was assessed using the PQRS at 15 minutes and 40 minutes after surgery, and on post-operative day 1. The recovery rate in the physiological domain was higher in the sugammadex group at 15 minutes after surgery (P = 0.02). Though there were no significant differences in the overall cognitive recovery domain, patients in the sugammadex group could recall more numbers in reverse order. However, there were no significant differences between the groups in the other domains of the PQRS. The use of sugammadex may increase the quality of the post-operative physiological recovery at early post-operative periods compared with neostigmine use following a single bolus dose of rocuronium in patients undergoing TPPV with general anaesthesia.

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Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting

Abstract: At the end of our study comparing neostigmine with sugammadex for neuromuscular blockage antagonism, we found use of sugammadex had lower incidence of PONV in the postoperative 1st hour and less anti-emetic use in 24 hours of monitoring.

Cited by 24 publications

References 24 publications

Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial

Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial

Reversal of Deep Effect of Rocuronium by Sugammadex or Neostigmine after Abdominal Laparoscopic Surgery: A Single Center Experience in Vietnam

Influence of Reversal with Sugammadex or Neostigmine on Post-Operative Quality of Recovery Following a Single Bolus Dose of Rocuronium: A Prospective, Randomised, Double-Blinded, Controlled Study

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