Effects of Sugammadex and Neostigmine on Post-operative Nausea and Vomiting in ENT Surgery

Mat, Nik Izyan Syaizana Nik; Nie, Yeoh Chih; Maaya, Muhammad; Zain, Jaafar Md; Ooi, Joanna

doi:10.3389/fmed.2022.905131

Cited by 5 publications

(3 citation statements)

References 33 publications

(41 reference statements)

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“…37 However, subsequent small studies have demonstrated reduction in PONV with sugammadex within the first 6 hours postoperatively compared to CI. 38,39 In our review, no study recorded PONV at different time points to elucidate temporal differences. This could suggest that differences in PONV are likely a function of CI avoidance rather than a benefit of sugammadex, with muscarinic effects of CI diminishing overtime leading to no difference in PONV after 6 hours.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Gastrointestinal Dysfunction After Neuromuscular Blockade Reversal With Sugammadex Versus Cholinesterase Inhibitors in Patients Undergoing Gastrointestinal Surgery: A Systematic Review and Meta-Analysis

Sharma,

McKechnie,

Talwar

et al. 2024

The American Surgeon™

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Background Postoperative gastrointestinal dysfunction (POGD) commonly occurs following gastrointestinal (GI) surgery and is associated with specific anesthetic agents. Cholinesterase inhibitors employed for reversing neuromuscular blockade have been implicated in development of POGD. Sugammadex, a novel reversal agent, is linked with reduced POGD. However, there is a lack of comprehensive comparative review between these agents regarding their impact on POGD following GI surgery. This study aims to systematically review the effects of sugammadex on POGD compared to cholinesterase inhibitors following GI surgery. Methods MEDLINE, EMBASE, and CENTRAL were searched as of July 2022 to identify articles comparing sugammadex with cholinesterase inhibitors in patients undergoing gastrointestinal surgery, specifically in relation to POGD. Secondary endpoints included length of hospital stay, readmission rates, pulmonary complications, and postoperative morbidity. Results From 198 citations, 2 randomized controlled trials (RCTs) and 3 retrospective cohorts with 717 patients receiving sugammadex and 812 patients receiving cholinesterase inhibitors were included. Significantly lower rates of prolonged postoperative ileus (OR .44, 95% CI .25-.77, P < .05, I2 = 56%, low certainty evidence) was observed with sugammadex. No significant difference in any other outcome was observed. Narrative review of readmission data demonstrated no significant difference. Conclusion The use of sugammadex following gastrointestinal surgery is associated with significantly lower rates of prolonged postoperative ileus compared to cholinesterase inhibitors. However, these do not translate into a significant reduction in length of stay, morbidity, or postoperative nausea and vomiting. Results are limited by the numer of studies included and missing data, more robust RCTs are needed before recommendations can be made.

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Section: Discussionmentioning

confidence: 99%

Postoperative Gastrointestinal Dysfunction After Neuromuscular Blockade Reversal With Sugammadex Versus Cholinesterase Inhibitors in Patients Undergoing Gastrointestinal Surgery: A Systematic Review and Meta-Analysis

Sharma,

McKechnie,

Talwar

et al. 2024

The American Surgeon™

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“…Therefore, many anesthesiologists choose to use antagonists at the end of surgery to avoid residual neuromuscular blockade, and the commonly used antagonists are neostigmine and sugammadex. The combination of neostigmine and atropine has been associated with postoperative nausea and vomiting, pneumonia and respiratory failure [13,14], and although sugammadex are preferred for their advantages [15]. In the absence of quantitative neuromuscular monitoring however, there is uncertainty as to whether an antagonist is required and whether the antagonist dose is fully antagonised.…”

Section: Discussionmentioning

confidence: 99%

Simple grip strength device for assessing the degree of recovery from residual neuromuscular blockade after general anaesthesia: An observational study

Tan

et al. 2022

Preprint

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Background：Residual neuromuscular blockade is common in patients after general anesthesia, but few anesthesiologists use neuromuscular monitoring. In order to reduce the incidence of residual neuromuscular blockade and find a safer time for extubation, the purpose of our study is to explore the use of a simple measure of grip strength to roughly assess the recovery degree of neuromuscular blockade. Methods: Seventy-six patients undergoing elective general anaesthesia from November 2021 to June 2022, aged 18-70 years, with ASA classification of grade I-II were selected. A random number table method was used to divide into rocuronium and cis-atracurium groups. Patients' gender, age, BMI, ASA classification, total duration of surgery, PACU stay, preoperative basal grip strength values were recorded using a simple grip strength device, while the corresponding grip strength values at train-of-four (TOF) ration of 70%, 80% and 90% were monitored using a neuromuscular monitor. Spearman's correlation analysis was used to analyse the correlation between grip strength values and neuromuscular monitor values to determine whether the simple grip device could be used as a crude assessment of the degree of neuromuscular blockade recovery. Results: There was a significant correlation between grip strength values measured by the simple grip strength device and TOF ration during the patients' recovery from general anaesthesia (R2 =0.632). There was no significant difference in mean maximum grip strength recovery values between patients using rocuronium and those using cis-atracurium at the same TOF ration (p>0.05), and there was no significant difference in the total time of surgery (p=0.489) and total time spent in the PACU (p=0.202) between the two groups. There was a significant difference in preoperative basal grip strength values by gender (p<0.001), but there was no significant difference in mean maximum grip strength recovery at 70%, 80% and 90% of TOF ration and total time spent in the PACU (p>0.05). Conclusions: In this study, we developed a significant correlation between this simple grip strength device measurement and TOF ration from quantitative neuromuscular monitoring, which can be used as an additional strategy to roughly estimate the degree of myosin recovery, further improvements in grip strength measurement are needed.

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“…Although there are several studies exploring the effects of sugammadex on PONV, most of the available evidence suggests that sugammadex only tends to reduce the occurrence of PONV; however, these results failed to reach statistical significance [ 9 , 10 ]. In addition, most of the possible explanations for the relationship between sugammadex and reduction in PONV focuses on the emetic effect of neostigmine [ 11 ]. Whether sugammadex use is related to the decreased occurrence of PONV during inpatient hospitalization, which is critical for the rehabilitation of patients undergoing bariatric surgery, remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Use of sugammadex is associated with reduced incidence and severity of postoperative nausea and vomiting in adult patients with obesity undergoing laparoscopic bariatric surgery: a post-hoc analysis

et al. 2023

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Background Postoperative nausea and vomiting (PONV) is a common but troublesome complication in patients who undergo laparoscopic bariatric surgery (LBS). Whether sugammadex use is related to the persistent decrease in the occurrence of PONV during postoperative inpatient hospitalization, which is critical for the rehabilitation of patients after LBS, remains unknown. Methods The study was based on a randomized controlled trial conducted in an accredited bariatric centre. A total of 205 patients who underwent LBS were included in the analysis. Univariate analysis and multivariable logistic regression model were used to identify the significant variables related to PONV. Then propensity score matching and inverse probability of treatment weighting (IPTW) were employed to compare outcomes between the sugammadex and neostigmine groups. The primary outcome was the incidence of PONV within 48 h after LBS. The secondary endpoints included the severity of PONV, time to first flatus, need for rescue antiemetic therapy, and water intake. Results The incidence of PONV was 43.4% (89/205) within the first 48 h after LBS. In multivariable analysis, sugammadex use (OR 0.03, 95% CI 0.01–0.09, P < 0.001) was an independent protective factor of PONV. After IPTW adjustment, sugammadex use was associated with lower incidence of PONV (OR 0.54, 95% CI 0.48–0.61, P < 0.001), postoperative nausea (PON) (OR 0.77, 95% CI 0.67–0.88, P < 0.001), and postoperative vomiting (POV) (OR 0.60, 95% CI 0.53–0.68, P < 0.001) within postoperative 48 h. The severity of PON as well as the incidence and severity of POV within the first 24 h were also lower in the sugammadex group (all P < 0.05). Reduced need for rescue antiemetic therapy within the first 24 h, increased water intake for both periods, and earlier first passage of flatus were observed in the sugammadex group (all P < 0.05). Conclusions Compared with neostigmine, sugammadex can reduce the incidence and severity of PONV, increase postoperative water intake, and shorten the time to first flatus in bariatric patients during postoperative inpatient hospitalization, which may play a pivotal role in enhanced recovery. Trial registration Chinese Clinical Trial Registry (ChiCTR2100052418, http://www.chictr.org.cn/showprojen.aspx?proj=134893, date of registration: October 25, 2021).

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Effects of Sugammadex and Neostigmine on Post-operative Nausea and Vomiting in ENT Surgery

Cited by 5 publications

References 33 publications

Postoperative Gastrointestinal Dysfunction After Neuromuscular Blockade Reversal With Sugammadex Versus Cholinesterase Inhibitors in Patients Undergoing Gastrointestinal Surgery: A Systematic Review and Meta-Analysis

Postoperative Gastrointestinal Dysfunction After Neuromuscular Blockade Reversal With Sugammadex Versus Cholinesterase Inhibitors in Patients Undergoing Gastrointestinal Surgery: A Systematic Review and Meta-Analysis

Simple grip strength device for assessing the degree of recovery from residual neuromuscular blockade after general anaesthesia: An observational study

Use of sugammadex is associated with reduced incidence and severity of postoperative nausea and vomiting in adult patients with obesity undergoing laparoscopic bariatric surgery: a post-hoc analysis

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