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

Abstract

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.

Deep neuromuscular blockade for endolaryngeal procedures: A multicenter randomized study

“…A recent randomized controlled study compared sugammadex 2 mg/kg with a combination of neostigmine 0.4 mg/kg and glycopyrrolate 400 μg in laparoscopic gynecological surgery. There was no significant difference between both groups in the incidence of early PONV . Similar to another previous study, which was a comparison between a deep NMB group that was reversed with sugammadex and a shallow NMB group that was reversed with neostigmine, the number of patients who had PONV in both groups was similar .…”

Comparison of the Effects of Sugammadex, Neostigmine, and Pyridostigmine on Postoperative Nausea and Vomiting: A Propensity Matched Study of Five Hospitals

“…Several studies have compared sugammadex with conventional cholinesterase inhibitors in terms of the likelihood of PONV [12,[17][18][19][20]. Yagan et al reported that sugammadex was associated with a lower incidence of PONV within the first 1 h postoperatively compared to neostigmine, and less antiemetic agent use within the first 24 h postoperatively [12].…”

Narkoseführung bei Elektrochemotherapie

“…B. Rocuronium) durchzuführen. Dieses kann im Anschluss an die Behandlung schnell und nebenwirkungsarm mit Sugammadex antagonisiert werden[7,8].NarkoseführungDie Narkose sollte laut ESOPE-Protokoll als totale intravenöse Anästhesie (TIVA) aufrechterhalten werden[4]. Denn die Verwendung von Propofol und Opioiden in ▶ Tab.…”