Effects of Sugammadex  on Time of First Postoperative Bowel Movement

Deljou, Atousa; Schroeder, Darrell R.; Ballinger, Beth A.; Šprung, Juraj; Weingarten, Toby N.

doi:10.1016/j.mayocpiqo.2019.06.003

Cited by 18 publications

(39 citation statements)

References 19 publications

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“…and neostigmine following open thyroidectomy. However, a recent retrospective study revealed that sugammadex was associated to earlier rst postoperative bowel movement than the combination of neostigmine and glycopyrrolate in patients undergoing intraperitoneal surgery [11]. In the current study, the median rst gas-passing time in the sugammadex group was shorter than in the neostigmine group [600 min.…”

Section: Discussioncontrasting

confidence: 53%

“…In intraperitoneal surgery, sugammadex does seem to accelerate bowel movement [10,11], but in nonintraperitoneal surgery, such as thyroidectomy, sugammadex and neostigmine/glycopyrrolate did not show signi cant differences in bowel movement. The difference between intraperitoneal and nonintraperitoneal surgery consists in the manipulation of the bowel during surgery.…”

Section: Discussionmentioning

confidence: 94%

“…Previous comparative reports regarding postoperative bowel function following the administration of sugammadex or neostigmine are limited to two randomized controlled trials and one retrospective study [9][10][11]. Sen et al [9] did not nd a signi cant difference in the time to rst atus between sugammadex…”

Section: Discussionmentioning

confidence: 97%

“…Indeed, the surgical manipulation itself may cause a delay in the return to normal bowel movement, so that the effect of neostigmine on bowel movement is not as strong as in surgeries not involving bowel manipulation. A retrospective study after intraperitoneal surgery [11] analyzed bowel movement at 24, 48, and 72 h, while in this study gas-passing within 12 h was su cient: Such difference must be taken into account.…”

Section: Discussionmentioning

confidence: 99%

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Influence of reversal with sugammadex or neostigmine on postoperative bowel movement following robotic thyroidectomy: a retrospective study

Lee¹,

Chun²,

Hong³

et al. 2020

Preprint

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Background Postoperative bowel dysfunction poses difficulty during recovery, and reversal agents may affect bowel function. The purpose of this study was to determine whether time to first postoperative bowel movement after non-abdominal surgery differs among neuromuscular (NM) blockade reversal with either anticholinesterase/anticholinergic combination or sugammadex. Methods The electronic medical records of 108 patients who underwent robotic thyroidectomy between March 2018 and July 2018 were retrospectively reviewed. The use of agents to reverse NM blockade (neostigmine 1 mg and glycopyrrolate 0.2 mg, or sugammadex 2 mg/kg) was decided by the attending anesthesiologist. Demographic, clinical, and laboratory findings and first gas-passing time after surgery were assessed. Results The median gas passing time after operation was 957.5 min (425–1455) in the neostigmine group and 600 min (310–1080) in the sugammadex group (P = 0.113). Univariate logistic regression analysis indicated that first gas-passing time within 12 h after operation was significantly associated with perioperative use of opioid analgesics (odds ratio = 2.85, 95% confidence interval 1.26–6.43, P = 0.012). Multivariate logistic regression analysis revealed no significant association of reversal agents, perioperative opioid use, or postoperative hypocalcemia with first gas-passing time within 12 h after operation. Conclusions Sugammadex may not cause a delay in postoperative gastric motility compared to neostigmine/glycopyrrolate in patients undergoing robotic thyroidectomy.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Influence of reversal with sugammadex or neostigmine on postoperative bowel movement following robotic thyroidectomy: a retrospective study

Lee¹,

Chun²,

Hong³

et al. 2020

Preprint

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“…In addition, the effects of glycopyrrolate on delayed gastric emptying are greater than those of atropine [5]. Contrary to the 2 favorable studies on reversal with sugammadex [1,2], atropine was administered along with neostigmine for neuromuscular block reversal in the study by Sen et al [3], revealing no association between the neuromuscular reversal technique and the recovery time for postoperative bowel function.…”

mentioning

confidence: 97%

Limited advantage of sugammadex reversal over the traditional neuromuscular reversal technique in terms of postoperative recovery of bowel function

Kim

2020

Korean J Anesthesiol

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Sugammadex provides rapid and reliable neuromuscular reversal from any depth of block, and its clinical use is increasing. Although evidence is limited to conclude that the routine use of sugammadex contributes to overall cost reduction, little doubt exists regarding the superiority of sugammadex over neostigmine or pyridostigmine. Sugammadex, a modified γ-cyclodextrin, acts by forming very tight water-soluble complexes at a ratio of 1 : 1 with steroidal neuromuscular blocking drugs (rocuronium > vecuronium > pancuronium). Both sugammadex and the sugammadex-rocuronium complex are chemically inert and therefore have no direct effects on the cholinergic receptors. However, traditional reversal technique for neuromuscular blocks using an admixture of anticholinesterase and anticholinergic drugs can pose undesirable gastrointestinal effects, depending on the used drug and dose ratio. In the April 2020 issue of the Korean Journal of Anesthesiology, An et al. [1] compared postoperative gastrointestinal motility between sugammadex and the combination of pyridostigmine and glycopyrrolate in patients undergoing laparoscopic cholecystectomy. This randomized controlled study revealed that the use of sugammadex as a reversal agent for neuromuscular blocks resulted in an earlier first postoperative passage of flatus compared to the use of the mixture of pyridostigmine and glycopyrrolate. Previous 2 trials on neuromuscular block reversal showed conflicting results [2,3]. In a retrospective study by Deljou et al. [2], sugammadex reversal resulted in an earlier first postoperative bowel movement in patients who underwent intraperitoneal surgery compared to reversal with neostigmine or glycopyrrolate. In contrast, a randomized controlled trial by Sen et al. [3] revealed no statistical differences in the time to first flatus or bowel movement following thyroid surgery between reversal with sugammadex and that with neostigmine or atropine. These conflicting results may be mainly attributed to multifactorial origins of postoperative ileus. Acetylcholine allows an increase in gastrointestinal motility as the principal excitatory neurotransmitter in the gastrointestinal tract. Therefore, drug-induced cholinergic stimulation or inhibition can cause a change in gastrointestinal motility. However, because postoperative ileus is caused by complex neuro-immuno-inflammatory responses, the cholinergic pathway is one of the causative mechanisms [4]. The surgical inflammatory response and μ-opioid receptor activation are clinically more relevant pathways of postoperative ileus. Thus, reduced surgical incision or intestinal manipulation and opioid-sparing multimodal postoperative analgesia are more effective than neuromuscular reversal. In the study by An et al. [1], the magnitude of difference in the time to first flatus

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Effect of neuromuscular reversal with neostigmine/glycopyrrolate versus sugammadex on postoperative ileus following colorectal surgery

et al. 2022

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Background Postoperative ileus (POI) is a common complication following colorectal surgery and is mediated in part by the cholinergic anti-inflammatory pathway (CAIP). Neostigmine (acetylcholinesterase inhibitor), co-administered with glycopyrrolate, is frequently given for neuromuscular reversal before tracheal extubation and modulates the CAIP. An alternative reversal agent, sugammadex (selective rocuronium or vecuronium binder), acts independently from the CAIP. The aim of our study was to assess the impact of neuromuscular reversal agents used during anaesthesia on gastrointestinal recovery. Methods Three hundred thirty-five patients undergoing elective colorectal surgery at the Royal Adelaide Hospital between January 2019 and December 2021 were retrospectively included. The primary outcome was GI-2, a validated composite measure of time to diet tolerance and passage of stool. Demographics, 30-day complications and length of stay were collected. Univariate and multivariate analyses were performed. Results Two hundred twenty-four (66.9%) patients (129 [57.6%] males and 95 [42.4%] females, median age 64 [19–90] years) received neostigmine/glycopyrrolate and 111 (33.1%) received sugammadex (62 [55.9%] males and 49 [44.1%] females, median age 67 [18–94] years). Sugammadex patients achieved GI-2 sooner after surgery (median 3 (0–10) vs. 3 (0–12) days, p = 0.036), and reduced time to first stool (median 2 (0–10) vs. 3 (0–12) days, p = 0.035). Rates of POI, complications and length of stay were similar. On univariate analysis, POI was associated with smoking history, previous abdominal surgery, colostomy formation, increased opioid use and postoperative hypokalaemia (p < 0.05). POI was associated with increased complications, including anastomotic leak and prolonged hospital stay (p < 0.001). On multivariate analysis, neostigmine, bowel anastomoses and increased postoperative opioid use (p < 0.05) remained predictive of time to GI-2. Conclusions Patients who received sugammadex had a reduced time to achieving first stool and GI-2. Neostigmine use, bowel anastomoses and postoperative opioid use were associated with delayed time to achieving GI-2.

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Effects of Sugammadex on Time of First Postoperative Bowel Movement

Cited by 18 publications

References 19 publications

Influence of reversal with sugammadex or neostigmine on postoperative bowel movement following robotic thyroidectomy: a retrospective study

Influence of reversal with sugammadex or neostigmine on postoperative bowel movement following robotic thyroidectomy: a retrospective study

Limited advantage of sugammadex reversal over the traditional neuromuscular reversal technique in terms of postoperative recovery of bowel function

Effect of neuromuscular reversal with neostigmine/glycopyrrolate versus sugammadex on postoperative ileus following colorectal surgery

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