Effects of sugammadex vs. pyridostigmine–glycopyrrolate on post‐operative nausea and vomiting: propensity score matching

Lee, Oh Haeng; Choi, Geun Joo; Kang, Hyun; Baek, Chong Wha; Jung, Yong Hun; Woo, Young Cheol; Oh, Je Hyeok; Park, Y. H.

doi:10.1111/aas.12813

Cited by 13 publications

(15 citation statements)

References 24 publications

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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%

“…These findings are in contrast with those of several previous studies. Lee et al in a large retrospective study (with propensity score matching to improve comparability) found lower frequency and severity of PONV after sugammadex reversal compared with pyridostigmine/glycopyrrolate reversal . In a randomised double‐blind trial of patients having extremity surgery without PONV prophylaxis by Koyuncu et al , PONV scores were lower on arrival in the recovery room following sugammadex, but the incidence of PONV in the first 24 h was high and did not differ significantly between sugammadex and neostigmine.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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: 99%

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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“…Increased heart rate and cardiac output may reduce hypotensive episodes, thus hypotension induced PONV [17]. As cholinergic receptors are distributed in the GI tract, as well as in the brain, glycopyrrolate may block cholinergic receptors in the GI tract, resulting in reduced gastric secretion and intestinal movement [11,28]. These mechanisms of glycopyrrolate may decrease the incidence of PONV.…”

Section: Discussionmentioning

confidence: 99%

“…Exclusion criteria were as follows: 1) patients who received re-operation on the same site, 2) patients who participated in other randomized controlled trials, 3) patients who received sugammadex as reversal agents, and 4) missing data. Patients who used sugammadex as a reversal agent were excluded due to the potential effect of sugammadex on PONV which was discussed in a study by Lee et al [11].…”

Section: Methodsmentioning

confidence: 99%

The Effects of Glycopyrrolate as Premedication on Post-Operative Nausea and Vomiting: A Propensity Score Matching Analysis

Lee¹,

Yoon²,

Choi³

et al. 2019

TOATJ

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Background:Glycopyrrolate is often used as a premedication for anesthesia as it has anti-sialogogue and vagolytic effect. Patients undergoing laparoscopic gynecologic surgery have high-risk of Post-Operative Nausea and Vomiting (PONV). Objectives:This retrospective study investigates the effect of glycopyrrolate as a premedication for PONV in patients receiving fentanyl-based Intravenous (IV) Patient-Controlled Analgesia (PCA) after laparoscopic gynecological surgery. Methods:We reviewed the medical records of adult patients who received fentanyl-based IV-PCA after laparoscopic gynecological surgery at Chung-Ang University Hospital between January 1, 2010, and June 30, 2016. We classified patients into two groups on the basis of glycopyrrolate premedication: non-premedicated group (Group N; n = 316) and glycopyrrolate premedicated group (Group P; n = 434). The Propensity Score Matching Method (PSM) was used to select 157 subjects in Group N and P, on the basis of their covariates which were matched with a counterpart in the other group. Results:Prior to PSM, the necessities for rescue anti-emetics were lower on Postoperative Day (POD) 0 (58[18.4%] vs. 45[10.4%], P = 0.002) and POD1 (60[19.0%] vs. 59[13.6%], P = 0.046), and Visual Analogue Scale (VAS) of pain on POD 1 (2.86 ± 1.49 vs. 3.13 ± 1.53, P = 0.017) was higher in group P. After PSM, the Numerical Rating Scale (NRS) score for nausea (0.38 ± 0.75 vs. 0.21 ± 0.62, P = 0.027) and rescue anti-emetics (27 [17.2%] vs. 15 [9.6%], P = 0.047) on POD 0 were both lower in the group P. Conclusion:In patients receiving fentanyl-based IV-PCA after laparoscopic gynecological surgery, the severity of nausea and necessity for rescue ant-emetic was lower in the glycopyrrolate premedication group.PONV causes a lot of discomfort to patients undergoing surgery, and can increase the length of hospital stay and overall medical cost [4].The risk factors of PONV can be divided into three main categories. Firstly, there are surgical factors such as the duration of operation and kinds of surgeries performed (laparoscopic surgery, gynecologic surgery, breast surgery, thyroid surgery, etc.). Secondly, there are anesthetic factors,

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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%

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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Effects of sugammadex vs. pyridostigmine–glycopyrrolate on post‐operative nausea and vomiting: propensity score matching

Abstract: Sugammadex might be more beneficial for PONV compared to pyridostigmine-glycopyrrolate mixture for patients who have received opioid-based IV-PCA.

Cited by 13 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

The Effects of Glycopyrrolate as Premedication on Post-Operative Nausea and Vomiting: A Propensity Score Matching Analysis

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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