Neostigmine with glycopyrrolate does not increase the incidence or severity of postoperative nausea and vomiting in outpatients undergoing gynaecological laparoscopy

Abstract

We studied 100 healthy women undergoing outpatient gynaecological laparoscopy in a randomized, double-blind and placebo-controlled study to evaluate the effect of neostigmine on postoperative nausea and vomiting (PONV). After induction of anaesthesia with propofol, anaesthesia was maintained with sevoflurane and 66% nitrous oxide in oxygen. Mivacurium was used for neuromuscular block. At the end of anaesthesia, neostigmine 2.0 mg and glycopyrrolate 0.4 mg, or saline, was given i.v. The incidence of PONV was evaluated in the postanaesthesia care unit, on the ward and at home. The severity of nausea and vomiting, worst pain, antiemetic and analgesic use, times to urinary voiding and home readiness were recorded. During the first 24 h after operation, 44% of patients in the neostigmine group and 43% in the saline group did not have PONV. We conclude that neostigmine with glycopyrrolate did not increase the occurrence of PONV in this patient group.

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

“…21 It has been reported that neuromuscular block antagonism with 2 mg neostigmine in laparoscopic gynecological operations did not cause an increase in the incidence of PONV. 22 The noticeable point in these two studies is the amount of neostigmine used. It has been determined that use of neostigmine in doses above 2.5 mg increases the risk of PONV.…”

Anesthesia for laparoscopy: a review

“…Because opioids are a potent cause of PONV, the concomitant use of NSAIDs and opioids helps to better control postoperative pain, while decreasing opioid-related side effects. The routine use of neostigmine to reverse residual neuromuscular block has been reported to increase the incidence of PONV compared with spontaneous recovery from mivacurium [43]; however, others have failed to confirm an adverse effect of neostigmine in a similar study [96].…”

Sugammadex: A Novel Agent for the Reversal of Neuromuscular Blockade

“…8 Large doses of acetylcholinesterase inhibitors may cause nausea and vomiting. [9][10][11][12][13][14][15] Prevention of these muscarinic adverse effects requires coadministration of an anticholinergic agent such as atropine and, more commonly, the quaternary ammonium compound glycopyrrolate. The administration of an anticholinergic agent also carries the risk of adverse effects, such as cardiac dysrhythmia, 16 excessive tachycardia, 17 and xerostomia.…”