Neuromuscular blockade reversal with sugammadex versus pyridostigmine/glycopyrrolate in laparoscopic cholecystectomy: a randomized trial of effects on postoperative gastrointestinal motility

Abstract

Background: Acetylcholinesterase inhibitors (e.g., pyridostigmine bromide) are used for neuromuscular blockade (NMB) reversal in patients undergoing surgery under general anesthesia (GA). Concurrent use of anticholinergic agents (e.g., glycopyrrolate) decreases cholinergic side effects but can impede bowel movements. Sugammadex has no cholinergic effects; its use modifies recovery of gastrointestinal (GI) motility following laparoscopic cholecystectomy compared to pyridostigmine/glycopyrrolate. This study evaluated the contribution of sugammadex to the recovery of GI motility compared with pyridostigmine and glycopyrrolate. Methods: We conducted a prospective study of patients who underwent laparoscopic cholecystectomy. Patients were randomly allocated to the experimental group (sugammadex, Group S) or control group (pyridostigmine-glycopyrrolate, Group P). After anesthesia (propofol and rocuronium, and 2% sevoflurane), recovery was induced by injection of sugammadex or a pyridostigmine-glycopyrrolate mixture. As a primary outcome, patients recorded the time of their first passage of flatus ('gas-out time') and defecation. The secondary outcome was stool types. Results: One-hundred and two patients participated (Group S [n = 49], Group P [n = 53]). Mean time from injection of NMB reversal agents to gas-out time was 15.03 (6.36-20.25) h in Group S and 20.85 (16.34-25.86) h in Group P (P = 0.001). Inter-group differences were significant. Time until the first defecation as well as types of stools was not significantly different. Conclusions: Sugammadex after laparoscopic cholecystectomy under GA resulted in an earlier first postoperative passage of flatus compared with the use of a mixture of pyridostigmine and glycopyrrolate. These findings suggest that the use of sugammadex has positive effects on the recovery of GI motility.

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

“…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.…”

“…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…”

The impact of acetylcholinesterase inhibitors on ileus and gut motility following abdominal surgery: a clinical review

“…Most of these studies compare neostigmine against sugammadex, a selective rocuronium or vecuronium binder, with varied results. Sugammadex has affinity to bind with steroid hormones, thus it is thought to theoretically increase gastric emptying and gut motility 42 . Sen et al .…”

Sugammadex, the Guardian of Deep Muscle Relaxation During Conventional and Robot-Assisted Laparoscopic Surgery: A Narrative Review

“… 91 Sugammadex administration against profound blockade in laparoscopic cholecystectomy or appendectomy had positive effects on the recovery of gastrointestinal motility compared with the use of a mixture of glycopyrrolate and pyridostigmine. 92 Concerning patients who underwent laparoscopic hysterectomy, a series of randomized controlled trials have proved the superiority of sugammadex administration in effectively reversing deep block at the end of the procedure and shortening the length of hospital stay. 93 , 94 Many studies showed that the robotic approach had longer operative time compared with conventional laparoscopic surgery.…”