The effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery

Shaydenfish, Denys; Wongtangman, Karuna; Eikermann, Matthias; Schaefer, Maximilian S.

doi:10.1016/j.neuropharm.2020.108134

Cited by 11 publications

(5 citation statements)

References 97 publications

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“…1 Traditional NMB reversal agents such as CIs, have been implicated as causes of POGD due to their influence on acetylcholine, a key neurotransmitter in GI motility. [24][25][26] Sugammadex, a novel reversal agent that does not exert its effects via an acetylcholine pathway, is suggested to reduce POGD. 10,12 There remains equipoise regarding the influence of sugammadex on POGD compared to CI in patients undergoing GI surgery.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Gastrointestinal Dysfunction After Neuromuscular Blockade Reversal With Sugammadex Versus Cholinesterase Inhibitors in Patients Undergoing Gastrointestinal Surgery: A Systematic Review and Meta-Analysis

Sharma,

McKechnie,

Talwar

et al. 2024

The American Surgeon™

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Background Postoperative gastrointestinal dysfunction (POGD) commonly occurs following gastrointestinal (GI) surgery and is associated with specific anesthetic agents. Cholinesterase inhibitors employed for reversing neuromuscular blockade have been implicated in development of POGD. Sugammadex, a novel reversal agent, is linked with reduced POGD. However, there is a lack of comprehensive comparative review between these agents regarding their impact on POGD following GI surgery. This study aims to systematically review the effects of sugammadex on POGD compared to cholinesterase inhibitors following GI surgery. Methods MEDLINE, EMBASE, and CENTRAL were searched as of July 2022 to identify articles comparing sugammadex with cholinesterase inhibitors in patients undergoing gastrointestinal surgery, specifically in relation to POGD. Secondary endpoints included length of hospital stay, readmission rates, pulmonary complications, and postoperative morbidity. Results From 198 citations, 2 randomized controlled trials (RCTs) and 3 retrospective cohorts with 717 patients receiving sugammadex and 812 patients receiving cholinesterase inhibitors were included. Significantly lower rates of prolonged postoperative ileus (OR .44, 95% CI .25-.77, P < .05, I2 = 56%, low certainty evidence) was observed with sugammadex. No significant difference in any other outcome was observed. Narrative review of readmission data demonstrated no significant difference. Conclusion The use of sugammadex following gastrointestinal surgery is associated with significantly lower rates of prolonged postoperative ileus compared to cholinesterase inhibitors. However, these do not translate into a significant reduction in length of stay, morbidity, or postoperative nausea and vomiting. Results are limited by the numer of studies included and missing data, more robust RCTs are needed before recommendations can be made.

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Section: Discussionmentioning

confidence: 99%

Postoperative Gastrointestinal Dysfunction After Neuromuscular Blockade Reversal With Sugammadex Versus Cholinesterase Inhibitors in Patients Undergoing Gastrointestinal Surgery: A Systematic Review and Meta-Analysis

Sharma,

McKechnie,

Talwar

et al. 2024

The American Surgeon™

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“…Its use has been hampered by an indirect mechanism of neuromuscular blockade reversal, limited and unpredictable efficacy, and undesirable muscarinic responses including bradycardia, diplopia, nausea, and vomiting, which are dose dependent (24). Compared to neostigmine, which could not rapidly reverse profound neuromuscular blockade, sugammadex has a distinct mechanism of action, with a very fast onset, and, most importantly, it causes fewer side effects (23).…”

Section: Discussionmentioning

confidence: 99%

Sugammadex enhances recovery after abdominal surgery in cancer patients: a real-world, observational study

Gu¹,

Gao²,

Li³

et al. 2021

Ann Palliat Med

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Background: Sugammadex, a modified γ-cyclodextrin that selectively binds to muscle relaxants, is increasingly being used to reverse neuromuscular blockade after surgery, but the potential benefits for cancer patients in the real-world setting are obscure. Methods: This was a real-world, retrospective study. Adult cancer patients (≥18 years) undergoing abdominal surgery at Jiangsu Cancer Hospital, a tertiary care cancer hospital in China, between 2 March 2018 and 25 November 2019, were included in the analysis. Patients received 2 mg/kg (maximally 200 mg) sugammadex based on the discretion of the attending anesthetists. Patients were extubated as soon as they were awake and able to follow commands. The endpoint measures included extubation time, bowel function recovery and length of hospital stay. Results: A total of 1,615 patients were included in the analysis: 795 participants received sugammadex at a dosage of 2 mg/kg (maximum 200 mg) upon completion of surgery; the remaining 820 participants did not receive sugammadex or neostigmine (another antidote for neuromuscular blockade). Despite several biases that clearly favored patients not receiving sugammadex [younger, better American Society of Anesthesiologists (ASA) status, and fewer comorbidities], the extubation time was significantly shorter in patients receiving sugammadex [median: 14 (range, 0-121) vs. 30.5 (range, 0-183) min; P<0.001]. In multivariate linear regression analysis, sugammadex use was associated with a significantly shorter extubation time (P<0.05). Patients who received sugammadex also had accelerated bowel function recovery and shorter postoperative hospital stay. Conclusions: Sugammadex shortens extubation time and accelerates postoperative recovery in cancer patients undergoing abdominal surgery.

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“…Acetylcholinesterase (AChE) inhibitors, such as neostigmine, are commonly used in clinical diagnosis and treatment as muscle relaxant antagonists. 8 However, the application of AChE inhibitors still has some disadvantages, such as increased glandular secretion, sinus bradycardia and insufficient muscle relaxation antagonism. Sugammadex (SUG) is a novel-specific antagonist for aminosteroid muscle relaxants, with high affinity and high selectivity, and it parcels amino non-steroidal muscle relaxants and forms a stable chelate.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Acetylcholinesterase (AChE) inhibitors, such as neostigmine, are commonly used in clinical diagnosis and treatment as muscle relaxant antagonists 8. However, the application of AChE inhibitors still has some disadvantages, such as increased glandular secretion, sinus bradycardia and insufficient muscle relaxation antagonism.…”

Section: Introductionmentioning

confidence: 99%

Diaphragm ultrasound to evaluate the antagonistic effect of sugammadex on rocuronium after liver surgery in patients with different liver Child-Pugh grades: study protocol for a prospective, double-blind, non-randomised controlled trial

Sun

Chen

et al. 2022

BMJ Open

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IntroductionThe use of muscle relaxants is an indispensable in the general anaesthesia but is prone to accidents, which are often related to residual muscle relaxant. Therefore, how to timely and effectively eliminate the residual effect of muscle relaxants after surgery has become an urgent clinical problem. Rocuronium is a non-depolarising muscle relaxant that is primarily metabolised by the liver. Patients with liver dysfunction can affect the metabolic process of rocuronium, thereby delaying the recovery of muscle relaxation. Sugammadex (SUG) is a novel-specific antagonist of aminosteroidal muscle relaxants, which can effectively antagonise muscle relaxants at different depths. However, whether liver dysfunction affects the antagonistic effect of SUG against rocuronium has not been reported. Therefore, we hypothesise that with the increase of patients’ liver Child-Pugh grade, the recovery time of rocuronium antagonised by the same dose of SUG after surgery will be prolonged, and the incidence of muscle relaxation residual will be increased in the short term.Methods and analysisThis study is a prospective, double-blind, low-intervention, non-randomised controlled clinical trial involving 99 patients with American Society of Anesthesiologists (ASA) Ⅰ–Ⅲ, body mass index 18.5–24.9 kg/m2, who will undergo laparoscopic radical resection of liver cancer under general anaesthesia in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. Ultrasonography will be applied to monitor the change rate of diaphragm thickness at different time after extubation to evaluate the occurrence of residual muscle relaxant, which indirectly reflects the dose–effect relationship of SUG antagonising against rocuronium in patients with different liver Child-Pugh grades preoperatively.Ethics and disseminationThe protocol was reviewed and approved by the Medical Ethics Committee of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (UHCT21012). The findings will be disseminated to the public through peer-reviewed scientific journals.Trial registration numberNCT05028088.

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The effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery

Cited by 11 publications

References 97 publications

Postoperative Gastrointestinal Dysfunction After Neuromuscular Blockade Reversal With Sugammadex Versus Cholinesterase Inhibitors in Patients Undergoing Gastrointestinal Surgery: A Systematic Review and Meta-Analysis

Postoperative Gastrointestinal Dysfunction After Neuromuscular Blockade Reversal With Sugammadex Versus Cholinesterase Inhibitors in Patients Undergoing Gastrointestinal Surgery: A Systematic Review and Meta-Analysis

Sugammadex enhances recovery after abdominal surgery in cancer patients: a real-world, observational study

Diaphragm ultrasound to evaluate the antagonistic effect of sugammadex on rocuronium after liver surgery in patients with different liver Child-Pugh grades: study protocol for a prospective, double-blind, non-randomised controlled trial

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