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Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial.
Anaesthesia. 2018 Mar; 73(3):340-347.A

Abstract

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-1 or neostigmine 40 μg.kg-1 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.

Authors+Show Affiliations

Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital, Perth, Australia.Department of Anaesthesia, Stoke Mandeville Hospital, Aylesbury, UK.Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Australia.School of Women's and Infants' Health, University of Western Australia, Perth, Australia.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29214645

Citation

Paech, M J., et al. "Recovery Characteristics of Patients Receiving Either Sugammadex or Neostigmine and Glycopyrrolate for Reversal of Neuromuscular Block: a Randomised Controlled Trial." Anaesthesia, vol. 73, no. 3, 2018, pp. 340-347.
Paech MJ, Kaye R, Baber C, et al. Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial. Anaesthesia. 2018;73(3):340-347.
Paech, M. J., Kaye, R., Baber, C., & Nathan, E. A. (2018). Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial. Anaesthesia, 73(3), 340-347. https://doi.org/10.1111/anae.14174
Paech MJ, et al. Recovery Characteristics of Patients Receiving Either Sugammadex or Neostigmine and Glycopyrrolate for Reversal of Neuromuscular Block: a Randomised Controlled Trial. Anaesthesia. 2018;73(3):340-347. PubMed PMID: 29214645.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial. AU - Paech,M J, AU - Kaye,R, AU - Baber,C, AU - Nathan,E A, Y1 - 2017/12/07/ PY - 2017/11/02/accepted PY - 2017/12/8/pubmed PY - 2019/3/8/medline PY - 2017/12/8/entrez KW - neuromuscular block reversal: assessment KW - neuromuscular block: rocuronium, neostigmine, sugammadex KW - postoperative nausea and vomiting (PONV): prophylaxis SP - 340 EP - 347 JF - Anaesthesia JO - Anaesthesia VL - 73 IS - 3 N2 - 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-1 or neostigmine 40 μg.kg-1 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. SN - 1365-2044 UR - https://www.unboundmedicine.com/medline/citation/29214645/Recovery_characteristics_of_patients_receiving_either_sugammadex_or_neostigmine_and_glycopyrrolate_for_reversal_of_neuromuscular_block:_a_randomised_controlled_trial_ L2 - https://doi.org/10.1111/anae.14174 DB - PRIME DP - Unbound Medicine ER -