Comparison of sugammadex and conventional reversal on postoperative nausea and vomiting: a randomized, blinded trial

Abstract

Study objective: To determine whether the new selective binding agent sugammadex causes less postoperative nausea and vomiting (PONV) than the cholinesterase inhibitor neostigmine.

Design: Prospective, randomized, double-blinded study.

Setting: University-affiliated hospital.

Patients: One hundred American Society of Anesthesiologists physical status 1 and 2 patients scheduled for extremity surgery.

Interventions: Patients were randomly assigned to neostigmine (70 μg/kg) and atropine (0.4 mg per mg neostigmine) or sugammadex 2 mg/kg for neuromuscular antagonism at the end of anesthesia, when 4 twitches in response to train-of-four stimulation were visible with fade.

Measurements: We recorded PONV, recovery parameters, antiemetic consumption, and side effects.

Main results: Nausea and vomiting scores were lower in the sugammadex patients upon arrival in the postanesthesia care unit (med: 0 [min-max, 0-3] vs med: 0 [min-max, 0-3]; P < .05), but thereafter low and comparable. Postoperative antiemetic and analgesic consumption were similar in each group. Extubation (median [interquartile range], 3 [1-3.25] vs 4 [1-3.25]; P < .001) first eye opening (4 [3-7.25] vs 7 [5-11]; P < .001), and head lift (4 [2-7.25] vs 8 [11-25]; P < .001) in minutes were shorter in patients given sugammadex. Postoperative heart rates were significantly lower in all measured times patients given neostigmine.

Conclusions: Nondepolarizing neuromuscular blocking antagonism with sugammadex speeds recovery of neuromuscular strength but only slightly and transiently reduces PONV compared with neostigmine and atropine.

Keywords: Neostigmine; Postoperative nausea; Sugammadex; Vomiting.