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

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.