Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Division of General Surgery, Department of Surgery, Liberty University, Lynchburg, VA, USA.
Am Surg. 2024 Jun;90(6):1618-1629. doi: 10.1177/00031348241227200. Epub 2024 Jan 10.
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.
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.
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, < .05, I = 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.
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.
胃肠道（GI）手术后常发生术后胃肠功能障碍（POGD），与特定的麻醉剂有关。用于逆转神经肌肉阻滞的胆碱酯酶抑制剂与 POGD 的发生有关。新型逆转剂琥珀酸舒马曲坦与 POGD 减少有关。然而，关于这些药物对 GI 手术后 POGD 的影响，缺乏全面的比较综述。本研究旨在系统评价琥珀酸舒马曲坦与 GI 手术后胆碱酯酶抑制剂相比对 POGD 的影响。
截至 2022 年 7 月，通过 MEDLINE、EMBASE 和 CENTRAL 检索文献，以比较接受 GI 手术的患者中使用琥珀酸舒马曲坦与胆碱酯酶抑制剂的文章，具体涉及 POGD。次要终点包括住院时间、再入院率、肺部并发症和术后发病率。
从 198 条引文中，纳入了 2 项随机对照试验（RCT）和 3 项回顾性队列研究，共 717 例接受琥珀酸舒马曲坦和 812 例接受胆碱酯酶抑制剂的患者。与使用胆碱酯酶抑制剂相比，使用琥珀酸舒马曲坦的患者术后肠麻痹的延长率显著降低（OR.44，95%CI.25-.77， <.05，I = 56%，低确定性证据）。未观察到其他任何结局的显著差异。对再入院数据的叙述性综述表明无显著差异。
与胆碱酯酶抑制剂相比，胃肠道手术后使用琥珀酸舒马曲坦与术后肠麻痹延长率显著降低相关。然而，这并未转化为住院时间、发病率或术后恶心和呕吐的显著减少。结果受到纳入研究的数量和缺失数据的限制，需要更有力的 RCT 来提出建议。
