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

• Nondepolarizing neuromuscular blocking antagonism with sugammadex speeds recovery of neuromuscular strength.
• Sugammadex slightly and transiently reduces postoperative nausea and vomiting compared with neostigmine and atropine.
• Sugammadex should be used in patients likely to benefit from rapid recovery of muscular strength but not because of a presumed reduction in postoperative nausea and vomiting.

Study ObjectiveTo determine whether the new selective binding agent sugammadex causes less postoperative nausea and vomiting (PONV) than the cholinesterase inhibitor neostigmine.DesignProspective, randomized, double-blinded study.SettingUniversity-affiliated hospital.PatientsOne hundred American Society of Anesthesiologists physical status 1 and 2 patients scheduled for extremity surgery.InterventionsPatients 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.MeasurementsWe recorded PONV, recovery parameters, antiemetic consumption, and side effects.Main ResultsNausea 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.ConclusionsNondepolarizing neuromuscular blocking antagonism with sugammadex speeds recovery of neuromuscular strength but only slightly and transiently reduces PONV compared with neostigmine and atropine.