Key result
Sugammadex resulted in significantly fewer patients experiencing mild cognitive impairment (MMSE scores 20-25) in the early post-operative period compared to the neostigmine/atropine combination (14.6% vs 32.6%, p=0.046).
Why the study?
Sugammadex could offer an alternative to conventional reversal agents to avoid cholinergic side effects, but its comparative effect versus neostigmine/atropine on post-operative cognitive dysfunction in bariatric surgery patients needed evaluation.
Does sugammadex improve post-operative cognitive function compared to neostigmine/atropine in bariatric surgery patients?
RCT (n=90)
Closed envelope method
No
Does sugammadex improve post-operative cognitive function compared to neostigmine/atropine in bariatric surgery patients?
Absolute Event Rate: 14.6% vs 32.6%
p-value: p=0.046
Sugammadex may produce fewer mild early post-operative cognitive effects compared to a neostigmine/atropine combination in bariatric surgery patients.
Supports sugammadex preference in bariatric surgery to minimize early cognitive impairment; extends reversal agent trials to neurocognitive outcomes.
Background/Aim: A recently introduced drug, sugammadex, can be a good alternative to conventional neuromuscular blockade reversal agents, such as neostigmine. This choice is of great importance, especially in the patients in whom it would be wise to avoid cholinergic side effects. The aim of this study was to compare the effects of sugammadex and the combination of neostigmine/atropine on post-operative cognitive dysfunction in bariatric surgery patients. Methods: This randomized controlled trial included a total of 90 patients with American Society of Anesthesiologists (ASA) I–III physical status and body mass index >30 who were scheduled for elective sleeve gastrectomy were recruited for the study after obtaining ethics committee approval. Written consent was obtained from each patient. The exclusion criteria consisted of several parameters: lack of consent, co-existing muscular diseases, and severe cardiovascular diseases (New York Heart Association [NYHA]). The patients were randomly divided into two groups, and the randomization was performed by the investigator using previously prepared envelopes. In both groups, Mini Mental State Examination (MMSE) was performed before the operation. The patients’ memory, attentive executive functions, and motor skills were evaluated as part of a control cognitive evaluation. After the operation while in the post-anesthesia care unit and when the Modified Aldrete Recovery Score was ≥9, the MMSE evaluation was repeated one and six hours later. Results: The pre-operative MMSE results were similar in both groups. In the post-operative period, MMSEpo, MMSEpo1, and MMSEpo6 values were not significantly different between the groups. When a detailed examination of MMSEpo data was performed, it was determined that the MMSE scores were 20–25 in 14 patients (32.6%) in Group N/A and six patients (14.6%) in Group S. In Group N/A, the percentage of patients with MMSE 20–25 was significantly higher than that of Group S (X2=3.807; P=0.046). Conclusion: In this study, sugammadex produced less effects on cognitive functions when compared with neostigmine/atropine combination. The neostigmine/atropine combination produced mild effects on cognitive functions in the first hour of recovery.
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Sabuncu et al. (2023) conducted an RCT in Bariatric surgery (elective sleeve gastrectomy) (n=90). Sugammadex vs. Neostigmine (0.04 mg/kg) and Atropine (0.02 mg/kg) was evaluated on Mild cognitive impairment (MMSE score 20-25) in the early post-operative period (p=0.046). Sugammadex resulted in significantly fewer patients experiencing mild cognitive impairment (MMSE scores 20-25) in the early post-operative period compared to the neostigmine/atropine combination (14.6% vs 32.6%, p=0.046).
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