Early postoperative gastric emptying in patients undergoing laparoscopic cholecystectomy: sugammadex vs. neostigmine/atropine neuromuscular blockade reversal agents

Background and Aim: Neostigmine/atropine is commonly used to antagonize residual neuromuscular block. Both drugs have an dose-response impact on gastric motility, neostigmine increase and atropine delay gastric emptying. Such a relationship between these drugs leads to unpredictable effects on gastric emptying in perioperative period. Sugammadex is a new reversal agent, pharmacologically unrelated to acetylcholine receptors, and therefore can be assumed that there is no impact on gastric emptying. The aim of this study was to evaluate the effect of sugammadex and neostigmine/atropine on gastric emptying in patients undergoing laparoscopic cholecystectomy (LP) in early postoperative period. Material and Methods: In the prospective, randomized, clinical study 42 adult patients undergoing LP were analyzed. The patients were divided in two groups: sugammadex group S (21 pts.: age 50±16 yr.; male 6) and neostigmine/atropine group NA (21pts.: age 51±12 yr.; male 6), respectively. In all patients after the induction of anesthesia a gastric tube is positioned in the stomach. Before awakening 1 g of paracetamol dissolved in 200 mL of water was administered into the stomach. Thereafter, the gastric tube was rinsed with 20 mL of water and removed. For reversal of neuromuscular blockade patients in group S received 2 mg/kg of sugammadex while patients from group NA received 0.04 mg/kg of neostigmine with 0.015 mg/kg of atropine. Venous blood samples were obtained immediately after the arrival of patients in the recovery room (T0) and then after 15 (T15), 30 (T30), 60 (T60), 90 (T90), 120 (T120) and 150 (T150) minute. Paracetamol absorption test was used to evaluate gastric emptying and paracetamol absorption was assessed from the plasma paracetamol concentration (PPC). Results: The values of PPC immediately after the arrival of patients in the recovery room (T0) were significantly higher between the group S 1.2±0.9 vs. group NA 0.4±0.4 (p < 0.01). Values of the PPC at 15, 30, 60, 120 and 150 min. were higher but not significantly in group S vs. group NA: T15, 2.1±1.5 vs. 1.5±1.4; T30, 3.7±3.8 vs. 2.9±2.2; T60, 4.2±2.8 vs. 3.5±2.7; T120, 5.0±3.4 vs. 4.6±3.6; T150, 5.9±3.4 vs. 4.9±3.2. Values of the PPC at 90 min were minimally higher in group NA: T90, 4.6±3.4 vs. 4.7±3.4 (p=NS). Conclusion: Although the study results show a tendency of faster gastric emptying in sugammadex group, this difference is not significant in most, possibly due to study small sample size.