Effects of Sugammadex and Neostigmine on Post-operative Nausea and Vomiting in ENT Surgery

We aim to compare the effects of sugammadex on postoperative nausea and vomiting (PONV) with those of neostigmine-atropine mixture. A total of 136 American Society of Anesthesiology (ASA) I or II patients, aged 18 to 65 years who underwent ear, nose, and throat (ENT) surgery under general anesthesia, were recruited in this prospective, randomized, double-blind study to receive either sugammadex 2 mg/kg or neostigmine 2.5 mg with atropine 1 mg for reversal of neuromuscular blockade. PONV scores and the need for the rescue of anti-emetic were assessed upon arrival in the post-anesthesia recovery unit and at 1-, 6-, 12-, and 24-h post-reversal. The incidence of PONV was significantly lower in patients who received sugammadex (3%) compared to patients who received neostigmine-atropine mixture (20%) at 6 h postoperative (p = 0.013). The incidence of PONV was comparable at other time intervals. None of the sugammadex recipients require rescue antiemetic whereas two patients from the neostigmine-atropine group required rescue antiemetic at 1 and 6 h post-reversal, respectively. The need for the rescue antiemetic was not statistically significant. We concluded that reversal of neuromuscular blockade with sugammadex showed lower incidence of PONV compared to neostigmine-atropine combination in the first 6 h post-reversal.