AT A GLANCE

A new study published in Anesthesia & Analgesia reports that, although no difference in gastric emptying speed was found between sugammadex and neostigmine–glycopyrrolate, the former does facilitate quicker times to first bowel movement and adequate reversal in patients undergoing colorectal surgery.¹

“Gastrointestinal function is mediated by the cholinergic pathway, which is impacted by neostigmine and glycopyrrolate, but not sugammadex. We hypothesized that sugammadex is associated with earlier gastric emptying in adults undergoing colorectal surgery, compared to neostigmine–glycopyrrolate,” explain study authors Togioka et al.

As part of a single-center, patient- and assessor-blinded, randomized, controlled trial, patients were randomized to sugammadex 2 mg/kg or neostigmine 0.07 mg/kg and glycopyrrolate (0.2 mg per 1 mg of neostigmine) at skin closure. Notably, all 60 patients randomized to sugammadex received the allocated intervention, while, of 60 patients randomized to neostigmine–glycopyrrolate, 56 received neostigmine–glycopyrrolate, two received sugammadex, and two received both agents.

The primary endpoint of interest was gastric emptying, which was assessed using the paracetamol absorption test. Meanwhile, secondary endpoints included time to first bowel movement, time to achieve adequate reversal (train-of-four ratio ≥ 0.9), gastrointestinal complications, hospital length of stay, and postanesthesia care unit recovery time.

According to the authors, gastric emptying did not differ significantly between the sugammadex and neostigmine–glycopyrrolate recipients. Sugammadex treatment was associated with shorter times to first bowel movement (44.3 vs. 61.0 h) and adequate reversal (5.2 vs 17.5 min). Further, the authors determined that neostigmine–glycopyrrolate treatment was not associated with a significant increase in gastrointestinal complications (32% vs 17%), a longer hospital length of stay (7.8 vs. 4.8 days), or a difference in postanesthesia care unit recovery time (108 vs. 115 min). Adverse events were also similar between the groups.

“Sugammadex treatment was not associated with faster gastric emptying (primary endpoint). Regarding prespecified secondary endpoints, sugammadex treatment was associated with a 12.3-min shorter time to adequate reversal in real-life practice conditions, but it did not benefit the proportion of subjects with gastrointestinal complications, [the] hospital length of stay, or [the] postanesthesia care unit recovery time,” the authors conclude.

“Further studies are needed to confirm our finding that sugammadex is associated with a clinically significant 16.7-h shorter time to first bowel movement, and to establish the role of sugammadex in colorectal surgery enhanced recovery protocols.”

Reference

1.     Togioka BM, Rakshe SK, Ye S, Tekkali P. A randomized controlled trial of sugammadex versus neostigmine for reversal of rocuronium on gastric emptying in adults undergoing elective colorectal surgery. Anesth Analg. 2025;141(2):373–383.