Abstract
Residual neuromuscular paralysis, the presence of clinically significant weakness after administration of pharmacologic neuromuscular blockade reversal, is associated with postoperative pulmonary complications and is more common in older patients. In contemporary anesthesia practice, reversal of neuromuscular blockade is accomplished with neostigmine or sugammadex. Neostigmine, an acetylcholinesterase inhibitor, increases the concentration of acetylcholine at the neuromuscular junction, providing competitive antagonism of neuromuscular blocking drug and facilitating muscle contraction. Sugammadex, a modified gamma-cyclodextrin, antagonizes neuromuscular blockade by encapsulating rocuronium and vecuronium in a one-to-one ratio for renal clearance, a pharmacokinetic property that led to the recommendation that sugammadex not be administered to those with end-stage renal disease. While data are limited, reports suggest sugammadex is efficacious and well tolerated in individuals with reduced renal function. Sugammadex provides a more rapid and complete reversal of neuromuscular blockade than neostigmine. There is also accumulating evidence that sugammadex may provide a protective effect against the development of postoperative pulmonary complications, nausea, and vomiting, and that it may have beneficial effects on the rate of bowel and bladder recovery after surgery. Accordingly, sugammadex administration is beneficial for most older patients undergoing surgery.
Similar content being viewed by others
References
Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet. 2015;385(Suppl 2):S11.
Das S, Forrest K, Howell S. General anaesthesia in elderly patients with cardiovascular disorders: choice of anaesthetic agent. Drugs Aging. 2010;27(4):265–82.
Bates AT, Divino C. Laparoscopic surgery in the elderly: a review of the literature. Aging Dis. 2015;6(2):149–55.
Fowler AJ, Abbott TEF, Prowle J, Pearse RM. Age of patients undergoing surgery. Br J Surg. 2019;106(8):1012–8.
Sukharamwala P, Thoens J, Szuchmacher M, Smith J, DeVito P. Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB (Oxford). 2012;14(10):649–57.
Sury MR, Palmer JH, Cook TM, Pandit JJ. The state of UK anaesthesia: a survey of National Health Service activity in 2013. Br J Anaesth. 2014;113(4):575–84.
Fortier LP, McKeen D, Turner K, de Medicis E, Warriner B, Jones PM, et al. The RECITE Study: a Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade. Anesth Analg. 2015;121(2):366–72.
Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Shear TD, Vender JS, et al. Residual neuromuscular block in the elderly: incidence and clinical implications. Anesthesiology. 2015;123(6):1322–36.
Pietraszewski P, Gaszynski T. Residual neuromuscular block in elderly patients after surgical procedures under general anaesthesia with rocuronium. Anaesthesiol Intensive Ther. 2013;45(2):77–81.
Brull SJ, Kopman AF. Current status of neuromuscular reversal and monitoring: challenges and opportunities. Anesthesiology. 2017;126(1):173–90.
Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111(1):110–9.
Blobner M, Hunter JM, Meistelman C, Hoeft A, Hollmann MW, Kirmeier E, et al. Use of a train-of-four ratio of 0.95 versus 0.9 for tracheal extubation: an exploratory analysis of POPULAR data. Br J Anaesth. 2020;124:63–72.
Herbstreit F, Peters J, Eikermann M. Impaired upper airway integrity by residual neuromuscular blockade: increased airway collapsibility and blunted genioglossus muscle activity in response to negative pharyngeal pressure. Anesthesiology. 2009;110(6):1253–60.
Eikermann M, Vogt FM, Herbstreit F, Vahid-Dastgerdi M, Zenge MO, Ochterbeck C, et al. The predisposition to inspiratory upper airway collapse during partial neuromuscular blockade. Am J Respir Crit Care Med. 2007;175(1):9–15.
Sundman E, Witt H, Olsson R, Ekberg O, Kuylenstierna R, Eriksson LI. The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans: pharyngeal videoradiography and simultaneous manometry after atracurium. Anesthesiology. 2000;92(4):977–84.
Eriksson LI, Sundman E, Olsson R, Nilsson L, Witt H, Ekberg O, et al. Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: simultaneous videomanometry and mechanomyography of awake human volunteers. Anesthesiology. 1997;87(5):1035–43.
Togioka BM, Xu X, Banner-Goodspeed V, Eikermann M. Does sugammadex reduce postoperative airway failure? Anesth Analg. 2020;131(1):137–40.
Cedborg AI, Sundman E, Boden K, Hedstrom HW, Kuylenstierna R, Ekberg O, et al. Pharyngeal function and breathing pattern during partial neuromuscular block in the elderly: effects on airway protection. Anesthesiology. 2014;120(2):312–25.
Raju M, Pandit JJ. Re-awakening the carotid bodies after anaesthesia: managing hypnotic and neuromuscular blocking agents. Anaesthesia. 2020;75(3):301–4.
Broens SJL, Boon M, Martini CH, Niesters M, van Velzen M, Aarts L, et al. Reversal of partial neuromuscular block and the ventilatory response to hypoxia: a randomized controlled trial in healthy volunteers. Anesthesiology. 2019;131(3):467–76.
Pandit JJ, Eriksson LI. Reversing neuromuscular blockade: not just the diaphragm, but carotid body function too. Anesthesiology. 2019;131(3):453–5.
Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. 2008;107(1):130–7.
Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS, et al. Intraoperative acceleromyographic monitoring reduces the risk of residual neuromuscular blockade and adverse respiratory events in the postanesthesia care unit. Anesthesiology. 2008;109(3):389–98.
Berg H, Roed J, Viby-Mogensen J, Mortensen CR, Engbaek J, Skovgaard LT, et al. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand. 1997;41(9):1095–103.
Martinez-Ubieto J, Ortega-Lucea S, Pascual-Bellosta A, Arazo-Iglesias I, Gil-Bona J, Jimenez-Bernardo T, et al. Prospective study of residual neuromuscular block and postoperative respiratory complications in patients reversed with neostigmine versus sugammadex. Minerva Anestesiol. 2016;82(7):735–42.
Bulka CM, Terekhov MA, Martin BJ, Dmochowski RR, Hayes RM, Ehrenfeld JM. Nondepolarizing neuromuscular blocking agents, reversal, and risk of postoperative pneumonia. Anesthesiology. 2016;125(4):647–55.
Thevathasan T, Shih SL, Safavi KC, Berger DL, Burns SM, Grabitz SD, et al. Association between intraoperative non-depolarising neuromuscular blocking agent dose and 30-day readmission after abdominal surgery. Br J Anaesth. 2017;119(4):595–605.
Grabitz SD, Rajaratnam N, Chhagani K, Thevathasan T, Teja BJ, Deng H, et al. The effects of postoperative residual neuromuscular blockade on hospital costs and intensive care unit admission: a population-based cohort study. Anesth Analg. 2019;128(6):1129–36.
Ramachandran SK, Thompson A, Pandit JJ, Devine S, Shanks AM. Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization. PLoS ONE. 2017;12(5): e0175408.
Pandit JJ, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, et al. The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods and analysis of data. Anaesthesia. 2014;69(10):1078–88.
Bash LD, Black W, Turzhitsky V, Urman RD. Neuromuscular blockade and reversal practice variability in the outpatient setting: insights from US Utilization Patterns. Anesth Analg. 2021;133(6):1437–50.
Luo J, Chen S, Min S, Peng L. Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade. Ther Clin Risk Manag. 2018;14:2397–406.
Baraka A. Depolarizing block is an endplate-muscular block, not a neuromuscular block. Anesthesiology. 2007;106(2):399–400 (author reply).
Nair PV, Hunter JM. Anticholinesterases and anticholinergic drugs. Continuing Education in Anaesthesia. Crit Care Pain. 2004;4(5):164–8.
USA FK. Neostigmine Methylsulfate injection [package insert[In: Administration UFaD, editor. accessdata.fda.gov2015.
Hristovska AM, Duch P, Allingstrup M, Afshari A. The comparative efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. A Cochrane systematic review with meta-analysis and trial sequential analysis. Anaesthesia. 2018;73(5):631–41.
Herbstreit F, Zigrahn D, Ochterbeck C, Peters J, Eikermann M. Neostigmine/glycopyrrolate administered after recovery from neuromuscular block increases upper airway collapsibility by decreasing genioglossus muscle activity in response to negative pharyngeal pressure. Anesthesiology. 2010;113(6):1280–8.
Eikermann M, Fassbender P, Malhotra A, Takahashi M, Kubo S, Jordan AS, et al. Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function. Anesthesiology. 2007;107(4):621–9.
Koscielniak-Nielsen ZJ, Law-Min JC, Donati F, Bevan DR, Clement P, Wise R. Dose-response relations of doxacurium and its reversal with neostigmine in young adults and healthy elderly patients. Anesth Analg. 1992;74(6):845–50.
Song IA, Seo KS, Oh AY, No HJ, Hwang JW, Jeon YT, et al. Timing of reversal with respect to three nerve stimulator end-points from cisatracurium-induced neuromuscular block. Anaesthesia. 2015;70(7):797–802.
Thompson CA. Sugammadex approved to reverse NMBA effects. Am J Health Syst Pharm. 2016;73(3):100.
Nag K, Singh DR, Shetti AN, Kumar H, Sivashanmugam T, Parthasarathy S. Sugammadex: a revolutionary drug in neuromuscular pharmacology. Anesth Essays Res. 2013;7(3):302–6.
Bash LD, Turzhitsky V, Black W, Urman RD. Neuromuscular blockade and reversal agent practice variability in the us inpatient surgical settings. Adv Ther. 2021;38(9):4736–55.
Stankiewicz-Rudnicki M. Neuromuscular blockade in the elderly. Anaesthesiol Intensive Ther. 2016;48(4):257–60.
Dubovoy TZ, Saager L, Shah NJ, Colquhoun DA, Mathis MR, Kapeles S, et al. Utilization patterns of perioperative neuromuscular blockade reversal in the United States: a retrospective observational study from the multicenter perioperative outcomes group. Anesth Analg. 2020;131(5):1510–9.
Chandrasekhar K, Togioka BM, Jeffers JL. Sugammadex. Treasure Island: StatPearls; 2022.
Togioka BM, Yanez D, Aziz MF, Higgins JR, Tekkali P, Treggiari MM. Randomised controlled trial of sugammadex or neostigmine for reversal of neuromuscular block on the incidence of pulmonary complications in older adults undergoing prolonged surgery. Br J Anaesth. 2020;124:533–61.
Flockton EA, Mastronardi P, Hunter JM, Gomar C, Mirakhur RK, Aguilera L, et al. Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine. Br J Anaesth. 2008;100(5):622–30.
Merck & Co. I. Bridion Package Insert. Whitehouse Station: Merck Sharp & Dohme Corp.; 2015-2018.
Min KC, Bondiskey P, Schulz V, Woo T, Assaid C, Yu W, et al. Hypersensitivity incidence after sugammadex administration in healthy subjects: a randomised controlled trial. Br J Anaesth. 2018;121(4):749–57.
de Kam PJ, Nolte H, Good S, Yunan M, Williams-Herman DE, Burggraaf J, et al. Sugammadex hypersensitivity and underlying mechanisms: a randomised study of healthy non-anaesthetised volunteers. Br J Anaesth. 2018;121(4):758–67.
Miyazaki Y, Sunaga H, Kida K, Hobo S, Inoue N, Muto M, et al. Incidence of anaphylaxis associated with sugammadex. Anesth Analg. 2018;126(5):1505–8.
Dirkmann D, Britten MW, Pauling H, Weidle J, Volbracht L, Gorlinger K, et al. Anticoagulant effect of sugammadex: just an in vitro artifact. Anesthesiology. 2016;124(6):1277–85.
Staals LM, Snoeck MM, Driessen JJ, van Hamersvelt HW, Flockton EA, van den Heuvel MW, et al. Reduced clearance of rocuronium and sugammadex in patients with severe to end-stage renal failure: a pharmacokinetic study. Br J Anaesth. 2010;104(1):31–9.
Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev. 2017;8:CD012763.
Carron M, Veronese S, Foletto M, Ori C. Sugammadex allows fast-track bariatric surgery. Obes Surg. 2013;23(10):1558–63.
Jones RK, Caldwell JE, Brull SJ, Soto RG. Reversal of profound rocuronium-induced blockade with sugammadex: a randomized comparison with neostigmine. Anesthesiology. 2008;109(5):816–24.
Alvis BD, Hughes CG. Physiology considerations in geriatric patients. Anesthesiol Clin. 2015;33(3):447–56.
Proakis AG, Harris GB. Comparative penetration of glycopyrrolate and atropine across the blood–brain and placental barriers in anesthetized dogs. Anesthesiology. 1978;48(5):339–44.
Atri A, Sherman S, Norman KA, Kirchhoff BA, Nicolas MM, Greicius MD, et al. Blockade of central cholinergic receptors impairs new learning and increases proactive interference in a word paired-associate memory task. Behav Neurosci. 2004;118(1):223–36.
By the American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society 2019 Updated AGS Beers Criteria(R) for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674–94.
Hughes CG, Boncyk CS, Culley DJ, Fleisher LA, Leung JM, McDonagh DL, et al. American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention. Anesth Analg. 2020;130(6):1572–90.
Berger M, Schenning KJ, Brown CHt, Deiner SG, Whittington RA, Eckenhoff RG, et al. Best practices for postoperative brain health: recommendations from the fifth international perioperative neurotoxicity working group. Anesth Analg. 2018;127(6):1406–13.
Burfeind KG, Tirado Navales AA, Togioka BM, Schenning K. Prevention of postoperative delirium through the avoidance of potentially inappropriate medications in a geriatric surgical patient. BMJ Case Rep. 2021;14(4):e240403.
Muedra V, Rodilla V, Llansola M, Agusti A, Pla C, Canto A, et al. Potential neuroprotective role of sugammadex: a clinical study on cognitive function assessment in an enhanced recovery after cardiac surgery approach and an experimental study. Front Cell Neurosci. 2022;16: 789796.
Kheterpal S, O’Reilly M, Englesbe MJ, Rosenberg AL, Shanks AM, Zhang L, et al. Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery. Anesthesiology. 2009;110(1):58–66.
Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123(3):515–23.
Shorten GD, Uppington J, Comunale ME. Changes in plasma catecholamine concentrations and haemodynamic effects of rocuronium and vecuronium in elderly patients. Eur J Anaesthesiol. 1998;15(3):335–41.
Muravchick S, Owens WD, Felts JA. Glycopyrrolate and cardiac dysrhythmias in geriatric patients after reversal of neuromuscular blockade. Can Anaesth Soc J. 1979;26(1):22–5.
Eldor J, Hoffman B, Davidson JT. Prolonged bradycardia and hypotension after neostigmine administration in a patient receiving atenolol. Anaesthesia. 1987;42(12):1294–7.
Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesth Analg. 2007;104(3):575–81.
Kizilay D, Dal D, Saracoglu KT, Eti Z, Gogus FY. Comparison of neostigmine and sugammadex for hemodynamic parameters in cardiac patients undergoing noncardiac surgery. J Clin Anesth. 2016;28:30–5.
Smetana GW, Conde MV. Preoperative pulmonary update. Clin Geriatr Med. 2008;24(4):607–24 (vii).
Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006;144(8):575–80.
Manku K, Bacchetti P, Leung JM. Prognostic significance of postoperative in-hospital complications in elderly patients. I. Long-term survival. Anesth Analg. 2003;96(2):583–9 (table of contents).
Pandit JJ, Buckler KJ. Differential effects of halothane and sevoflurane on hypoxia-induced intracellular calcium transients of neonatal rat carotid body type I cells. Br J Anaesth. 2009;103(5):701–10.
Cammu GV, Smet V, De Jongh K, Vandeput D. A prospective, observational study comparing postoperative residual curarisation and early adverse respiratory events in patients reversed with neostigmine or sugammadex or after apparent spontaneous recovery. Anaesth Intensive Care. 2012;40(6):999–1006.
Kheterpal S, Vaughn MT, Dubovoy TZ, Shah NJ, Bash LD, Colquhoun DA, et al. Sugammadex versus Neostigmine For Reversal Of Neuromuscular Blockade And Postoperative Pulmonary Complications (STRONGER): a multicenter matched cohort analysis. Anesthesiology. 2020;132(6):1371–81.
Krause M, McWilliams SK, Bullard KJ, Mayes LM, Jameson LC, Mikulich-Gilbertson SK, et al. Neostigmine versus sugammadex for reversal of neuromuscular blockade and effects on reintubation for respiratory failure or newly initiated noninvasive ventilation: an interrupted time series design. Anesth Analg. 2020;131(1):141–51.
Li G, Freundlich RE, Gupta RK, Hayhurst CJ, Le CH, Martin BJ, et al. Postoperative pulmonary complications’ association with sugammadex versus neostigmine: a retrospective registry analysis. Anesthesiology. 2021;134(6):862–73.
Yu J, Park JY, Lee Y, Hwang JH, Kim YK. Sugammadex versus neostigmine on postoperative pulmonary complications after robot-assisted laparoscopic prostatectomy: a propensity score-matched analysis. J Anesth. 2021;35(2):262–9.
Alday E, Munoz M, Planas A, Mata E, Alvarez C. Effects of neuromuscular block reversal with sugammadex versus neostigmine on postoperative respiratory outcomes after major abdominal surgery: a randomized-controlled trial. Can J Anaesth. 2019;66(11):1328–37.
Evron S, Abelansky Y, Ezri T, Izakson A. Respiratory events with sugammadex vs. neostigmine following laparoscopic sleeve gastrectomy: a prospective pilot study assessing neuromuscular reversal strategies. Rom J Anaesth Intensive Care. 2017;24(2):111–4.
Ledowski T, Szabo-Maak Z, Loh PS, Turlach BA, Yang HS, de Boer HD, et al. Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: a prospective, randomised, double-blind trial in high-risk older patients. Br J Anaesth. 2021;127(2):316–23.
Lee TY, Jeong SY, Jeong JH, Kim JH, Choi SR. Comparison of postoperative pulmonary complications between sugammadex and neostigmine in lung cancer patients undergoing video-assisted thoracoscopic lobectomy: a prospective double-blinded randomized trial. Anesth Pain Med (Seoul). 2021;16(1):60–7.
Leslie K, Chan MTV, Darvall JN, De Silva AP, Braat S, Devlin NJ, et al. Sugammadex, neostigmine and postoperative pulmonary complications: an international randomised feasibility and pilot trial. Pilot Feasibil Stud. 2021;7(1):200.
Unal DY, Baran I, Mutlu M, Ural G, Akkaya T, Ozlu O. Comparison of sugammadex versus neostigmine costs and respiratory complications in patients with obstructive sleep apnoea. Turk J Anaesthesiol Reanim. 2015;43(6):387–95.
Cowen LE, Hodak SP, Verbalis JG. Age-associated abnormalities of water homeostasis. Endocrinol Metab Clin North Am. 2013;42(2):349–70.
Veering BT, Burm AG, Souverijn JH, Serree JM, Spierdijk J. The effect of age on serum concentrations of albumin and alpha 1-acid glycoprotein. Br J Clin Pharmacol. 1990;29(2):201–6.
Salive ME, Cornoni-Huntley J, Phillips CL, Guralnik JM, Cohen HJ, Ostfeld AM, et al. Serum albumin in older persons: relationship with age and health status. J Clin Epidemiol. 1992;45(3):213–21.
Rupp SM, Castagnoli KP, Fisher DM, Miller RD. Pancuronium and vecuronium pharmacokinetics and pharmacodynamics in younger and elderly adults. Anesthesiology. 1987;67(1):45–9.
Bell PF, Mirakhur RK, Clarke RS. Dose-response studies of atracurium, vecuronium and pancuronium in the elderly. Anaesthesia. 1989;44(11):925–7.
Parker CJ, Hunter JM, Snowdon SL. Effect of age, gender and anaesthetic technique on the pharmacodynamics of atracurium. Br J Anaesth. 1993;70(1):38–41.
McCarthy G, Elliott P, Mirakhur RK, Cooper R, Sharpe TD, Clarke RS. Onset and duration of action of vecuronium in the elderly: comparison with adults. Acta Anaesthesiol Scand. 1992;36(4):383–6.
Matteo RS, Ornstein E, Schwartz AE, Ostapkovich N, Stone JG. Pharmacokinetics and pharmacodynamics of rocuronium (Org 9426) in elderly surgical patients. Anesth Analg. 1993;77(6):1193–7.
Evers BM, Townsend CM Jr, Thompson JC. Organ physiology of aging. Surg Clin N Am. 1994;74(1):23–39.
Lee LA, Athanassoglou V, Pandit JJ. Neuromuscular blockade in the elderly patient. J Pain Res. 2016;9:437–44.
Slavov V, Khalil M, Merle JC, Agostini MM, Ruggier R, Duvaldestin P. Comparison of duration of neuromuscular blocking effect of atracurium and vecuronium in young and elderly patients. Br J Anaesth. 1995;74(6):709–11.
Yamamoto H, Uchida T, Yamamoto Y, Ito Y, Makita K. Retrospective analysis of spontaneous recovery from neuromuscular blockade produced by empirical use of rocuronium. J Anesth. 2011;25(6):845–9.
Furuya T, Suzuki T, Kashiwai A, Konishi J, Aono M, Hirose N, et al. The effects of age on maintenance of intense neuromuscular block with rocuronium. Acta Anaesthesiol Scand. 2012;56(2):236–9.
Arain SR, Kern S, Ficke DJ, Ebert TJ. Variability of duration of action of neuromuscular-blocking drugs in elderly patients. Acta Anaesthesiol Scand. 2005;49(3):312–5.
McDonagh DL, Benedict PE, Kovac AL, Drover DR, Brister NW, Morte JB, et al. Efficacy, safety, and pharmacokinetics of sugammadex for the reversal of rocuronium-induced neuromuscular blockade in elderly patients. Anesthesiology. 2011;114(2):318–29.
Marsh RH, Chmielewski AT, Goat VA. Recovery from pancuronium. A comparison between old and young patients. Anaesthesia. 1980;35(12):1193–6.
Paredes S, Porter SB, Porter IE 2nd, Renew JR. Sugammadex use in patients with end-stage renal disease: a historical cohort study. Can J Anaesth. 2020;67(12):1789–97.
Adams DR, Tollinche LE, Yeoh CB, Artman J, Mehta M, Phillips D, et al. Short-term safety and effectiveness of sugammadex for surgical patients with end-stage renal disease: a two-centre retrospective study. Anaesthesia. 2020;75(3):348–52.
Staals LM, Snoeck MM, Driessen JJ, Flockton EA, Heeringa M, Hunter JM. Multicentre, parallel-group, comparative trial evaluating the efficacy and safety of sugammadex in patients with end-stage renal failure or normal renal function. Br J Anaesth. 2008;101(4):492–7.
Lobaz S, Sammut M, Damodaran A. Sugammadex rescue following prolonged rocuronium neuromuscular blockade with 'recurarisation' in a patient with severe renal failure. BMJ Case Rep. 2013;2013:bcr2012007603.
Navare SR, Garcia Medina O, Prielipp RC, Weinkauf JL. Sugammadex reversal of a large subcutaneous depot of rocuronium in a dialysis patient: a case report. A A Pract. 2019;12(10):375–7.
Madsen JL, Graff J. Effects of ageing on gastrointestinal motor function. Age Ageing. 2004;33(2):154–9.
Shimamoto C, Hirata I, Hiraike Y, Takeuchi N, Nomura T, Katsu K. Evaluation of gastric motor activity in the elderly by electrogastrography and the (13)C-acetate breath test. Gerontology. 2002;48(6):381–6.
Gomes OA, de Souza RR, Liberti EA. A preliminary investigation of the effects of aging on the nerve cell number in the myenteric ganglia of the human colon. Gerontology. 1997;43(4):210–7.
Leon AD. The aging digestive tract: what should anesthesiologists know about it? Minerva Anestesiol. 2016;82(12):1336–42.
An J, Noh H, Kim E, Lee J, Woo K, Kim H. Neuromuscular blockade reversal with sugammadex versus pyridostigmine/glycopyrrolate in laparoscopic cholecystectomy: a randomized trial of effects on postoperative gastrointestinal motility. Korean J Anesthesiol. 2020;73(2):137–44.
Sen A, Erdivanli B, Tomak Y, Pergel A. Reversal of neuromuscular blockade with sugammadex or neostigmine/atropine: Effect on postoperative gastrointestinal motility. J Clin Anesth. 2016;32:208–13.
Deljou A, Soleimani J, Sprung J, Schroeder DR, Weingarten TN. Effects of reversal technique for neuromuscular paralysis on time to recovery of bowel function after craniotomy. Am Surg. 2022. https://doi.org/10.1177/00031348211058631.
Hunt ME, Yates JR, Vega H, Heidel RE, Buehler JM. Effects on postoperative gastrointestinal motility after neuromuscular blockade reversal with sugammadex versus neostigmine/glycopyrrolate in colorectal surgery patients. Ann Pharmacother. 2020;54(12):1165–74.
Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg. 1994;78(1):7–16.
Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012;109(5):742–53.
Apfel CC, Philip BK, Cakmakkaya OS, Shilling A, Shi YY, Leslie JB, et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology. 2012;117(3):475–86.
Paech MJ, Kaye R, Baber C, Nathan EA. Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial. Anaesthesia. 2018;73(3):340–7.
Tuna A, Palabiyik O, Orhan M, Sonbahar T, Sayhan H, Tomak Y, et al. Does sugammadex administration affect postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective, double-blind, randomized study. Surg Laparosc Endosc Percutan Tech. 2017;27:237–40.
Woo T, Kim KS, Shim YH, Kim MK, Yoon SM, Lim YJ, et al. Sugammadex versus neostigmine reversal of moderate rocuronium-induced neuromuscular blockade in Korean patients. Korean J Anesthesiol. 2013;65(6):501–7.
Yagan O, Tas N, Mutlu T, Hanci V. Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting. Braz J Anesthesiol. 2017;67(2):147–52.
Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J, et al. Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg. 2005;101(2):592–6.
Han J, Oh AY, Jeon YT, Koo BW, Kim BY, Kim D, et al. Quality of Recovery after Laparoscopic Cholecystectomy Following Neuromuscular Blockade Reversal with Neostigmine or Sugammadex: A Prospective, Randomized, Controlled Trial. J Clin Med. 2021;10(5):938.
Valencia Morales DJ, Stewart BR, Heller SF, Sprung J, Schroeder DR, Ghanem OM, et al. Urinary retention following inguinal herniorrhaphy: role of neuromuscular blockade reversal. Surg Laparosc Endosc Percutan Tech. 2021;31(5):613–7.
Klein AA, Meek T, Allcock E, Cook TM, Mincher N, Morris C, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2021: guideline from the Association of Anaesthetists. Anaesthesia. 2021;76(9):1212–23.
Acknowledgments
The authors would like to thank Ngoc Wasson (funded by the Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University) for her support with formatting, revising, and reference management during manuscript writing.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
Support provided in part by department sources within Oregon Health & Science University.
Conflict of interest
Brandon Togioka has received two investigator-initiated research grants from Merck & Co., the company that owns and sells ugammadex. The opinions expressed in this article are those of the authors and do not necessarily reflect those of Merck & Co. Katie Schenning declares no conflicts of interest.
Ethics approval
Not applicable.
Consent (to participate & for publication)
Not applicable.
Data & code availability statements
Not applicable.
Author contributions
BT: This author helped with manuscript design, literature review, summary of data, drafting and critically revising the manuscript. KS: This author helped with manuscript design, literature review, summary of data, drafting and critically revising the manuscript.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Togioka, B.M., Schenning, K.J. Optimizing Reversal of Neuromuscular Block in Older Adults: Sugammadex or Neostigmine. Drugs Aging 39, 749–761 (2022). https://doi.org/10.1007/s40266-022-00969-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40266-022-00969-4