Background: Acetylcholinesterase inhibitors (e.g., pyridostigmine bromide) are used for neuromuscular blockade (NMB) reversal in patients undergoing surgery under general anesthesia (GA). Concurrent use of anticholinergic agents (e.g., glycopyrrolate) decreases cholinergic side effects but can impede bowel movements. Sugammadex has no cholinergic effects; its use modifies recovery of gastrointestinal (GI) motility following laparoscopic cholecystectomy compared to pyridostigmine/glycopyrrolate. This study evaluated the contribution of sugammadex to the recovery of GI motility compared with pyridostigmine and glycopyrrolate. Methods: We conducted a prospective study of patients who underwent laparoscopic cholecystectomy. Patients were randomly allocated to the experimental group (sugammadex, Group S) or control group (pyridostigmine-glycopyrrolate, Group P). After anesthesia (propofol and rocuronium, and 2% sevoflurane), recovery was induced by injection of sugammadex or a pyridostigmine-glycopyrrolate mixture. As a primary outcome, patients recorded the time of their first passage of flatus (‘gas-out time’) and defecation. The secondary outcome was stool types. Results: One-hundred and two patients participated (Group S, 49; Group P, 53). Mean time from injection of NMB reversal agents to gas-out time was 15.03 (6.36–20.25) h in Group S and 20.85 (16.34–25.86) h in Group P (P = 0.001). Inter-group differences were significant. Time until the first defecation as well as types of stools was not significantly different. Conclusions Sugammadex after laparoscopic cholecystectomy under GA resulted in an earlier first postoperative passage of flatus compared with the use of a mixture of pyridostigmine and glycopyrrolate. These findings suggest that the use of sugammadex has positive effects on the recovery of GI motility.

BACKGROUND: Maternal hypotension is a common complication during obstetric spinal anesthesia. This study was conducted to investigate the role of autonomic function testing in predicting maternal hypotension during spinal anesthesia induced to conduct Cesarean sections (C-section). METHODS: This study was conducted on 32 parturients undergoing C-section under spinal anesthesia. Sympathetic function tests included measuring diastolic blood pressure changes in response to hand gripping and systolic blood pressure changes response to moving from a supine to a standing position. Sympathetic dysfunction is said to exist when there are abnormal responses to both sympathetic function tests. Parasympathetic function tests included measuring heart rate responses to deep breathing and heart rate responses to moving from a supine to a standing position. Parasympathetic dysfunction is said to exist when there are abnormal responses to both parasympathetic function tests. After the onset of spinal anesthesia, blood pressure was measured every minute until childbirth. RESULTS: Hypotension occurred in 22 of the 32 parturients. There was no correlation between sympathetic dysfunction and hypotension incidence, but 12 of the 12 (100%) of the positive group and 10 of the 20 (50%) of the negative group experiencing parasympathetic dysfunction, respectively, experienced hypotension with a significant difference of P = 0.004. The group experiencing parasympathetic dysfunction had statistically significantly higher phenylephrine requirements were also greater in the parasympathetic dysfunction positive group (P < 0.003). CONCLUSIONS: This study's findings suggested that the parasympathetic function tests may be useful methods for predicting the incidence of maternal hypotension during spinal anesthesia induced for C-section.
Anesthesia, Spinal ; Autonomic Nervous System ; Blood Pressure ; Cesarean Section ; Female ; Hand ; Hand Strength ; Heart Rate ; Humans ; Hypotension ; Incidence ; Parasympathetic Nervous System ; Parturition ; Phenylephrine ; Pilot Projects ; Posture ; Pregnancy ; Respiration ; Sympathetic Nervous System