Neostigmine vs. sugammadex: on postoperative nausea and vomiting (PONV) after general anaesthesia

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Sugammadex (SGM) is the first cyclodextrin derivative approved as an API, the result of a rational drug design, with a well described mechanism.

It is used as the specific antidote of rocuronium, a non-depolarizing neuromuscular blocker. SGM binds specifically to rocuronium, virtually irreversibly and the complex is eliminated through the kidneys.

However, in anaesthesia neostigmine or glycopyrrolate are still used to reverse the effects of rocuronium, despite their systemic side effects. The main reason is the currently higher price of Sugammadex.

This recent article shows that the use of Sugammadex was associated with a significantly lower incidence of overall PONV in the first 24 h following general anaesthesia ((15.8% vs. 17.7%; odds ratio, 0.87; 95% confidence interval [CI], 0.79-0.97; P = 0.010)).

Soon SGM becomes generic worldwide, and let’s hope that the price won’t be a barrier for this unique cyclodextrin derivative to be used in general anaesthesia.

Ju, JW., Hwang, I.E., Cho, HY. et al. Effects of sugammadex versus neostigmine on postoperative nausea and vomiting after general anesthesia in adult patients:a single-center retrospective study. Sci Rep 13, 5422 (2023).

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