Comparison the effects of sugammadex and neostigmine/atropine on cognitive functions in bariatric surgery patents: Randomized controlled trial

Abstract

Background/Aim: A recently introduced drug, sugammadex, can be a good alternative to conventional neuromuscular blockade reversal agents, such as neostigmine. This choice is of great importance, especially in the patients in whom it would be wise to avoid cholinergic side effects. The aim of this study was to compare the effects of sugammadex and the combination of neostigmine/atropine on post-operative cognitive dysfunction in bariatric surgery patients. Methods: This randomized controlled trial included a total of 90 patients with American Society of Anesthesiologists (ASA) I–III physical status and body mass index >30 who were scheduled for elective sleeve gastrectomy were recruited for the study after obtaining ethics committee approval. Written consent was obtained from each patient. The exclusion criteria consisted of several parameters: lack of consent, co-existing muscular diseases, and severe cardiovascular diseases (New York Heart Association [NYHA]). The patients were randomly divided into two groups, and the randomization was performed by the investigator using previously prepared envelopes. In both groups, Mini Mental State Examination (MMSE) was performed before the operation. The patients’ memory, attentive executive functions, and motor skills were evaluated as part of a control cognitive evaluation. After the operation while in the post-anesthesia care unit and when the Modified Aldrete Recovery Score was ≥9, the MMSE evaluation was repeated one and six hours later. Results: The pre-operative MMSE results were similar in both groups. In the post-operative period, MMSEpo, MMSEpo1, and MMSEpo6 values were not significantly different between the groups. When a detailed examination of MMSEpo data was performed, it was determined that the MMSE scores were 20–25 in 14 patients (32.6%) in Group N/A and six patients (14.6%) in Group S. In Group N/A, the percentage of patients with MMSE 20–25 was significantly higher than that of Group S (X2=3.807; P=0.046). Conclusion: In this study, sugammadex produced less effects on cognitive functions when compared with neostigmine/atropine combination. The neostigmine/atropine combination produced mild effects on cognitive functions in the first hour of recovery.