# Comparison of the Effects of Sugammadex and Pyridostigmine on Postoperative Nausea and Vomiting and the Recovery Profile in Pediatric Patients Undergoing Strabismus Surgery: A Prospective, Double-Blind, Observational Study

## TL;DR

This study compares sugammadex and pyridostigmine in children after strabismus surgery, finding similar nausea rates but faster recovery with sugammadex.

## Contribution

The study provides new evidence on the safety and recovery profile of sugammadex in pediatric patients undergoing strabismus surgery.

## Key findings

- Sugammadex and pyridostigmine had similar postoperative nausea and vomiting rates in children.
- Sugammadex showed significantly faster neuromuscular recovery compared to pyridostigmine.
- Heart rate changes after sugammadex were more pronounced but resolved without intervention.

## Abstract

Background and Objectives: Postoperative nausea and vomiting (PONV) is a common and potentially crucial side effect in pediatric patients. Neuromuscular blockade reversal drugs (NMBRDs) used during surgery have been associated with PONV. This study investigated whether sugammadex, a recently approved NMBRD for children in Korea, induces PONV and possible changes after NMBRD administration in children undergoing strabismus surgery. Materials and Methods: In total, 60 pediatric patients (3–16 years old) undergoing strabismus surgery with general anesthesia were included. They were divided into two groups: sugammadex (group S, n = 30) or pyridostigmine (group P, n = 30). The primary endpoint was the incidence of PONV using the Baxter Animated Retching Faces (BARF) scale at 0.5, 1, 3, and 6 h after NMBRD administration. The secondary endpoints included the recovery time (train-of-four > 0.9) and changes in heart rate following NMBRD administration. Results: There was no significant difference in PONV incidence between the groups according to the BARF scale (13.3% vs. 13.3% at 0.5 h, 6.7% vs. 3.3% at 1 h). Sugammadex demonstrated a significantly faster recovery time than pyridostigmine (p < 0.001). The changes in heart rate were more significant in the sugammadex group than those in the pyridostigmine group after NMBRD administration (p < 0.001); however, the heart rate returned to preoperative levels without any need for rescue medications or anticholinergics during the emergence period. Conclusions: There was no significant difference in PONV incidence between the administration of sugammadex and pyridostigmine in pediatric patients after strabismus surgery. Nevertheless, sugammadex appeared to facilitate faster recovery from the neuromuscular blockade without requiring intervention for the heart rate.