• Emiri Suganuma, Teruhiko Ishikawa, Yuji Kitamura, Taiichiro Hayashida, Tomoaki Matsumura, Mai Fujie, Natsuko Nozaki-Taguchi, Yasunori Sato, and Shiroh Isono.
• From the Department of Anaesthesia, Chiba Cancer Center (ES), Department of Anaesthesiology, Graduate School of Medicine, Chiba University, Chiba (TI, NNT, SI), Department of Anaesthesiology, Matsudo City General Hospital, Matsudo (YK), Department of Anaesthesiology, Chiba University Hospital (TH), Department of Gastroenterology, Graduate School of Medicine, Chiba University (TM), Clinical Engineering Center, Chiba University Hospital, Chiba (MF), Department of Preventive Medicine and Public Health, Keio School of Medicine, Tokyo, Japan (YS).
• Eur J Anaesthesiol. 2021 Aug 1; 38 (8): 856-864.

BackgroundThe lower oesophageal sphincter (LOS) barrier serves to prevent regurgitation of gastric contents. Although general anaesthesia depresses its function, its recovery process during emergence from anaesthesia has not been systematically examined.ObjectiveTo explore whether recovery of lower oesophageal barrier function differed between patients receiving a mixture of 1 mg atropine and 2 mg neostigmine and those receiving 2 mg kg-1 sugammadex during emergence from anaesthesia.DesignAn unblinded randomised controlled pilot study.SettingA single university hospital from January 2016 to December 2018.PatientsA total of 20 non-obese adult females undergoing minor surgery.InterventionThe patients were randomly assigned to a group either receiving atropine and neostigmine or sugammadex for reversal of rocuronium.Main Outcome MeasuresThrough use of the high-resolution manometry technique, the lower oesophageal barrier pressure (PBAR: primary variable) defined as a pressure difference between pressures at the LOS and the stomach was measured at five distinguishable time points during emergence from total intravenous anaesthesia. A mixed effects model for repeated measures was used to test the hypothesis.ResultsIn all patients baseline PBAR values were positive even under muscle paralysis and general anaesthesia before administration of reversal agents, and did not differ between the groups (P = 0.299). During recovery from muscle paralysis and general anaesthesia, PBAR (mean ± SD) significantly increased (P = 0.004) from 17.0 ± 2.9 to 21.0 ± 5.0 mmHg in the atropine and neostigmine group (n = 8) and from 19.1 ± 9.0 to 24.5 ± 12.7 mmHg in the sugammadex group (n = 11). PBAR significantly increased immediately after return of consciousness in both groups, whereas return of muscle tone, lightening of anaesthesia and tracheal extubation did not change it.ConclusionRecovery of the lower oesophageal barrier function does not differ between patients receiving either atropine and neostigmine or sugammadex and is completed after recovery of consciousness from general anaesthesia.Trial RegistrationUMIN Clinical Trials Registry: UMIN000020500: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000023594&type=summary&language=E.Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology.

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