by Wei Dou, Kai Jiang, Jing-hui Hu, Min-yuan Zhuang, Hong Liu, Fu-hai Ji, Ke Peng Background Postoperative delirium (POD) is an acute disturbance of attention and awareness in older adults undergoing surgery. It is associated with prolonged hospital stay and increased morbidity and mortality.
Recent studies suggested that neostigmine, an acetylcholinesterase inhibitor used to reverse neuromuscular blockade, may reduce POD risk. We aim to evaluate whether neuromuscular blockade reversal with neostigmine/glycopyrrolate reduces POD compared with sugammadex.
Methods This single-center, triple-masked, randomized, controlled superiority trial will enroll 320 older adults scheduled for major non-cardiac and non-neurosurgical surgery. Patients will be randomized (1:1) to receive either neostigmine 40 μg/kg plus glycopyrrolate 8 μg/kg or sugammadex 2 mg/kg for neuromuscular blockade reversal at the end of surgery.
The primary outcome is the incidence of POD within postoperative 7 days or until discharge, assessed twice daily with the validated Chinese version of 3-min Diagnostic Interview for Confusion Assessment Method.
The study aims to determine whether neostigmine combined with glycopyrrolate can reduce postoperative delirium (POD) relative to sugammadex.
The protocol notes that findings will influence agent selection for reversal, yet definitive conclusions await trial completion.