Comparing the effects of sugammadex and neostigmine on neuromuscular block and bispectral index in recovery from intracranial mass resection operations

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

“…Times to train-of-four ratio greater than or equal to 0.9 were shorter in patients antagonized with sugammadex compared with neostigmine from deep 65,69–71 to moderate 62,72–85 depths of blockade (moderate strength of evidence) and from shallow 86–90 (moderate strength of evidence) to minimal 69 depths of blockade (very low strength of evidence; supplementalfigs. S9 to S12, http://links.lww.com/ALN/C929).…”

“…S19, http://links.lww.com/ALN/C929, risk difference for sugammadex versus neostigmine of ˗2.9% [95% CI, ˗8.5 to 2.7]; low strength of evidence). 65,68,70,72,73,81,86–88,90,99,118,119…”

“…64,68,110–113 Postoperative reintubation was unreported in five randomized trials for sugammadex and neostigmine (low strength of evidence). 81,104,110,112,114 A single trial reported postoperative reintubation with neostigmine only. 104 Four studies reported lower rates of reintubation with sugammadex (very low strength of evidence; supplemental fig.…”

“…Postoperative nausea was reported in 31 studies (26 randomized controlled trials, 61,62,65,67,69–71,73,74,77,79–81,84,100,102,132–141 1 nonrandomized study, 142 and 3 cohort studies 48,143,144 ). No difference was apparent between sugammadex and neostigmine (very low strength of evidence; supplemental fig.…”

“…The body of evidence enrolling adults included 191 studies (133 randomized controlled trials, 4,59–90,92,95,98–104,110–114,118–127,132–141,145–148,155–157,163,173–181,206–254 11 nonrandomized trials, 17,128,142,182–184,191,255–258 45 cohort studies, 15,42,86,91,93,94,96,97,105–109,116,117,129–131,143,144,186–190,227,259–277 and 2 before–after designs 115,168 ) evaluating efficacy and safety of antagonist drugs for neuromuscular blockade. The randomized controlled trials enrolling only adults had a median of 88 participants (range, 16 to 350).…”