Influence of sugammadex versus neostigmine for neuromuscular block reversal on the incidence of postoperative pulmonary complications: a meta-analysis of randomized controlled trials

Abstract

Background The influence of sugammadex for reversal of neuromuscular block (NMB) on postoperative pulmonary complications (PPCs), compared with neostigmine, remains to be determined. We performed a meta-analysis of randomized controlled trials (RCTs) to compare the incidence of PPCs between patients who received sugammadex versus neostigmine. Methods Relevant studies were obtained by searching the PubMed, Embase, and Cochrane Library databases. A random effects model incorporating the potential heterogeneity was used to pool the results. Results Fourteen RCTs including 1478 adult patients who underwent surgeries with general anesthesia were included, and of these, 753 received sugammadex and 725 received neostigmine for reversal of NMB. The pooled results showed that sugammadex was associated with a lower risk of overall PPCs compared to neostigmine (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.43–0.89, p = 0.01; I2 = 0%). This finding remained consistent after exclusion of two studies with potential overlapping events (OR: 0.58, 95% CI: 0.36–0.96, p = 0.03; I2=9%). Stratified analyses according to the categories of PPCs showed that sugammadex was associated with a significantly lower risk of postoperative respiratory failure (OR: 0.60, 95% CI: 0.38–0.97, p = 0.04; I2 = 0%) but not of postoperative pulmonary infection (OR: 0.79, p = 0.71), atelectasis (OR: 0.78, p = 0.33), or pneumothorax (OR: 0.87, p = 0.79). Conclusions Compared with neostigmine, the use of sugammadex for reversal of NMB was associated with a lower risk of PPCs, mainly due to a lower incidence of postoperative respiratory failure with the use of sugammadex.

Choice of neuromuscular block reversal agent to reduce postoperative pulmonary complications

“…Among the studies published so far on the occurrence of PPCs with sugammadex and neostigmine, a recently published meta-analysis analyzed 14 RCTs and 1,478 patients [ 45 ]. In the main meta-analysis, the risk of overall PPCs was lower with sugammadex than with neostigmine.…”

“…Additionally, PPCs such as respiratory infections, atelectasis, and pneumothorax were included only in 1–3 studies. These limitations should also be clearly considered [ 45 ].…”

Influence of Sugammadex in Decreasing Postoperative Pulmonary Complications in Thoracic Surgery, is There Evidence?

“…Wang et al 14 performed a meta-analysis evaluating 14 randomized control trials and demonstrated that the use of sugammadex was associated with a lower risk of PPCs compared with neostigmine. In addition, Song et al, 15 in a retrospective, observational study involving 257 thoracic surgical patients undergoing open lobectomy, demonstrated the advantage of using sugammadex over neostigmine due to a shorter average length of stay (10 v 12 days) and a lower incidence of atelectasis (18% v 29%).…”

Tailored Routine Sugammadex Reversal is More Cost-Effective Than Neostigmine: A Narrative Review

“…Sugammadex or neostigmine are commonly used for NMB reversal. Factors influencing the choice of reversal agent include depth of NMB, speed of action, risk of adverse effects and relative costs [1]. Sugammadex has been shown to confer a faster and more complete reversal of NMB in comparison to neostigmine potentially reducing the risk of incomplete NMB reversal, thereby decreasing postoperative pulmonary complications (PPCs).…”

“…Wang et al presented a meta-analysis of randomized controlled trials (RCTs) reviewing the incidence of PPCs with a train of four guided sugammadex reversal of rocuronium paralysis in comparison to neostigmine [1]. Ledowski et al performed a prospective, double-blind RCT on the incidence of PPCs following a train of four guided reversal of rocuronium induced neuromuscular block in high-risk patients with sugammadex compared to neostigmine [2].…”