Sugammadex is associated with better respiratory recovery than neostigmine following reversal of anaesthesia-associated neuromuscular blockade in the morbidly obese patients following elective laparoscopic surgery

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

“…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).…”

Efficacy and Safety of Sugammadex versus Neostigmine in Reversing Neuromuscular Blockade in Morbidly Obese Adult Patients

“…This finding agrees with three observational studies which found that sugammadex reversed moderate NMB significantly faster than neostigmine in MO patients. [ 20 21 22 ] This can result in a reduced duration of anesthesia, higher flow of patients through the operating theater, and more efficient use of healthcare resources. There are also potential benefits in terms of reduced incidence of PORC[ 22 ] and various muscarinic receptor-mediated side effects associated with neostigmine.…”

“…[ 20 21 22 ] This can result in a reduced duration of anesthesia, higher flow of patients through the operating theater, and more efficient use of healthcare resources. There are also potential benefits in terms of reduced incidence of PORC[ 22 ] and various muscarinic receptor-mediated side effects associated with neostigmine. [ 6 ] Although our sensitivity analysis excluding the conference abstracts did not show any difference between the sugammadex and neostigmine groups in the time to recovery of TOF ≥0.9; this finding may be inadequately powered due to paucity in the number of published full RCTs.…”

“…Johnson et al found that patients reversed with sugammadex had a significantly higher postoperative peak expiratory flow rate (PEFR) than those reversed with neostigmine and glycopyrrolate. [ 22 ] PEFR has been shown to be a good surrogate measure of respiratory muscle strength, with low PEFR indicative of ineffective inadequate protective reflexes from the larynx and pharynx. [ 25 27 ]…”

“…Moreover, sugammadex is superior to neostigmine in terms of patient safety, as it is associated with a lower incidence of PORC and associated complications. [ 22 ]…”