Abstract
BackgroundThe 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.MethodsRelevant 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.ResultsFourteen 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).ConclusionsCompared 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.
Highlights
The influence of sugammadex for reversal of neuromuscular block (NMB) on postoperative pulmonary complications (PPCs), compared with neostigmine, remains to be determined
Some previous randomized controlled trials (RCTs) showed that sugammadex is associated with a reduced risk of PPCs as compared with neostigmine (Carron et al, 2013; Unal et al, 2015), while other studies did not show a significant difference regarding the incidence of PPCs among patients allocated to the two drugs (Schaller et al, 2010; Geldner et al, 2012; Brueckmann et al, 2015; Koyuncu et al, 2015; Hakimoglu et al, 2016; Agha et al, 2017; Yagan et al, 2017; Alday et al, 2019; Claroni et al, 2019; Ba et al, 2020; Lee et al, 2020; Togioka et al, 2020)
The inclusion criteria according to the PICO principle were (1) Patients: adult patients undergoing surgeries with general anesthesia with NMB were included; (2) Intervention: sugammadex was used as intervention for NMB reversal; (3) Comparison: neostigmine was used as control for NMB reversal; and (4) Outcomes: reporting of the incidence of PPCs during the perioperative periods
Summary
The influence of sugammadex for reversal of neuromuscular block (NMB) on postoperative pulmonary complications (PPCs), compared with neostigmine, remains to be determined. Some previous randomized controlled trials (RCTs) showed that sugammadex is associated with a reduced risk of PPCs as compared with neostigmine (Carron et al, 2013; Unal et al, 2015), while other studies did not show a significant difference regarding the incidence of PPCs among patients allocated to the two drugs (Schaller et al, 2010; Geldner et al, 2012; Brueckmann et al, 2015; Koyuncu et al, 2015; Hakimoglu et al, 2016; Agha et al, 2017; Yagan et al, 2017; Alday et al, 2019; Claroni et al, 2019; Ba et al, 2020; Lee et al, 2020; Togioka et al, 2020). In view of the limited sample sizes in previous RCTs, which may cause potential statistical inadequacy, we aimed to compare the influence of NMB reversal with sugammadex or neostigmine on the risk of PPCs after general anesthesia via a meta-analysis
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