title: Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Sugammadex has been introduced for reversal of rocuronium (or vecuronium)-induced neuromuscular blockade (NMB). Although its efficacy has been established, data are conflicting whether it is safer than neostigmine traditionally used for reversing NMB.
  
  
  METHODS
  Meta-analysis of data about effectiveness and safety of sugammadex compared to neostigmine for reversing NMB in adults was performed using the PRISMA methodology.
  
  
  METHODS
  University medical hospital.
  
  
  METHODS
  A comprehensive search was conducted using PubMed, Web of Science, and Cochrane Library electronic databases to identify English-language randomized controlled trials. Two reviewers independently selected the trials; extracted data on reversal times, incomplete reversals of NMB, and adverse events (AEs); and assessed the trials' methodological quality and evidence level. Only AEs that were related to study drug by a blinded safety assessor were considered for meta-analysis.
  
  
  METHODS
  A total of 1384 patients from 13 articles were included in this meta-analysis.
  
  
  RESULTS
  Compared to neostigmine, sugammadex was faster in reversing NMB (P<.0001) and more likely to be associated with higher train-of-four ratio values at extubation (mean difference, 0.18; 95% confidence interval [CI], 0.14-0.22; P<.0001) and lower risk of postoperative residual curarization after extubation (odds ratio [OR], 0.05; 95% CI, 0.01-0.43; P=.0068). Compared to neostigmine, sugammadex was associated with a significantly lower likelihood of global AEs (OR, 0.47; 95% CI, 0.34-0.66; P<.0001), respiratory AEs (OR, 0.36; 95% CI, 0.14-0.95; P=.0386), cardiovascular AEs (OR, 0.23; 95% CI, 0.08-0.61; P=.0036), and postoperative weakness (OR, 0.45; 95% CI, 0.21-0.97; P=.0409). Sugammadex and neostigmine were associated with a similar likelihood of postoperative nausea and vomiting (OR, 1.23; 95% CI, 0.70-2.15; P=.4719), pain (OR, 1.06; 95% CI, 0.15-7.36; P=.9559), neurologic AEs (OR, 1.47; 95% CI, 0.52-4.17; P=.4699), general AEs (OR, 0.75; 95% CI, 0.47-1.21; P=.2448), and changes in laboratory tests' values (OR, 0.57; 95% CI, 0.18-1.78; P=.3368).
  
  
  CONCLUSIONS
  Results from this meta-analysis suggest that sugammadex is superior to neostigmine, as it reverses NMB faster and more reliably, with a lower risk of AEs.
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Via C. Battisti, 267, 35121 Padova, Italy. Electronic address: michele.carron@unipd.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Carron
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Via C. Battisti, 267, 35121 Padova, Italy. Electronic address: fzarantonello@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Zarantonello
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padova, Via Loredan, 18, 35121 Padova, Italy. Electronic address: paola.tellaroli@unipd.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Tellaroli
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Via C. Battisti, 267, 35121 Padova, Italy. Electronic address: carloori@unipd.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
mesh_terms: D000732:Androstanols / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors; D000762:Anesthesia Recovery Period; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D009388:Neostigmine / Q000008:administration & dosage / Q000009:adverse effects*; D019148:Neuromuscular Blockade / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic; D000077123:Rocuronium; D000077122:Sugammadex; D016896:Treatment Outcome; D014673:Vecuronium Bromide / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors; D047408:gamma-Cyclodextrins / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000732:Androstanols; D002800:Cholinesterase Inhibitors; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D009388:Neostigmine; D014673:Vecuronium Bromide; D000077123:Rocuronium
keywords: Adverse event; Anesthesia; Meta-analysis; Neostigmine; Neuromuscular blockade; Sugammadex