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Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials.
J Clin Anesth. 2016 Dec; 35:1-12.JC

Abstract

BACKGROUND AND 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.

DESIGN

Meta-analysis of data about effectiveness and safety of sugammadex compared to neostigmine for reversing NMB in adults was performed using the PRISMA methodology.

SETTING

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.

PATIENTS

A total of 1384 patients from 13 articles were included in this meta-analysis.

MAIN 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+Show Affiliations

Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Via C. Battisti, 267, 35121 Padova, Italy. Electronic address: michele.carron@unipd.it.Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Via C. Battisti, 267, 35121 Padova, Italy. Electronic address: fzarantonello@gmail.com.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.Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Via C. Battisti, 267, 35121 Padova, Italy. Electronic address: carloori@unipd.it.

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

27871504

Citation

Carron, Michele, et al. "Efficacy and Safety of Sugammadex Compared to Neostigmine for Reversal of Neuromuscular Blockade: a Meta-analysis of Randomized Controlled Trials." Journal of Clinical Anesthesia, vol. 35, 2016, pp. 1-12.
Carron M, Zarantonello F, Tellaroli P, et al. Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials. J Clin Anesth. 2016;35:1-12.
Carron, M., Zarantonello, F., Tellaroli, P., & Ori, C. (2016). Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials. Journal of Clinical Anesthesia, 35, 1-12. https://doi.org/10.1016/j.jclinane.2016.06.018
Carron M, et al. Efficacy and Safety of Sugammadex Compared to Neostigmine for Reversal of Neuromuscular Blockade: a Meta-analysis of Randomized Controlled Trials. J Clin Anesth. 2016;35:1-12. PubMed PMID: 27871504.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials. AU - Carron,Michele, AU - Zarantonello,Francesco, AU - Tellaroli,Paola, AU - Ori,Carlo, Y1 - 2016/08/04/ PY - 2016/02/20/received PY - 2016/06/02/revised PY - 2016/06/07/accepted PY - 2016/11/23/entrez PY - 2016/11/23/pubmed PY - 2017/8/12/medline KW - Adverse event KW - Anesthesia KW - Meta-analysis KW - Neostigmine KW - Neuromuscular blockade KW - Sugammadex SP - 1 EP - 12 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 35 N2 - BACKGROUND AND 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. DESIGN: Meta-analysis of data about effectiveness and safety of sugammadex compared to neostigmine for reversing NMB in adults was performed using the PRISMA methodology. SETTING: 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. PATIENTS: A total of 1384 patients from 13 articles were included in this meta-analysis. MAIN 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. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/27871504/Efficacy_and_safety_of_sugammadex_compared_to_neostigmine_for_reversal_of_neuromuscular_blockade:_a_meta_analysis_of_randomized_controlled_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952-8180(16)30293-8 DB - PRIME DP - Unbound Medicine ER -