Cochrane · systematic review · CD012763
Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults
Hristovska, AM, Duch, P, Allingstrup, M, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
AnaesthesiaAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
13
current version
GRADE rated
7
No studies
6
Included studies
NR
No studies 6 · 46.2%Ungraded 0 · 0%Very low 0 · 0%Low 3 · 23.1%Moderate 4 · 30.8%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Sugammadex 2.0 mg/kg vs neostigmine 0.05 mg/kg
Population: adult patients, ASA I to IV, who received non‐depolarizing NMBAs
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery timea from second twitch (T2) to train‐of‐four ratio (TOFR) > 0.9 (moderate block) Sugammadex 2.0 mg/kg vs neostigmine 0.05 mg/kg | no estimate extracted | 10 studies · 835 participants | Moderate Downgraded: risk of bias |
Recovery timea from post‐tetanic count (PTC) Sugammadex 2.0 mg/kg vs neostigmine 0.05 mg/kg | no estimate extracted | NR | No studies |
Risks of adverse events and serious adverse eventsb, bradycardia, PONV, and signs of residual neuromuscular blockade Sugammadex 2.0 mg/kg vs neostigmine 0.05 mg/kg | no estimate extracted | NR | No studies |
Sugammadex 4.0 mg/kg vs neostigmine 0.07 mg/kg
Population: adult patients, ASA I to IV, who received non‐depolarizing NMBAs
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery timea from second twitch (T2) to train‐of‐four ratio (TOFR) > 0.9 (moderate block) Sugammadex 4.0 mg/kg vs neostigmine 0.07 mg/kg | no estimate extracted | NR | No studies |
Recovery timea from post‐tetanic count (PTC 1 to 5) to train‐of‐four ratio (TOFR) > 0.9 (deep block) Sugammadex 4.0 mg/kg vs neostigmine 0.07 mg/kg | no estimate extracted | 2 studies · 114 participants | Low Downgraded: risk of bias, imprecision |
Risk of adverse events and serious adverse eventsb, bradycardia, PONV, and signs of residual neuromuscular blockade Sugammadex 4.0 mg/kg vs neostigmine 0.07 mg/kg | no estimate extracted | NR | No studies |
Sugammadex (any dose) vs neostigmine (any dose)
Population: Adult patients, ASA I‐IV, who received non‐depolarizing NMBAs
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery timea from second twitch (T2) to train‐of‐four ratio (TOFR) > 0.9 (moderate block) Sugammadex (any dose) vs neostigmine (any dose) | no estimate extracted | NR | No studies |
Recovery timea from post‐tetanic count (PTC) Sugammadex (any dose) vs neostigmine (any dose) | no estimate extracted | NR | No studies |
Risk of composite adverse eventsb Sugammadex (any dose) vs neostigmine (any dose) | RR 0.6 [0.49, 0.74] | 28 studies · 2298 participants | Moderate Downgraded: risk of bias, imprecision |
Bradycardia Sugammadex (any dose) vs neostigmine (any dose) | RR 0.16 [0.07, 0.34] | 11 studies · 1218 participants | Moderate Downgraded: risk of bias, imprecision |
PONV Sugammadex (any dose) vs neostigmine (any dose) | RR 0.52 [0.28, 0.97] | 6 studies · 389 participants | Low Downgraded: risk of bias, imprecision |
Overall signs of postoperative residual paralysis Sugammadex (any dose) vs neostigmine (any dose) | RR 0.4 [0.28, 0.57] | 15 studies · 1474 participants | Moderate Downgraded: risk of bias, imprecision |
Risk of serious adverse eventsb Sugammadex (any dose) vs neostigmine (any dose) | RR 0.54 [0.13, 2.25] | 10 studies · 959 participants | Low Downgraded: risk of bias, imprecision |