Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Via C. Battisti, 267, 35121 Padova, Italy.
Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padova, Via Loredan, 18, 35121 Padova, Italy.
J Clin Anesth. 2016 Dec;35:1-12. doi: 10.1016/j.jclinane.2016.06.018. Epub 2016 Aug 4.
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.
Meta-analysis of data about effectiveness and safety of sugammadex compared to neostigmine for reversing NMB in adults was performed using the PRISMA methodology.
University medical hospital.
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.
A total of 1384 patients from 13 articles were included in this meta-analysis.
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).
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.
舒更葡糖钠已被引入用于逆转罗库溴铵（或维库溴铵）引起的神经肌肉阻滞（NMB）。尽管其疗效已得到证实，但关于它是否比传统用于逆转 NMB 的新斯的明更安全的数据仍存在争议。
采用 PRISMA 方法对舒更葡糖钠与新斯的明在成人中逆转 NMB 的有效性和安全性进行数据分析。
大学附属医院。
与新斯的明相比，舒更葡糖钠逆转 NMB 的速度更快（P<.0001），并且在拔管时更有可能与更高的四成比数值相关（平均差异，0.18；95%置信区间[CI]，0.14-0.22；P<.0001），并且术后残余肌松的风险更低（比值比[OR]，0.05；95%CI，0.01-0.43；P=.0068）。与新斯的明相比，舒更葡糖钠与全身不良事件（OR，0.47；95%CI，0.34-0.66；P<.0001）、呼吸不良事件（OR，0.36；95%CI，0.14-0.95；P=.0386）、心血管不良事件（OR，0.23；95%CI，0.08-0.61；P=.0036）和术后无力（OR，0.45；95%CI，0.21-0.97；P=.0409）的发生风险显著降低。舒更葡糖钠和新斯的明与术后恶心和呕吐（OR，1.23；95%CI，0.70-2.15；P=.4719）、疼痛（OR，1.06；95%CI，0.15-7.36；P=.9559）、神经不良事件（OR，1.47；95%CI，0.52-4.17；P=.4699）、全身不良事件（OR，0.75；95%CI，0.47-1.21；P=.2448）和实验室检查值变化（OR，0.57；95%CI，0.18-1.78；P=.3368）的发生风险相似。
这项荟萃分析的结果表明，舒更葡糖钠优于新斯的明，因为它能更快更可靠地逆转 NMB，且不良事件的风险更低。
