Department of Pediatric and Obstetric Anaesthesia, Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Neuroanaesthesia, Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Anaesthesia. 2018 May;73(5):631-641. doi: 10.1111/anae.14160. Epub 2017 Dec 27.
We compared the efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. Our outcomes were: recovery time from second twitch to train-of-four ratio > 0.9; recovery time from post-tetanic count 1-5 to train-of-four ratio > 0.9; and risk of composite adverse and serious adverse events. We searched for randomised clinical trials irrespective of publication status and date, blinding status, outcomes reported or language. We included 41 studies with 4206 participants. Time to reversal of neuromuscular blockade from second twitch to a train-of-four ratio > 0.9 was 2.0 min with sugammadex 2 mg.kg and 12.9 min with neostigmine 0.05 mg.kg , with a mean difference (MD) (95%CI)) of 10.2 (8.5-12.0) (I = 84%, 10 studies, n = 835, Grades of Recommendation, Assessment, Development and Evaluation (GRADE): moderate quality). Time to reversal of neuromuscular blockade from a post-tetanic count of 1-5 to a train-of-four ratio > 0.9 was 2.9 min with sugammadex 4 mg.kg and 48.8 min with neostigmine 0.07 mg.kg , with a MD (95%CI) of 45.8 (39.4-52.2) (I = 0%, 2 studies, n = 114, GRADE: low quality). There were significantly fewer composite adverse events in the sugammadex group compared with neostigmine, with a risk ratio (95%CI) of 0.60 (0.49-0.74) (I = 40%, 28 studies, n = 2298, number needed to treat (NNT): 8, GRADE: moderate quality). Specifically, the risk of bradycardia (RR (95%CI) 0.16 (0.07-0.34), n = 1218, NNT: 14, GRADE: moderate quality), postoperative nausea and vomiting (RR (95%CI) 0.52 (0.28-0.97), n = 389, NNT: 16, GRADE: low quality) and overall signs of postoperative residual paralysis (RR (95%CI) 0.40 (0.28-0.57), n = 1474, NNT: 13, GRADE: moderate quality) were all reduced. There was no significant difference regarding the risk of serious adverse events (RR 0.54, 95%CI 0.13-2.25, I = 0%, n = 959, GRADE: low quality). Sugammadex reverses neuromuscular blockade more rapidly than neostigmine and is associated with fewer adverse events.
我们比较了舒更葡糖钠和新斯的明在成人中逆转神经肌肉阻滞的疗效和安全性。我们的结局为：第二个肌颤搐至四个成串刺激（TOF）比值>0.9 的恢复时间；从强直刺激后计数 1-5 到 TOF 比值>0.9 的恢复时间；以及复合不良和严重不良事件的风险。我们检索了无论发表状态和日期、盲法状态、报告结局或语言如何的随机临床试验。我们纳入了 41 项研究，共 4206 名参与者。舒更葡糖钠 2mg/kg 使第二个肌颤搐至 TOF 比值>0.9 的逆转时间为 2.0 分钟，新斯的明 0.05mg/kg 为 12.9 分钟，平均差异（MD）（95%CI）为 10.2（8.5-12.0）（I 2=84%，10 项研究，n=835，推荐分级的评估、制定与评价（Grades of Recommendation, Assessment, Development and Evaluation，GRADE）：中质量）。舒更葡糖钠 4mg/kg 使强直刺激后计数 1-5 至 TOF 比值>0.9 的恢复时间为 2.9 分钟，新斯的明 0.07mg/kg 为 48.8 分钟，MD（95%CI）为 45.8（39.4-52.2）（I 2=0%，2 项研究，n=114，GRADE：低质量）。与新斯的明相比，舒更葡糖钠组发生复合不良事件的风险显著降低，风险比（95%CI）为 0.60（0.49-0.74）（I 2=40%，28 项研究，n=2298，需要治疗的人数（number needed to treat，NNT）：8，GRADE：中质量）。具体而言，心动过缓（RR（95%CI）0.16（0.07-0.34），n=1218，NNT：14，GRADE：中质量）、术后恶心和呕吐（RR（95%CI）0.52（0.28-0.97），n=389，NNT：16，GRADE：低质量）和总体术后残余瘫痪迹象（RR（95%CI）0.40（0.28-0.57），n=1474，NNT：13，GRADE：中质量）的风险均降低。严重不良事件的风险无显著差异（RR 0.54，95%CI 0.13-2.25，I 2=0%，n=959，GRADE：低质量）。舒更葡糖钠逆转神经肌肉阻滞的速度快于新斯的明，且与更少的不良事件相关。
