Wang Hao, Lv Xinghua, Wu Lin, Ma Fangli, Wang Ling, Wang Yongqi, Wang Xiaoxia, Li Yulan
Ambulatory Surgery Center, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.
The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China.
BMC Anesthesiol. 2025 Apr 4;25(1):152. doi: 10.1186/s12871-025-03019-9.
Perioperative neurocognitive dysfunction (PND) is influenced by various perioperative factors. Recent studies suggest that neuromuscular blocking reversal agents (NMBRs) may impact on PND. However, the results have been inconsistent. Therefore, we aimed to compare the effects of perioperative NMBRs on PND through this systematic review and meta-analysis.
We searched PubMed, CENTRAL, Embase, Web of Science, Scopus, and China Biology Medicine from their inception until May 2024. Two reviewers independently identified randomized controlled trials (RCTs) that compared the perioperative use of NMBRs with either a placebo or other NMBRs in patients undergoing general anaesthesia. We assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The primary outcome was the incidence of PND within 7 days following surgery, while the secondary outcomes included the time required to achieve a Train-of-Four ratio (TOF) ≥ 0.9 after administration of NMBRs, length of stay (LOS) in both the post-anaesthesia care unit (PACU) and the hospital, as well as the risk of adverse events (i.e. postoperative nausea and vomiting (PONV) and mortality).
A total of 10 randomized controlled trials involving 1705 patients compared the effects of NMBRs on PND. Neostigmine and sugammadex are the most commonly used NMBRs in clinical anaesthesia practice. In the primary analyses of all regimens, sugammadex significantly reduced the incidence of PND compared to neostigmine (risk ratio [RR] 0.67; 95% confidence interval [CI]:0.48-0.94; I = 0%; P = 0.02; moderate quality). However, the results indicated that there is no significant association between neostigmine and PND when compared to placebo (RR 0.76; 95% CI: 0.55-1.05; I = 35%; P = 0.09; moderate quality). The secondary outcomes revealed that sugammadex could significantly shorten the time of TOF ≥ 0.9 compared to neostigmine (mean difference [MD] -4.52; 95%CI: -5.04 to -3.99; I = 80%; P < 0.01; Moderate quality). Furthermore, no significant differences were observed in the incidence of adverse events or hospital LOS.
This meta-analysis demonstrated that the use of sugammadex was associated with improved early perioperative neurocognitive function compared to neostigmine when used to reverse neuromuscular blockade, without an increase in the incidence of adverse events.
PROSPERO CRD42024520287.
围手术期神经认知功能障碍（PND）受多种围手术期因素影响。近期研究表明，神经肌肉阻滞逆转剂（NMBRs）可能会对PND产生影响。然而，结果并不一致。因此，我们旨在通过这项系统评价和荟萃分析比较围手术期NMBRs对PND的影响。
我们检索了PubMed、CENTRAL、Embase、Web of Science、Scopus和中国生物医学数据库，检索时间从各数据库建库至2024年5月。两名研究者独立识别比较在全身麻醉患者中围手术期使用NMBRs与安慰剂或其他NMBRs的随机对照试验（RCTs）。我们使用推荐分级的评估、制定与评价（GRADE）方法评估证据的确定性。主要结局是术后7天内PND的发生率，次要结局包括给予NMBRs后达到四个成串刺激比值（TOF）≥0.9所需的时间、在麻醉后护理单元（PACU）和医院的住院时间（LOS）以及不良事件风险（即术后恶心呕吐（PONV）和死亡率）。
共有10项涉及1705例患者的随机对照试验比较了NMBRs对PND的影响。新斯的明和舒更葡糖是临床麻醉实践中最常用的NMBRs。在所有方案的主要分析中，与新斯的明相比，舒更葡糖显著降低了PND的发生率（风险比[RR]0.67；95%置信区间[CI]：0.48 - 0.94；I² = 0%；P = 0.02；中等质量）。然而，结果表明，与安慰剂相比，新斯的明与PND之间无显著关联（RR 0.76；95% CI：0.55 - 1.05；I² = 35%；P = 0.09；中等质量）。次要结局显示，与新斯的明相比，舒更葡糖可显著缩短TOF≥0.9的时间（平均差[MD] -4.52；95%CI： -5.04至 -3.99；I² = 80%；P < 0.01；中等质量）。此外，在不良事件发生率或住院LOS方面未观察到显著差异。
这项荟萃分析表明，在用于逆转神经肌肉阻滞时，与新斯的明相比，使用舒更葡糖与围手术期早期神经认知功能改善相关，且不良事件发生率未增加。
PROSPERO CRD42024520287
