Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

The comparative efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. A Cochrane systematic review with meta-analysis and trial sequential analysis

Publikation: Bidrag til tidsskriftReviewpeer review

DOI

  1. Exploring the limits of prolonged apnoea with high-flow nasal oxygen: an observational study

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Emergency laparotomy success - optimisation or triage?

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. A retrospective observational study of neuromuscular monitoring practice in 30,430 cases from six Danish hospitals

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. From variance to guidance for awake tracheal intubation

    Publikation: Bidrag til tidsskriftLederpeer review

  1. Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Pharmacokinetics of an intravenous bolus dose of clonidine in children undergoing surgery

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: a joint ESA/ESICM guideline

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: A joint ESA/ESICM guideline

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Vis graf over relationer

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-1 and 12.9 min with neostigmine 0.05 mg.kg-1 , with a mean difference (MD) (95%CI)) of 10.2 (8.5-12.0) (I2 = 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-1 and 48.8 min with neostigmine 0.07 mg.kg-1 , with a MD (95%CI) of 45.8 (39.4-52.2) (I2 = 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) (I2 = 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, I2 = 0%, n = 959, GRADE: low quality). Sugammadex reverses neuromuscular blockade more rapidly than neostigmine and is associated with fewer adverse events.

OriginalsprogEngelsk
TidsskriftAnaesthesia
Vol/bind73
Udgave nummer5
Sider (fra-til)631-641
ISSN0003-2409
DOI
StatusUdgivet - 2018

ID: 52406889