Abstract：
BACKGROUND: Cholinesterase inhibitors, such as neostigmine and edrophonium, commonly used to reverse the residual effects of nondepolarizing neuromuscular blocking drugs at the end of surgery are associated with a high rate of residual neuromuscular blockade (NMB). Due to its direct mechanism of action, sugammadex is associated with rapid and predictable reversal of deep NMB. The current analysis compares the clinical efficacy and risk of postoperative nausea and vomiting (PONV) on using sugammadex or neostigmine for routine NMB reversal in adult and pediatric populations.
METHODS: PubMed and ScienceDirect were searched as the primary databases. Randomized controlled trials comparing sugammadex with neostigmine for routine NMB reversal in adult and pediatric patients have been included. The primary efficacy endpoint was the time from initiation of sugammadex or neostigmine to the recovery of a time-of-four ratio (TOF) ≥ 0.9. PONV events have been reported as secondary outcomes.
RESULTS: A total of 26 studies have been included in this meta-analysis, 19 for adults with 1574 patients and 7 for children with 410 patients. Sugammadex, when compared to neostigmine, has been reported to take a shorter time to reverse NMB in adults (mean difference = -14.16 min; 95% CI [-16.88, -11.43], P < 0.01), as well as in children (mean difference = -26.36 min; 95% CI [- 40.16, -12.57], P < 0.01). Events of PONV have been found to be similar in both the groups in adults, but significantly lower in children treated with sugammadex, i.e., 7 out of 145 with sugammadex versus 35 out of 145 with neostigmine (odds ratio = 0.17; 95% CI [0.07, 0.40]).
CONCLUSIONS: Sugammadex is associated with a significantly shorter period of reversal from NMB in comparison to neostigmine in adult and pediatric patients. Regarding PONV, the use of sugammadex for NMB antagonism may offer a better option for pediatric patients.
METHODS: PubMed and ScienceDirect were searched as the primary databases. Randomized controlled trials comparing sugammadex with neostigmine for routine NMB reversal in adult and pediatric patients have been included. The primary efficacy endpoint was the time from initiation of sugammadex or neostigmine to the recovery of a time-of-four ratio (TOF) ≥ 0.9. PONV events have been reported as secondary outcomes.
RESULTS: A total of 26 studies have been included in this meta-analysis, 19 for adults with 1574 patients and 7 for children with 410 patients. Sugammadex, when compared to neostigmine, has been reported to take a shorter time to reverse NMB in adults (mean difference = -14.16 min; 95% CI [-16.88, -11.43], P < 0.01), as well as in children (mean difference = -26.36 min; 95% CI [- 40.16, -12.57], P < 0.01). Events of PONV have been found to be similar in both the groups in adults, but significantly lower in children treated with sugammadex, i.e., 7 out of 145 with sugammadex versus 35 out of 145 with neostigmine (odds ratio = 0.17; 95% CI [0.07, 0.40]).
CONCLUSIONS: Sugammadex is associated with a significantly shorter period of reversal from NMB in comparison to neostigmine in adult and pediatric patients. Regarding PONV, the use of sugammadex for NMB antagonism may offer a better option for pediatric patients.
摘要：
背景：胆碱酯酶抑制剂，如新斯的明和edrophonium，通常在手术结束时用于逆转非去极化神经肌肉阻滞药物的残余作用与高残余神经肌肉阻滞(NMB)率相关.由于其直接的作用机制，sugammadex与深度NMB的快速和可预测的逆转有关。当前的分析比较了在成人和儿童人群中使用sugamadex或新斯的明进行常规NMB逆转的临床疗效和术后恶心和呕吐（PONV）的风险。
方法：检索PubMed和ScienceDirect作为主要数据库。纳入了比较sugammadex和新斯的明在成人和儿科患者中常规NMB逆转的随机对照试验。主要疗效终点是从sugamadex或新斯的明开始到恢复4倍时间（TOF）≥0.9的时间。PONV事件被报告为次要结局。
结果：本次荟萃分析共纳入26项研究，19为成人1574例患者，7为儿童410例患者。Sugammadex,与新斯的明相比，据报道，成年人需要更短的时间来逆转NMB（平均差=-14.16分钟；95%CI[-16.88，-11.43]，P<0.01),以及儿童(平均差异=-26.36分钟；95%CI[-40.16，-12.57]，P<0.01)。已发现PONV的事件在两个成年人组中相似，但在接受sugammadex治疗的儿童中，即，145人中有7人服用sugamadex，145人中有35人服用新斯的明(比值比=0.17；95%CI[0.07，0.40])。
结论：在成人和儿童患者中，与新斯的明相比，Sugamadex与NMB逆转期明显缩短相关。关于PONV,使用sugammadex拮抗NMB可能为儿科患者提供更好的选择.
方法：检索PubMed和ScienceDirect作为主要数据库。
结果：本次荟萃分析共纳入26项研究，
结论：在成人和儿童患者中，与新斯的明相比，Sugamadex与NMB逆转期明显缩短相关。
