背景:残余神经肌肉阻滞与患者发病率增加相关。因此,预防残留的神经肌肉阻滞是使用神经肌肉阻断剂的全身麻醉的重要组成部分。而sugammadex根据神经肌肉抽搐监测参数改善逆转,没有前景,充分有力的确定性研究表明sugammadex也与较低的患者发病率相关。
方法:我们进行了一项关于比较sugammadex与基于抗胆碱酯酶的逆转或安慰剂逆转的随机试验的系统评价,这些试验报告了超出麻醉后监护单元的重要患者结局。
结果:我们确定了43篇文章,包括5839名试验参与者。只有一项试验报告存活天数和出院天数为30天(DAOH-30),这表明DAOH-30的数量与基于新斯的明的逆转相比,分配给sugamadex的DAOH-30的数量相似(25天[19-27]vs24天[21-27],中位数差异0.00[-2.15至2.15])。对来自16项试验的数据进行汇总分析显示,使用sugammadex后,术后肺部并发症的估计比值比(OR)为0.67(95%置信区间0.47-0.95)。汇总分析显示,肺炎(使用sugammadex的8项试验OR0.51[0.24-1.01]),住院时间(23项试验,使用sugammadex的平均差-0.31[-0.84至0.22]),和患者报告的恢复质量(11项试验,根据使用的度量而变化)在分配给sugammadex与控制的那些中相似。死亡率的差异(11项试验,使用sugammadex的OR0.39[0.15-1.01])将被认为具有临床意义,值得进一步调查,然而,这些事件的罕见性阻碍了得出明确的结论。
结论:尽管很少有关于DAOH-30或重要患者结局的试验报道,sugammadex与术后肺部并发症的减少有关,然而,这可能不会转化为住院时间的差异,患者报告的恢复质量,或死亡率。
背景:PROSPERO数据库(CRD42022325858)。
BACKGROUND: Residual neuromuscular block is associated with increased patient morbidity. Therefore prevention of residual neuromuscular block is an important component of general anaesthesia where neuromuscular blocking agents are used. Whereas sugammadex improves reversal based on neuromuscular twitch monitoring parameters, there have been no prospective, adequately powered definitive studies demonstrating that sugammadex is also associated with less patient morbidity.
METHODS: We performed a systematic
review of randomised trials comparing sugammadex with anticholinesterase-based reversal or placebo reversal that reported important patient outcomes beyond the postanaesthesia care unit.
RESULTS: We identified 43 articles, including 5839 trial participants. Only one trial reported days alive and out of hospital to 30 days (DAOH-30), which showed that the number of DAOH-30 was similar in those allocated to sugammadex compared with neostigmine-based reversal (25 days [19-27] vs 24 days [21-27], median difference 0.00 [-2.15 to 2.15]). Pooled analyses of data from 16 trials showed an estimated odds ratio (OR) for postoperative pulmonary complications of 0.67 (95% confidence interval 0.47-0.95) with sugammadex use. Pooled analysis showed that pneumonia (eight trials OR 0.51 [0.24-1.01] with sugammadex use), hospital length of stay (23 trials, mean difference -0.31 [-0.84 to 0.22] with sugammadex use), and patient-reported quality of recovery (11 trials, varied depending on metric used) are similar in those allocated to sugammadex vs control. The difference seen in mortality (11 trials, OR 0.39 [0.15-1.01] with sugammadex use) would be considered to be clinically significant and warrants further investigation, however, the rarity of these events precludes drawing definitive conclusions.
CONCLUSIONS: Although few trials reported on DAOH-30 or important patient outcomes, sugammadex is associated with a reduction in postoperative pulmonary complications, however, this might not translate to a difference in hospital length of stay, patient-reported quality of recovery, or mortality.
BACKGROUND: PROSPERO database (CRD42022325858).