Neostigmine 15mg/5ml oral solution

BackgroundPostoperative urinary retention (POUR) is a frequent complication following general anesthesia. There is growing interest in whether sugammadex, a neuromuscular blockade (NMB) reversal agent that does not require anticholinergic coadministration, might reduce its incidence. This systematic review and meta-analysis aimed to evaluate the effects of sugammadex on POUR and other postoperative recovery outcomes, such as 30-day readmission rates and postoperative pain scores (POPS).MethodsPubMed, Cochrane, Embase, and Web of Science were comprehensively searched for studies published through June 3, 2024. Randomized controlled trials (RCTs) and cohort studies comparing sugammadex with conventional reversal agents or no reversal agents were included. Meta-analysis was performed using Stata 15.1 to synthesize the results.ResultsThe analysis ultimately included 25 studies involving a total of 163,367 patients: 84,362 received sugammadex, while 79,005 received neostigmine, or did not receive an antagonist.Meta-analysis revealed a significant reduction in the incidence of POUR with sugammadex use (Relative Risk (RR): 0.47, 95% Confidence Interval (CI): 0.34-0.64, P ConclusionThese findings suggest that sugammadex substantially reduces POUR incidence, with no significant impact on POPS or 30-day readmission rates. Further research is warranted to explore its role in diverse patient populations and surgical procedures and to investigate its potential influence on postoperative pain management and readmission rates.

Abstract licence: CC BY-NC-ND

This response addresses feedback on our systematic review and meta-analysis comparing sugammadex with neostigmine for neuromuscular block reversal. We acknowledge high heterogeneity for time-based outcomes, likely due to differences in clinical settings and anesthetic/surgical protocols, but pooled effects consistently favored sugammadex for faster and more complete reversal. We agree hypnotic depth and other perioperative factors may modify emergence and airway safety, yet these variables were inconsistently reported and could not be analyzed quantitatively. We also clarify that time outcomes were synthesized using standardized mean differences to account for different reporting units, and any presentation inconsistencies will be corrected. Overall, our findings support pharmacologic superiority of sugammadex with reductions in selected complications, while emphasizing that broader recovery quality may not uniformly improve and should be interpreted in clinical context.

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BackgroundPostoperative delirium (POD) frequently occurs in elderly surgical patients and is associated with adverse outcomes. This review aimed to evaluate whether sugammadex, a selective neuromuscular blockade reversal agent, reduces postoperative delirium-incidence (POD-I) compared with neostigmine.MethodsPubMed, EMBASE, and Cochrane CENTRAL were searched up to May 2025 for randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) comparing sugammadex and neostigmine regarding to POD-I. Primary outcome was POD-I, with subgroup analyses according to postoperative period (within 24 hours vs after postoperative 1 day) and the type of anticholinergic coadministered with neostigmine (atropine vs glycopyrrolate). Secondary outcome was perioperative changes in Mini-Mental State Examination scores (preoperative vs postoperative). Analyses were performed separately for RCTs and NRCTs using RevMan 5.4.ResultsTwelve studies (7 RCTs, n = 759; 5 NRCTs, n = 50,115) were included. In RCTs, sugammadex significantly reduced POD-I compared with neostigmine (risk ratio (RR), 0.67; 95% confidence interval (CI), 0.49-0.91; I2 = 0%; P = .008). Subgroup analysis of RCTs on POD-I within the 1st 24 hours postoperatively showed a significantly lower incidence in the sugammadex group (RR, 0.64; 95% CI, -0.45 to 0.90; P = .010). Subgroup analysis of RCTs by coadministered anticholinergics did not significantly influence POD-I (atropine: RR, 0.67; P = .06; glycopyrrolate: RR, 0.66; P = .06). In contrast, subgroup analysis of NRCTs on POD-I showed no significant difference between the groups (RR, 1.15; 95% CI, 0.88-1.50; I2 = 82%; P = .33). Preoperative and postoperative Mini-Mental State Examination scores in RCTs were similar between groups (preoperative: mean difference 0.03, P = .78; postoperative: mean difference 0.75, P = .12).ConclusionSugammadex is associated with a reduced incidence of POD compared to neostigmine, particularly within the 1st 24 hours after surgery, based on consistent findings from RCTs. This benefit was not observed in NRCTs. Further well-designed RCTs using standardized delirium assessments are required.

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