Neostigmine 2.5mg/1ml / Glycopyrronium bromide 500micrograms/1ml solution for injection ampoules

Postoperative cognitive dysfunction is a major clinical concern, particularly in elderly patients, leading to reduced quality of life and increased mortality. The impact of neuromuscular blockade reversal agents, such as sugammadex and neostigmine, on cognitive recovery remains uncertain. A systematic search of PubMed, EMBASE, and Cochrane databases identified randomized controlled trials (RCTs) and observational studies comparing sugammadex and neostigmine (± anticholinergics) for reversal of neuromuscular blockade in adults under general anesthesia for elective surgery. Studies published up to February 2025 that used the Mini-Mental State Examination (MMSE) or the cognitive domain of the Postoperative Quality Recovery Scale (PQRS) were included, as they both evaluate cognition on multiple aspects. Standardized mean differences (SMD) and standard errors (SE) were calculated, and a meta-analysis using the generic inverse variance method was performed. Heterogeneity was assessed with the I² statistic. Six RCTs and three observational studies, including 1,116 patients, were analyzed. Sugammadex was associated with better early cognitive recovery (40 to 60 minutes postoperatively) compared to neostigmine (SMD 0.20; 95% CI (0.07, 0.33); p = 0.003). No significant cognitive differences were observed immediately (≤15 minutes), on day one, or on days three to seven postoperatively. Sugammadex also improved physiological recovery at 40 minutes (RR 1.20; 95% CI (1.09, 1.30); p < 0.0001). Sensitivity analysis confirmed these findings. No differences were found in nociceptive, emotive, activities of daily living, or overall recovery domains. Sugammadex may improve early postoperative cognitive and physiological recovery over neostigmine, which could lead to a faster post-anesthesia care unit (PACU) discharge. No differences were observed at other time points or PQRS domains.

Abstract licence: CC BY

The aim of this study is to evaluate the efficacy and safety of sugammadex for reversing neuromuscular blockade in pediatric patients. MEDLINE and other three Databases were searched. Randomized clinical trials were included if they compared sugammadex with neostigmine or placebo in pediatric patients undergoing surgery involving the use of rocuronium or vecuronium. The primary outcome was the time interval from administration of reversal agents to train-of-four ratio (TOFr, T4/T1) > 0.9. Incidences of any drug-related adverse events were secondary outcomes. Trial inclusion, data extraction, and risk of bias assessment were performed independently. Mean difference and relative risk were used as summary statistics with random effects models. Statistical heterogeneity was assessed by the I2 statistic. Funnel plot was used to detect publication bias. Ten studies with 580 participants were included. Although considerable heterogeneity (I2 = 98.5%) was detected in primary outcome, the results suggested that, compared with placebo or neostigmine, sugammadex can reverse rocuronium-induced neuromuscular blockade more rapidly with lower incidence of bradycardia. No significant differences were found in the incidences of other adverse events. Compared with neostigmine or placebo, sugammadex may reverse rocuronium-induced neuromuscular blockade in pediatric patients rapidly and safely.

Abstract licence: CC BY

IntroductionReversal of non-depolarizing neuromuscular blocking agent neostigmine is associated with QT prolongation under general anesthesia. To clarify the effects of neostigmine and sugammadex on hemodynamic status, the QT interval and QT dispersion after reversal of neuromuscular blockade were evaluated with a 12-lead electrocardiogram. To exclude QT prolongation due to sevoflurane, the present study was performed under propofol anesthesia.MethodsAfter receiving approval from the ethics committee of Dokkyo Medical University Hospital, 40 patients with American Society of Anesthesiologists physical status I or II were randomly allocated to group N (n = 20) or group S (n = 20). Group N was administered neostigmine (40 μg/kg) and atropine (20 μg/kg), while Group S was administered sugammadex (4 mg/kg) for reversal of neuromuscular blockade after surgery. The changes in RR interval, QT interval (QT), corrected QT interval (QTc), QT dispersion (QTD), and corrected QT dispersion (QTcD) before and after administration of reversal agents were recorded using computerized measurements. Statistical analysis was performed using two-way analysis of variance.ResultsThe RR interval significantly decreased after reversal of the neuromuscular blockade in group N, compared with group S (p ConclusionIn the present study, a mixture of neostigmine and atropine, but not sugammadex, increased QTc and QTcD under propofol anesthesia. Thus, neostigmine may cause electrocardiogram abnormalities that could precede the development of fatal arrhythmias.

Abstract licence: CC BY-NC

Introduction: Pitted keratolysis (PK) is a superficial bacterial infection located almost exclusively on the soles. The most important predisposing factor is hyperhidrosis. PK is characterized by small, isolated or confluent, crateriform, noninflammatory pits. Maceration and malodor are the two most important signs and symptoms. The therapy of PK is very often unsatisfactory. Case Presentation: Two patients with chronic-relapsing PK were successfully treated with a cream containing 1% glycopyrronium bromide, a new topical anticholinergic with anti-hyperhidrosis action. Conclusions: Although our experience is currently based on only 2 patients, glycopyrronium bromide cream can be taken into consideration for prevention of chronic-relapsing PK.

Abstract licence: CC BY-NC 4.0