Sugammadex 200mg/2ml solution for injection vials

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

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.

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BackgroundPostoperative pulmonary complications (PPCs) remain common after video-assisted thoracoscopic (VATS) lung surgery. Whether sugammadex reduces the incidence of PPCs compared with traditional antagonists remains uncertain. This meta-analysis aimed to evaluate the impact of sugammadex on PPCs in patients undergoing VATS pulmonary resection.MethodsThis meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). PubMed, Web of Science, Cochrane Library, and CNKI were searched from inception to December 13, 2024. Randomized controlled trials (RCTs) and cohort studies comparing sugammadex with other antagonists (e.g., neostigmine or pyridostigmine) in patients undergoing VATS pulmonary resection were included. The primary outcome was overall PPCs. Risk of bias was assessed using the Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa Scale (NOS) for cohort studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using fixed- or random-effects models according to heterogeneity.ResultsNine studies involving 2,240 patients were included, of which eight reported data on overall PPCs and were included in the primary meta-analysis. Sugammadex significantly reduced the incidence of overall PPCs compared with control agents (OR = 0.68, 95% CI: 0.58-0.80, P ConclusionsSugammadex may effectively reduce the risk of PPCs, particularly atelectasis, in patients undergoing VATS pulmonary resection. Further large-scale, high-quality studies are warranted.

Abstract licence: CC BY