Sugammadex versus neostigmine for neuromuscular blockade reversal after surgery in pediatric patients: a systematic review and meta-analysis of randomized clinical trials
Abstract
Background & objective: The use of muscle relaxants is a routine in most of the pediatric surgeries. At the end of the surgery, the residual effect of the muscle relaxants needs to be reversed. In most of the countries the reversal agents used are neostigmine plus atropine. In the previous few decades sugammadex has been introduced for this purpose. We reviewed the available research regarding efficacy and safety of sugammadex compared with neostigmine in reversing rocuronium-induced neuromuscular blockade (NMB) among pediatric patients.
Methodology: Using specific keywords, we comprehensively went through the potential articles, comparing efficacy and safety of sugammadex with neostigmine in reversing rocuronium-induced neuromuscular blockade (NMB) among pediatric patients. We searched Europe PMC, Cochrane Library, Scopus, Medline, and ClinicalTrials.gov sources until September 22, 2022. Outcomes were expressed in risk ratio (RR) and mean difference (MD).
Results: A total of 17 randomized controlled trials (RCTs) were included. Our pooled analysis revealed that the use of sugammadex as NMB agent in pediatric population was associated with faster time to reach train of four (TOF) > 0.9 [MD -10.32 min (95% CI -12.42, -8.23), P < 0.00001] and shorter time of extubation [MD -9.40 min (95% CI -11.84, -6.96), P < 0.00001] compared with neostigmine + atropine. Regarding safety, incidence of post-operative nausea vomiting (PONV) [RR 0.44 (95% CI 0.25 – 0.78), P = 0.005] and tachycardia [RR 0.13 (95% CI 0.04 – 0.42), P = 0.0006] was significantly lower among children receiving sugammadex than those who received neostigmine + atropine. Incidence of other adverse events did not differ significantly between the two groups.
Conclusions: Based upon the results of our research, we conclude that sugammadex possesses higher efficacy and better safety than neostigmine to reverse rocuronium-induced NMB among pediatric populations.
Abbreviations: NMB: neuromuscular blockade, NMBA: neuromuscular blocking agents, PMC: PubMed Central, RCT: randomized controlled trial, TOF: train of four
Keywords: Sugammadex; Neostigmine; Neuromuscular Blockade; Pediatric; Meta-Analysis
Citation: Waren K, Fuadi I, Lestari AP. Sugammadex versus neostigmine for neuromuscular blockade reversal after surgery in pediatric patients: a systematic review and meta-analysis of randomized clinical trials. Anaesth. pain intensive care 2025;29(5):393-404. DOI: 10.35975/apic.v29i5.2869
Received: May 09, 2024; Revised: October 26, 2024; Accepted: January 01, 2025
