The Efficacy and Adverse Effects of Sugammadex and Neostigmine in Reversing Neuromuscular Blockade Inpatients with Obesity Undergoing Metabolic and Bariatric Surgery: A Systematic Review with Meta-Analysis and Trial Sequential Analysis.

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  • Author(s): Wang S;Wang S; Dong Y; Dong Y; Wang S; Wang S; Han Y; Han Y; Li Q; Li Q
  • Source:
    Medicina (Kaunas, Lithuania) [Medicina (Kaunas)] 2024 Nov 08; Vol. 60 (11). Date of Electronic Publication: 2024 Nov 08.
  • Publication Type:
    Systematic Review; Journal Article; Meta-Analysis; Review
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: MDPI Country of Publication: Switzerland NLM ID: 9425208 Publication Model: Electronic Cited Medium: Internet ISSN: 1648-9144 (Electronic) Linking ISSN: 1010660X NLM ISO Abbreviation: Medicina (Kaunas) Subsets: MEDLINE
    • Publication Information:
      Publication: 2018- : Basel, Switzerland : MDPI
      Original Publication: Kaunas : Lietuvos gydytojų sąjunga
    • Subject Terms:
      Sugammadex*/therapeutic use ; Sugammadex*/administration & dosage ; Neostigmine*/therapeutic use ; Bariatric Surgery*/methods ; Bariatric Surgery*/adverse effects ; Neuromuscular Blockade*/methods ; Obesity*/complications ; Obesity*/surgery; Humans ; Inpatients/statistics & numerical data
    • Abstract:
      Background and Objectives : Metabolic and bariatric surgery (MBS) is practiced worldwide. Sugammadex was proven to have multiple benefits in reversing neuromuscular blockade (NMB) for patients with obesity undergoing MBS, but its effects on complications of various systems are not clear and concrete. Materials and Methods: This systematic review and meta-analysis was conducted as per the PRISMA guidelines and registered on the PROSPERO database (CRD42023491171). A systematic search was conducted in multiple databases for studies comparing sugammadex with neostigmine in MBS. Continuous data are reported as mean differences (MDs) and 95% confidence intervals (CIs). Dichotomous data are reported as relative risks (RRs) and 95% CIs. A two-sided p < 0.05 was considered statistically significant. Trial sequential analysis (TSA) was performed to evaluate the reliability of the conclusions. Results: Nine studies with 633 patients met the inclusion criteria. Compared with those from the neostigmine group, patients from the sugammadex group were characterized by a significantly shorter recovery time from the administration of the study drug to a train-of-four (TOF) ratio of ≥90% (MD [95% CI]: -15.40 [-26.64; -4.15]; I 2 = 96.6%; p = 0.0073; n = 380; random effects model), a lower risk of postoperative residual curarization (PORC) (RR [95% CI]: 0.18 [0.09; 0.38]; p < 0.0001; I 2 = 27.9%; n = 344; common effect model), postoperative nausea and vomiting (PONV) (RR [95% CI]: 0.67 [0.48; 0.93]; p = 0.0164; I 2 = 0%; n = 335; common effect model), and cardiovascular complications (RR [95% CI]: 0.48 [0.26; 0.88]; p = 0.0186; I 2 = 14.7%; n = 178; common effect model). TSA confirmed the conclusions regarding the recovery time and PORC risk. Conclusions: In conclusion, our systemic review and meta-analysis with TSA revealed that sugammadex provided a faster and more reliable choice to reverse NMB in patients with obesity undergoing MBS, with a lower risk of PORC. Sugammadex reduced the risk of cardiovascular complications and postoperative nausea and vomiting. However, the conclusions were not confirmed, and, so, further studies may be necessary.
      Competing Interests: The authors declare no conflicts of interest.
    • References:
      North Clin Istanb. 2022 Aug 16;9(4):311-316. (PMID: 36276569)
      Surg Obes Relat Dis. 2022 Dec;18(12):1345-1356. (PMID: 36280539)
      J Clin Epidemiol. 2008 Jan;61(1):64-75. (PMID: 18083463)
      PLoS One. 2011;6(10):e25491. (PMID: 22028777)
      Front Med (Lausanne). 2022 May 20;9:905131. (PMID: 35669920)
      BMC Med Res Methodol. 2014 Dec 19;14:135. (PMID: 25524443)
      Br J Anaesth. 2010 Nov;105(5):558-67. (PMID: 20935005)
      Dtsch Arztebl Int. 2023 Nov 17;120(46):779-785. (PMID: 37874129)
      Br J Anaesth. 2017 Jun 1;118(6):834-842. (PMID: 28575335)
      Cochrane Database Syst Rev. 2017 Aug 14;8:CD012763. (PMID: 28806470)
      Acta Anaesthesiol Scand. 2017 May;61(5):471-479. (PMID: 28374473)
      Anaesthesia. 2018 May;73(5):631-641. (PMID: 29280475)
      Anesthesiology. 2003 Jun;98(6):1333-7. (PMID: 12766640)
      BMJ Open. 2022 Feb 01;12(2):e052279. (PMID: 35105573)
      BMC Anesthesiol. 2023 May 15;23(1):163. (PMID: 37189069)
      Anaesthesia. 2023 Mar;78(3):294-302. (PMID: 36562202)
      Anesth Analg. 2007 Sep;105(3):877; author reply 878. (PMID: 17717257)
      Stat Methods Med Res. 2018 Jun;27(6):1785-1805. (PMID: 27683581)
      Eur J Pharmacol. 2014 Jan 5;722:55-66. (PMID: 24495419)
      Rom J Anaesth Intensive Care. 2017 Oct;24(2):111-114. (PMID: 29090263)
      BMJ. 2021 Mar 29;372:n71. (PMID: 33782057)
      AANA J. 2022 Apr;90(2):133-140. (PMID: 35343895)
      Anesth Analg. 2010 Jul;111(1):120-8. (PMID: 20442260)
      J Clin Epidemiol. 2009 Aug;62(8):825-830.e10. (PMID: 19136233)
      J Anesth. 2019 Feb;33(1):96-102. (PMID: 30617589)
      BMJ. 2013 Oct 22;347:f5934. (PMID: 24149519)
      Ann Saudi Med. 2018 Sep-Oct;38(5):366-375. (PMID: 30284992)
      J Int Med Res. 2022 Aug;50(8):3000605221116760. (PMID: 35983671)
      Obes Surg. 2013 Oct;23(10):1558-63. (PMID: 23519634)
      JAMA. 2020 Sep 1;324(9):879-887. (PMID: 32870301)
      Anesth Essays Res. 2021 Jan-Mar;15(1):111-118. (PMID: 34667357)
      Br J Anaesth. 2012 Feb;108(2):236-9. (PMID: 22012861)
      Anesth Analg. 2020 Aug;131(2):411-448. (PMID: 32467512)
      Surg Laparosc Endosc Percutan Tech. 2014 Oct;24(5):420-3. (PMID: 24752165)
      Br J Anaesth. 2023 Feb;130(2):133-141. (PMID: 36564246)
      BMC Cancer. 2021 May 7;21(1):513. (PMID: 33962555)
      J Appl Physiol (1985). 2010 Jan;108(1):206-11. (PMID: 19875713)
      Cochrane Database Syst Rev. 2009 Oct 07;(4):CD007362. (PMID: 19821409)
      Anesthesiology. 2012 Jul;117(1):93-8. (PMID: 22549697)
      Curr Pharm Des. 2019;25(19):2140-2148. (PMID: 31272347)
      JAMA. 2015 Jan 6;313(1):62-70. (PMID: 25562267)
      J Gastrointest Surg. 2021 Nov;25(11):2806-2813. (PMID: 33565010)
      Int J Epidemiol. 2009 Feb;38(1):287-98. (PMID: 18824466)
      Angew Chem Int Ed Engl. 2002 Jan 18;41(2):266-70. (PMID: 12491405)
      Anaesth Crit Care Pain Med. 2016 Feb;35(1):25-29. (PMID: 26597732)
      Obes Surg. 2019 Aug;29(8):2670-2677. (PMID: 31127496)
      Curr Pharm Des. 2014;20(16):2703-12. (PMID: 23886386)
      N Engl J Med. 2017 Sep 21;377(12):1143-1155. (PMID: 28930514)
    • Grant Information:
      2023YFS0135 Key Research and Development Program of Science and Technology Department of Sichuan Province; 2023ZYD0168 Sichuan Province Science and Technology Support Program
    • Contributed Indexing:
      Keywords: metabolic and bariatric surgery; reversal of neuromuscular blockade; sugammadex
    • Accession Number:
      361LPM2T56 (Sugammadex)
      3982TWQ96G (Neostigmine)
    • Publication Date:
      Date Created: 20241127 Date Completed: 20241127 Latest Revision: 20241204
    • Publication Date:
      20241204
    • Accession Number:
      PMC11596585
    • Accession Number:
      10.3390/medicina60111842
    • Accession Number:
      39597027