Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults

Abstract

Review results suggest that in comparison with neostigmine, sugammadex can more rapidly reverse rocuronium-induced neuromuscular block regardless of the depth of the block. Sugammadex 2 mg/kg is 10.22 minutes (˜ 6.6 times) faster in reversing moderate neuromuscular blockade (T2) than neostigmine 0.05 mg/kg (GRADE: moderate quality), and sugammadex 4 mg/kg is 45.78 minutes (˜ 16.8 times) faster in reversing deep neuromuscular blockade (PTC 1 to 5) than neostigmine 0.07 mg/kg (GRADE: low quality). With an NNTB of 8 to avoid an adverse event, sugammadex appears to have a better safety profile than neostigmine. Patients receiving sugammadex had 40% fewer adverse events compared with those given neostigmine. Specifically, risks of bradycardia (RR 0.16, NNTB 14; GRADE: moderate quality), PONV (RR 0.52, NNTB 16; GRADE: low quality), and overall signs of postoperative residual paralysis (RR 0.40, NNTB 13; GRADE: moderate quality) were reduced. Both sugammadex and neostigmine were associated with serious adverse events in less than 1% of patients, and data showed no differences in risk of serious adverse events between groups (RR 0.54; GRADE: low quality).

Neuromuscular Block and Blocking Agents in 2018

“…Geometric mean times of recovery were less variable with sugammadex (2.0 min; range: 1.0-8.3 min) than with neostigmine (12.9 min; range: 3.7-106 min). Just 11% of neostigmine recipients reached a TOFR of 0.9 within 5 min in contrast to 98% of sugammadex recipients (55)(56)(57). Surprisingly sugammadex reversing a vecuronium-induced moderate neuromuscular blockade had a wider range of neuromuscular recovery from 1.2 to 64.2 min (32).…”

“…The main advantage of sugammadex compared to anticholinesterase inhibitors is its fast recovery time and its unique ability to reverse every level of NMB rapidly and effectively (55,67). This might be beneficial in situations, where deep neuromuscular blockade is required like in precision procedures, where unexspected movements might be deleterious (robot-guided procedures, neurosurgery, vocal cord and eye laser surgery) or in interventions where maximal muscle relaxation might improve operating conditions, like in laparscopic surgery (68).…”

“…This might be beneficial in situations, where deep neuromuscular blockade is required like in precision procedures, where unexspected movements might be deleterious (robot-guided procedures, neurosurgery, vocal cord and eye laser surgery) or in interventions where maximal muscle relaxation might improve operating conditions, like in laparscopic surgery (68). Meta-analysis identified fewer composite adverse events in using sugammadex compared to neostigmine (risk ratio [RR]: 0.6), with a number needed to treat (NNT) of 8 in order to prevent adverse events as follows (55,67): Bradycardia (RR: 0.16; NNT: 14), postoperative nausea and vomiting (RR: 0.52; NNT: 16), risk of overall signs of PORC (headlift-test, general muscle weakness, amblyopia, oxygen desaturation, POPCs) (RR: 0.40; NNT: 13) (55). Patients recieving sugammadex had 40% fewer adverse events compared to those who recieved neostigmine (55).…”

“…Meta-analysis identified fewer composite adverse events in using sugammadex compared to neostigmine (risk ratio [RR]: 0.6), with a number needed to treat (NNT) of 8 in order to prevent adverse events as follows (55,67): Bradycardia (RR: 0.16; NNT: 14), postoperative nausea and vomiting (RR: 0.52; NNT: 16), risk of overall signs of PORC (headlift-test, general muscle weakness, amblyopia, oxygen desaturation, POPCs) (RR: 0.40; NNT: 13) (55). Patients recieving sugammadex had 40% fewer adverse events compared to those who recieved neostigmine (55). Both were associated with serious adverse events in less than 1% of patients.…”

CARDIAC ARREST IN A POSTOPERATIVE CARE UNIT. LITERATURE REVIEW OF PULMONARY PERIOPERATIVE CRITICAL SITUATIONS - Paro cardiaco en unidad de cuidado postoperatorio. Revisión de la literaturade situaciones críticas pulmonares preoperatorias.

“…Dado que la plena reversión de intensos niveles de BNM pueden requerir 30 minutos, los anticolinesterásicos deben utilizarse al menos 15-30 min antes de la hora prevista de la extubación traqueal, es decir, cuando la relajación muscular ya no es necesaria en lugar de al finalizar el procedimiento. Sin embargo, resulta significativo tener en cuenta que los diferentes estudios han publicado resultados que indican una reversión del BNM más rápida con sugammadex independientemente de la profundidad del bloqueo (menos de 3 minutos) (53)(54)(55)(56) , por lo que este paso solo aplicaría al momento de usar anticolinesterásico.…”