1. Postoperative pulmonary complications after sugammadex reversal of neuromuscular blockade: a systematic review and meta-analysis with trial sequential analysis.
- Author
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Liu, Hong-Mei, Yu, Hong, Zuo, Yi-Ding, and Liang, Peng
- Subjects
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RESPIRATORY disease prevention , *PNEUMONIA prevention , *ONLINE information services , *MEDICAL databases , *PARASYMPATHOMIMETIC agents , *META-analysis , *MEDICAL information storage & retrieval systems , *CONFIDENCE intervals , *PLEURAL effusions , *PROSTATECTOMY , *SYSTEMATIC reviews , *SURGICAL robots , *CHOLINESTERASE inhibitors , *ASPIRATION pneumonia , *LAPAROSCOPIC surgery , *DISEASE incidence , *SURGICAL complications , *NEUROMUSCULAR blockade , *ARTIFICIAL respiration , *RESPIRATORY obstructions , *DESCRIPTIVE statistics , *SLEEP apnea syndromes , *MEDLINE , *DATA analysis software , *ODDS ratio , *ATELECTASIS , *VIDEO-assisted thoracic surgery , *SUGAMMADEX , *PNEUMOTHORAX ,PREVENTION of surgical complications - Abstract
Background: Sugammadex has been reported to lower the incidence of postoperative residual neuromuscular blockade. Despite the advantages, until recently the effects of sugammadex on postoperative pulmonary complications (PPCs) were controversial. We conducted a systematic review and meta-analysis to determine whether reversal with sugammadex was associated with a lower risk of PPCs compared with neostigmine. Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to May 2022. Randomized controlled trials (RCTs) and observational studies comparing PPCs in patients receiving sugammadex or neostigmine as reversal agent at the end of surgery were included. The primary outcomes focused on PPCs including desaturation, pneumonia, atelectasis, noninvasive ventilation (NIV) and reintubation. Trial sequential analysis was performed on the primary outcomes to confirm whether firm evidence was reached. Results: Meta-analysis of included studies showed that the rate of desaturation (43.2% vs 45.0%, RR = 0.82; 95% CI 0.63 to 1.05; p = 0.11) were comparable between the two groups. When looking at other primary outcomes, significantly lower risk of pneumonia (1.37% vs 2.45%, RR = 0.65; 95% CI 0.49 to 0.85; p = 0.002), atelectasis (24.6% vs 30.4%, RR = 0.64; 95% CI 0.42 to 0.98; p = 0.04), NIV (1.37% vs 2.33%, RR = 0.65; 95% CI 0.43 to 0.98; p = 0.04) and reintubation (0.99% vs 1.65%, RR = 0.62; 95% CI 0.43 to 0.91; p = 0.01) in the sugammadex group were detected compared with the neostigmine group. Conclusions: We concluded that sugammadex is more effective at reducing the incidence of PPCs including pneumonia, atelectasis, NIV and reintubation compared with neostigmine. Further evidence, preferably from RCTs, is required to confirm these findings. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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