Sugammadex versus Neostigmine for Reversal

CA-1 · I.C.8.a I.C.8.b I.A.4.b.6

23Sources
6Kept
1Dropped

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23 candidate papers

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7 points

Dose sugammadex in the morbidly obese by corrected or total body weight, not ideal body weight: ideal body weight dosing lengthened reversal by about 56 seconds. PMID 35983671 — not confirmed against the abstract: The sentence states that dosing based on corrected body weight (CBW) is recommended, which is not stated in the abstract. It also claims ideal body weight (IBW) dosing lengthened reversal by about 56 seconds, while the abstract reports a mean difference of 55.77 seconds (95% CI 32.01, 79.53 s). The sentence implies CBW is dropped
The 2023 ASA practice guideline directs both how neuromuscular blockade is monitored and how it is antagonised, with the explicit aim of reducing residual blockade after general anaesthesia. PMID 36520073 kept
Routine sugammadex is the cheaper choice once operating-room time is valued above about $8.60 per minute; on drug and nausea costs alone the economics do not support it. PMID 32980763 kept
In patients over 70 having surgery of three hours or more, sugammadex cut residual paralysis in recovery from 49% to 10% versus neostigmine, without a significant difference in postoperative pulmonary complications. PMID 32139135 kept
Across 45,712 matched inpatients, sugammadex was associated with a 30% lower risk of major pulmonary complications, a 47% lower risk of pneumonia and a 55% lower risk of respiratory failure than neostigmine. PMID 32282427 kept
Sugammadex can fail in myasthenia gravis — 800 mg left the train-of-four ratio stuck at 60% until neostigmine was given — so monitor the block rather than assuming reversal. PMID 31421671 kept
Pooled against neostigmine, sugammadex lowered pneumonia, atelectasis, non-invasive ventilation and reintubation, while the rate of desaturation was no different between the two. PMID 37081384 kept

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