Superiority of sugammadex in preventing postoperative pulmonary complications

Background: Postoperative pulmonary complications often lead to increased mortality and financial burden. Residual paralysis plays a critical role in postoperative pulmonary complications. This meta-analysis was performed to determine whether sugammadex overmatches neostigmine in reducing postoperative pulmonary complications. Methods: PubMed, Embase, Web of Science, Medline through Ovid, Cochrane Library, Wanfang, China National Knowledge Infrastructure, and Chinese BioMedical Literature Databases were searched from their inception to 24 June, 2021. Random effects models were used for all analyses. Cochrane risk of bias tool was used to assess the quality of RCTs, while Newcastle Ottawa Quality Assessment Scale was used to assess for the quality of cohort studies. Results: Seventeen studies were included in the meta-analysis. Pooled data from cohort studies showed reversing neuromuscular blocking with sugammadex had less risk of compound postoperative pulmonary complications (relative risk [RR]: 0.73; 95% confidence interval [CI]: 0.60-0.89; P = 0.002; I-2 = 81%), pneumonia (RR: 0.64; 95% CI: 0.48-0.86; I-2 = 42%) and respiratory failure (RR: 0.48; 95% CI: 0.41-0.56; I-2 = 0%). However, pooled data from RCTs did not show any difference between the two groups in pneumonia (RR: 0.58; 95% CI: 0.24-1.40; I-2 = 0%) and no respiratory failure was reported in the included RCTs. The difference was not found between sugammadex and neostigmine about atelectasis in pooled data from either RCTs (RR: 0.85; 95% CI: 0.69-1.05; I-2 = 0%) or cohort studies (RR: 1.01; 95% CI: 0.87-1.18; I-2 = 0%). Conclusion: The evidence of superiority of sugammadex was limited by the confounding factors in cohort studies and small scale of RCTs. Whether sugammadex precedes neostigmine in preventing pulmonary complications after surgery is still unknown. Welldesigned RCTs with large scale are needed. Registration: PROSPERO (https://www.crd.york.ac.uk/PROSPERO/); CRD 42020191575

Automated summary

This meta-analysis examined the difference between sugammadex and neostigmine in reducing postoperative pulmonary complications. The results showed that using sugammadex to reverse neuromuscular blockade can reduce the risk of compound postoperative pulmonary complications, pneumonia, and respiratory failure. However, the evidence is limited by confounding factors and small-scale randomized controlled trials.