Background:Cholinesterase inhibitors, such as neostigmine and edrophonium, commonly
used to reverse the residual effects of nondepolarizing neuromuscular blocking drugs at the
end of surgery are associated with a high rate of residual neuromuscular blockade (NMB). Due to
its direct mechanism of action, sugammadex is associated with rapid and predictable reversal of
deep NMB. The current analysis compares the clinical efficacy and risk of postoperative nausea
and vomiting (PONV) on using sugammadex or neostigmine for routine NMB reversal in adult and
pediatric populations.Methods:PubMed and ScienceDirect were searched as the primary databases. Randomized controlled
trials comparing sugammadex with neostigmine for routine NMB reversal in adult and pediatric
patients have been included. The primary efficacy endpoint was the time from initiation of
sugammadex or neostigmine to the recovery of a time-of-four ratio (TOF) ≥ 0.9. PONV events
have been reported as secondary outcomes.Results:A total of 26 studies have been included in this meta-analysis, 19 for adults with 1574 patients
and 7 for children with 410 patients. Sugammadex, when compared to neostigmine, has
been reported to take a shorter time to reverse NMB in adults (mean difference = -14.16 min; 95%
CI [-16.88, -11.43], P < 0.01), as well as in children (mean difference = -26.36 min; 95% CI [-
40.16, -12.57], P < 0.01). Events of PONV have been found to be similar in both the groups in
adults, but significantly lower in children treated with sugammadex, i.e., 7 out of 145 with sugammadex
versus 35 out of 145 with neostigmine (odds ratio = 0.17; 95% CI [0.07, 0.40]).Conclusion:Sugammadex is associated with a significantly shorter period of reversal from NMB
in comparison to neostigmine in adult and pediatric patients. Regarding PONV, the use of sugammadex
for NMB antagonism may offer a better option for pediatric patients.