{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T20:12:33Z","timestamp":1783455153286,"version":"3.55.0"},"reference-count":13,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neostigmine is widely used to reverse nondepolarizing neuromuscular blockade in children, but the optimal dose under total intravenous anesthesia is uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The primary aim was to compare the time to full neuromuscular recovery (TOF ratio of 1.0) following administration of neostigmine at doses of 0, 10, 20, and 30\u2009\u03bcg\/kg in children at a TOF count of 3. Secondary objectives were full reversal within 10\u2009min and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective, randomized, double\u2010blind, parallel\u2010group, superiority trial enrolled 120 children (2\u201310\u2009years; ASA I\u2013II) undergoing tonsillectomy. Participants received 0, 10, 20, or 30\u2009\u03bcg\/kg neostigmine at a TOF count of 3 measured by quantitative acceleromyography. The primary outcome was the time from TOF count of 3 to full reversal (TOF ratio\u2009=\u20091.0). Secondary outcomes were the proportion of patients achieving full reversal within 10\u2009min and adverse events. Comparisons among active groups used the Kruskal\u2013Wallis test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 118 patients were analyzed. Median [IQR] time to full reversal was 20.2 [14.8\u201324.1], 14.0 [10.7\u201316.8], 11.0 [8.2\u201315.5], and 11.2 [7.9\u201314.6] min in the 0, 10, 20, and 30\u2009\u03bcg\/kg groups, respectively. Reversal was significantly slower in the control group compared with all neostigmine doses. However, there was no statistically significant difference among the active doses (Kruskal\u2013Wallis,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.33). At 10\u2009min, full reversal had occurred in 10.7%, 23.3%, 43.3%, and 33.3% of patients in the respective groups. Adverse events were uncommon, occurring in 10 of 118 patients, and consisted exclusively of transient bradycardia and tachycardia, without differences among groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>At TOF count of 3, neostigmine 10\u201330\u2009\u03bcg\/kg shortened reversal compared with no reversal, but doses above 10\u2009\u03bcg\/kg conferred no additional benefit. Quantitative monitoring remains essential, as fewer than half of patients achieved a TOF ratio of 1.0 within 10\u2009min.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registry<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/ensaiosclinicos.gov.br\/rg\/RBR-4xrx2g3\">https:\/\/ensaiosclinicos.gov.br\/rg\/RBR\u20104xrx2g3<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70216","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T12:20:21Z","timestamp":1778242821000},"page":"983-988","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Different Neostigmine Doses for Reversal of Cisatracurium\u2010Induced Neuromuscular Block in Children Under Total Intravenous Anesthesia: A Randomized Controlled Trial"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7846-2035","authenticated-orcid":false,"given":"Antonio J. M. M.","family":"Neto","sequence":"first","affiliation":[{"name":"Department of Surgery Pontifical Catholic University of S\u00e3o Paulo (PUC\u2010SP), School of Medical and Health Sciences  S\u00e3o Paulo Brazil"},{"name":"Department of Surgical Specialties and Anesthesiology S\u00e3o Paulo State University (UNESP), Medical School  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme L.","family":"Benette","sequence":"additional","affiliation":[{"name":"Department of Surgery Pontifical Catholic University of S\u00e3o Paulo (PUC\u2010SP), School of Medical and Health Sciences  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Let\u00edcia C.","family":"Siqueira","sequence":"additional","affiliation":[{"name":"Department of Surgery Pontifical Catholic University of S\u00e3o Paulo (PUC\u2010SP), School of Medical and Health Sciences  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian M.","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Surgery Pontifical Catholic University of S\u00e3o Paulo (PUC\u2010SP), School of Medical and Health Sciences  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco A. P.","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Surgery Pontifical Catholic University of S\u00e3o Paulo (PUC\u2010SP), School of Medical and Health Sciences  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo L.","family":"Alves","sequence":"additional","affiliation":[{"name":"Department of Surgical Specialties and Anesthesiology S\u00e3o Paulo State University (UNESP), Medical School  S\u00e3o Paulo Brazil"},{"name":"Department of Anesthesiology and Surgery Bahia School of Medicine, Federal University of Bahia  Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo T.","family":"Moro","sequence":"additional","affiliation":[{"name":"Department of Surgery Pontifical Catholic University of S\u00e3o Paulo (PUC\u2010SP), School of Medical and Health Sciences  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norma S. P.","family":"M\u00f3dolo","sequence":"additional","affiliation":[{"name":"Department of Surgical Specialties and Anesthesiology S\u00e3o Paulo State University (UNESP), Medical School  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13806"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004379"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.10.001"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000007296"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/77.6.710"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005872"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006511"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010110.pub2"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000002357"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.14279"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000001769"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200405000-00013"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460\u20109592.2004.01563.x"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pan.70216","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pan.70216","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pan.70216","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T19:09:44Z","timestamp":1783451384000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pan.70216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,8]]},"references-count":13,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/pan.70216"],"URL":"https:\/\/doi.org\/10.1002\/pan.70216","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,8]]},"assertion":[{"value":"2025-10-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}