{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:43:11Z","timestamp":1791855791487,"version":"4.3.4"},"reference-count":76,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T00:00:00Z","timestamp":1514332800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    We compared the efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. Our outcomes were: recovery time from second twitch to train\u2010of\u2010four ratio &gt;\u00a00.9; recovery time from post\u2010tetanic count 1\u20135 to train\u2010of\u2010four ratio &gt;\u00a00.9; and risk of composite adverse and serious adverse events. We searched for randomised clinical trials irrespective of publication status and date, blinding status, outcomes reported or language. We included 41 studies with 4206 participants. Time to reversal of neuromuscular blockade from second twitch to a train\u2010of\u2010four ratio &gt;\u00a00.9 was 2.0\u00a0min with sugammadex 2\u00a0mg.kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    and 12.9\u00a0min with neostigmine 0.05\u00a0mg.kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    , with a mean difference (MD) (95%CI)) of 10.2 (8.5\u201312.0) (I\n                    <jats:sup>2<\/jats:sup>\n                    \u00a0=\u00a084%, 10 studies, n\u00a0=\u00a0835, Grades of Recommendation, Assessment, Development and Evaluation (GRADE): moderate quality). Time to reversal of neuromuscular blockade from a post\u2010tetanic count of 1\u20135 to a train\u2010of\u2010four ratio &gt;\u00a00.9 was 2.9\u00a0min with sugammadex 4\u00a0mg.kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    and 48.8\u00a0min with neostigmine 0.07\u00a0mg.kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    , with a\n                    <jats:styled-content style=\"fixed-case\">MD<\/jats:styled-content>\n                    (95%CI) of 45.8 (39.4\u201352.2) (I\n                    <jats:sup>2<\/jats:sup>\n                    \u00a0=\u00a00%, 2 studies, n\u00a0=\u00a0114,\n                    <jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content>\n                    : low quality). There were significantly fewer composite adverse events in the sugammadex group compared with neostigmine, with a risk ratio (95%CI) of 0.60 (0.49\u20130.74) (I\n                    <jats:sup>2<\/jats:sup>\n                    \u00a0=\u00a040%, 28 studies, n\u00a0=\u00a02298, number needed to treat (NNT): 8,\n                    <jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content>\n                    : moderate quality). Specifically, the risk of bradycardia (\n                    <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\n                    (95%CI) 0.16 (0.07\u20130.34), n\u00a0=\u00a01218, NNT: 14,\n                    <jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content>\n                    : moderate quality), postoperative nausea and vomiting (\n                    <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\n                    (95%CI) 0.52 (0.28\u20130.97), n\u00a0=\u00a0389, NNT: 16,\n                    <jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content>\n                    : low quality) and overall signs of postoperative residual paralysis (\n                    <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\n                    (95%CI) 0.40 (0.28\u20130.57), n\u00a0=\u00a01474, NNT: 13,\n                    <jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content>\n                    : moderate quality) were all reduced. There was no significant difference regarding the risk of serious adverse events (\n                    <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\n                    0.54, 95%CI 0.13\u20132.25, I\n                    <jats:sup>2<\/jats:sup>\n                    \u00a0=\u00a00%, n\u00a0=\u00a0959,\n                    <jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content>\n                    : low quality). Sugammadex reverses neuromuscular blockade more rapidly than neostigmine and is associated with fewer adverse events.\n                  <\/jats:p>","DOI":"10.1111\/anae.14160","type":"journal-article","created":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T06:49:27Z","timestamp":1514357367000},"page":"631-641","source":"Crossref","is-referenced-by-count":130,"title":["The comparative efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. A Cochrane systematic review with meta\u2010analysis and trial sequential analysis"],"prefix":"10.1111","volume":"73","author":[{"given":"A.\u2010M.","family":"Hristovska","sequence":"first","affiliation":[{"name":"Department of Pediatric and Obstetric Anaesthesia Juliane Marie Centre Copenhagen University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Duch","sequence":"additional","affiliation":[{"name":"Department of Neuroanaesthesia Juliane Marie Centre Copenhagen University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Allingstrup","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Obstetric Anaesthesia Juliane Marie Centre Copenhagen University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Afshari","sequence":"additional","affiliation":[{"name":"Department of Pediatric and 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