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To date, the duration of neuromuscular blocking agent effect in children has not been analyzed in a quantitative review. The current meta\u2010analysis aimed to compare spontaneous recovery following administration of various types and doses of neuromuscular blocking agents and to quantify the effect of prognostic variables associated with the recovery time in pediatric patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared the time to 25% T1 (t25), from 25% to 75% T1 (RI25\u201375), and to \u226590% train\u2010of\u2010four (tTOF90) neuromuscular recovery between common neuromuscular blocking agent treatments administered as a single bolus to healthy pediatric participants. We compared spontaneous t25, RI25\u201075, and tTOF90 between (1) neuromuscular blocking agent treatments and (2) age groups receiving a given neuromuscular blocking agent intervention and anesthesia technique. Bayesian random\u2010effects network and pairwise meta\u2010analyses along with meta\u2010regression were used to evaluate the results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We used data from 71 randomized controlled trials\/controlled clinical trials including 4319 participants. Network meta\u2010analysis allowed for the juxtaposition and ranking of spontaneous t25, RI25\u201075, and tTOF90 following common neuromuscular blocking agent interventions. For all neuromuscular blocking agents a log\u2010linear relationship between dose and duration of action was found. With the neuromuscular blocking agent treatments studied, the average tTOF90 (mean[CrI95]) in children (&gt;2\u201311\u2009y) was 41.96 [14.35, 69.50] and 17.06 [5.99, 28.30] min shorter than in neonates (&lt;28\u2009d) and infants (28\u2009d\u201312\u2009M), respectively. We found a negative log\u2010linear correlation between age and duration of neuromuscular blocking agent effect. The difference in the tTOF90 (mean[CrI95]) between children and other age groups increased by 21.66 [8.82, 34.53] min with the use of aminosteroid neuromuscular blocking agents and by 24.73 [7.92, 41.43] min with the addition of sevoflurane\/isoflurane for anesthesia maintenance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The times to neuromuscular recovery are highly variable. These can decrease significantly with age and are prolonged when volatile anesthetics are administered. This variability, combined with the short duration of many pediatric surgical procedures, makes quantitative neuromuscular monitoring mandatory even after a single dose of neuromuscular blocking agent.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14908","type":"journal-article","created":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T06:50:27Z","timestamp":1714200627000},"page":"720-733","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta\u2010analytic and meta\u2010regression approach"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4541-5037","authenticated-orcid":false,"given":"Luc E.","family":"Vanlinthout","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques J.","family":"Driessen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3714-7447","authenticated-orcid":false,"given":"Robert Jan","family":"Stolker","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3747-6905","authenticated-orcid":false,"given":"Emmanuel M.","family":"Lesaffre","sequence":"additional","affiliation":[{"name":"Interuniversity Institute for Biostatistics and statistical Bioinformatics, Universities of Leuven\u2010Hasselt  Hasselt Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3835-562X","authenticated-orcid":false,"given":"Johan M.","family":"Berghmans","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative medicine University of Ghent  Ghent Belgium"},{"name":"Department of Basic and Applied Medical Sciences University of Ghent  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7867-971X","authenticated-orcid":false,"given":"Lonneke M.","family":"Staals","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,26]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"1","volume-title":"Muscle Relaxants: Monographs in Anesthesiology. 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