{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T15:16:57Z","timestamp":1777303017272,"version":"3.51.4"},"reference-count":30,"publisher":"The Korean Society of Anesthesiologists","issue":"4","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Korean Society of Anesthesiologists","award":["KSA-2022-001"],"award-info":[{"award-number":["KSA-2022-001"]}]}],"content-domain":{"domain":["anesth-pain-med.org"],"crossmark-restriction":true},"short-container-title":["Anesth Pain Med"],"published-print":{"date-parts":[[2025,10,31]]},"abstract":"<jats:p>Background: The effects of sugammadex, which reverses neuromuscular blockade, on emergence-related respiratory events in children remains unclear. This study compared the respiratory outcomes of sugammadex and neostigmine in pediatric tonsillectomy.Methods: Children aged 2 years to 6 years old undergoing tonsillectomy were randomly assigned to sugammadex or neostigmine groups. The primary outcome was the occurrence of respiratory adverse events, including oxygen desaturation &lt; 95%, airway obstruction, laryngospasm, bronchospasm, severe coughing, or postoperative stridor. Secondary outcomes included bradycardia, allergic reactions, and emergence delirium.Results: The study included 172 pediatric patients (n = 86 per group). Neuromuscular blockade reversal was faster in the sugammadex group than in the neostigmine group, achieving a train-of-four ratio of 90% in a median of 1 min vs. 4 min in the neostigmine group (P &lt; 0.001). The time to extubation was comparable between the two groups (median, 8 min; P = 0.679), as was the overall incidence of respiratory adverse events (29.0% vs. 30.2%; relative risk, 0.962; 95% confidence interval [CI], 0.607\u20131.524; P = 0.858). Emergence delirium occurred in 27.9% of patients overall, but the incidence was higher in the sugammadex group than in the neostigmine group (34.9% vs. 20.9%; relative risk, 1.214; 95% CI, 1.005\u20131.467; P = 0.044).Conclusions: Sugammadex provides significantly faster neuromuscular blockade reversal compared to neostigmine but does not shorten the time to extubation or reduce the incidence of emergence-related respiratory adverse events in children undergoing tonsillectomy. Moreover, its use may be associated with an increased risk of emergence delirium.<\/jats:p>","DOI":"10.17085\/apm.25315","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T05:31:01Z","timestamp":1761888661000},"page":"406-414","update-policy":"https:\/\/doi.org\/10.17085\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sugammadex and emergence-related respiratory adverse events in pediatric tonsillectomy: a randomized controlled trial"],"prefix":"10.17085","volume":"20","author":[{"given":"Sang-Hwan","family":"Ji","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pyoyoon","family":"Kang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung-bin","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young-Eun","family":"Jang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji-Hyun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin-Tae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hee-Soo","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eun-Hee","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2573","reference":[{"key":"ref1","first-page":"1","volume-title":"Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010","author":"Hall","year":"2017"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000006355"},{"key":"ref3","first-page":"529","volume-title":"The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing adenotonsillectomy: a randomised controlled trial","author":"von Ungern-Sternberg","year":"2013"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjae.2023.10.005"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen176"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1097\/aln.0b013e3181f70f3d"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14386"},{"key":"ref8","first-page":"1371","volume-title":"Sugammadex versus neostigmine for reversal of neuromuscular blockade and postoperative pulmonary complications (STRONGER): a multicenter matched cohort analysis","author":"Kheterpal","year":"2020"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000005294"},{"key":"ref10","first-page":"e148","volume-title":"Multicenter Perioperative Outcomes Group (MPOG) Perioperative Clinical Research Committee. 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