{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T07:08:24Z","timestamp":1785308904689,"version":"3.55.0"},"reference-count":35,"publisher":"The Korean Society of Anesthesiologists","issue":"3","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["anesth-pain-med.org"],"crossmark-restriction":true},"short-container-title":["Anesth Pain Med"],"published-print":{"date-parts":[[2026,7,31]]},"abstract":"<jats:p>Background: Sugammadex has recently been approved globally for use in pediatric patients aged \u2265 2 years. This meta-analysis with trial sequential analysis (TSA) evaluated the efficacy and safety of sugammadex for reversal of neuromuscular blockade (NMB) in pediatric patients.Methods: PubMed, EMBASE, the Cochrane Library, Web of Science, Scopus, KoreaMed, and ClinicalTrials.gov were searched from inception to December 31, 2023. Randomized controlled trials (RCTs) evaluating sugammadex in pediatric patients were included. Efficacy outcomes were time to recovery to a train-of-four (TOF) ratio \u2265 0.9 and extubation time. Safety outcomes included overall post-anesthetic adverse events, bradycardia, tachycardia, postoperative nausea and vomiting (PONV), recurarization, and desaturation. Data were analyzed using RevMan, and TSA was performed using Copenhagen Trial Unit software.Results: A total of 21 RCTs (n=1,394 pediatric patients) were included in the study. Time to TOF ratio \u2265 0.9 was significantly shorter with sugammadex than with control (neostigmine or placebo) for both 2 mg\/kg (mean difference [95% confidence interval], \u20136.03 [\u20137.85 to \u20134.21] min) and 4 mg\/kg (\u201330.06 [\u201337.58 to \u201322.55] min). The extubation time was shorter with sugammadex (\u201314.26 [\u201317.22 to \u201311.30] min). The TSA for both efficacy outcomes indicated that the required information size had been reached, suggesting that additional trials are unlikely to change the efficacy conclusions. PONV, tachycardia, and desaturation occurred less frequently with sugammadex, whereas the overall post-anesthetic adverse events, recurarization, and bradycardia were comparable.Conclusions: Sugammadex was associated with faster and more effective reversal of rocuronium-induced NMB in pediatric patients.<\/jats:p>","DOI":"10.17085\/apm.25488","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T07:39:01Z","timestamp":1784619541000},"page":"375-390","update-policy":"https:\/\/doi.org\/10.17085\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of sugammadex for reversal of neuromuscular blockade in pediatric patients: an updated systematic review and meta-analysis of randomized controlled trials with trial sequential analysis"],"prefix":"10.17085","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0383-9126","authenticated-orcid":true,"given":"Hyosung","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3302-1831","authenticated-orcid":true,"given":"Byung Gun","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8551-979X","authenticated-orcid":true,"given":"Young Sung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7649-4151","authenticated-orcid":true,"given":"Seok Woo","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5693-3788","authenticated-orcid":true,"given":"Jisung","family":"Bae","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2573","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjp.0706404"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14160"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.2147\/CE.S35675"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1705133"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000005842"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2017.05.004"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1111\/aas.12868"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-022-03288-0"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.4103\/aer.aer_139_21"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcorm.2021.100224"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000004678"},{"key":"ref12","volume-title":"Cochrane handbook for systematic reviews of interventions. Version 6.3. Cochrane [Internet]","author":"Higgins","year":"2022"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-5-13"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1177\/0145445516673998"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.17085\/apm.21038"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1127932"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-32730-1"},{"key":"ref19","first-page":"ii308","volume-title":"Efficacy and safety of the reversal with sugammadex in deep neuromuscular blockade induced by rocuronium in pediatrics","author":"Gaona","year":"2012"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2020.110180"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.egja.2016.08.021"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1080\/11101849.2023.2171541"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.4103\/1658-354x.154696"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.4274\/haseki.3091"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.26452\/ijrps.v11i2.2335"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjane.2014.03.001"},{"key":"ref27","volume-title":"Effect of sugammadex vs. neostigmine\/glycopyrrolate on pediatric emergence delirium in sevoflurane-rocuronium anesthesia. ClinicalTrials.gov [Internet]","author":"Kim","year":"2020"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.15537\/smj.2019.9.24485"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2020.08.069"},{"key":"ref30","first-page":"329","volume-title":"Abstract PR253: Comparison between the efficacy of neostigmine versus sugammadex for reversal of rocuronium induced neuromuscular blockade in paediatric patients","author":"Mohamad Zaini","year":"2016"},{"key":"ref31","first-page":"762","volume-title":"Comparison of reversal and adverse effects of sugammadex and combination of - anticholinergic-anticholinesterase agents in pediatric patients","author":"Ozg\u00fcn","year":"2014"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1097\/aln.0b013e318194caaa"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1097\/00003643-201106001-00490"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14370"},{"key":"ref35","first-page":"546","volume-title":"Comparison of sugammadex versus neostigmine in reducing respiratory complications after extubation in children with adenotonsillectomy","author":"Zhen","year":"2022"}],"container-title":["Anesthesia and Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/anesth-pain-med.org\/upload\/pdf\/apm-25488.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/anesth-pain-med.org\/journal\/view.php?doi=10.17085\/apm.25488","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/anesth-pain-med.org\/upload\/pdf\/apm-25488.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:50:18Z","timestamp":1785307818000},"score":1,"resource":{"primary":{"URL":"http:\/\/anesth-pain-med.org\/journal\/view.php?doi=10.17085\/apm.25488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"URL":"https:\/\/doi.org\/10.17085\/apm.25488","relation":{},"ISSN":["1975-5171","2383-7977"],"issn-type":[{"value":"1975-5171","type":"print"},{"value":"2383-7977","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"assertion":[{"value":"2025-12-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-21","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-31","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}