BACKGROUND： It has been previously shown that intrathecal administration of either ouabain or neosdgmine can produce antinociceptive effects. Moreover, ouabain and neostigmine are differently associated with acetylch...BACKGROUND： It has been previously shown that intrathecal administration of either ouabain or neosdgmine can produce antinociceptive effects. Moreover, ouabain and neostigmine are differently associated with acetylcholine. OBJECTIVE： It has been hypothesized that intrathecal administration of ouabain, in combination with neostigmine, can produce antinociceptive synergistic effects. Atropine, as a competitive antagonist, was pre-injected to verify the mechanisms of action. DESIGN, TIME AND SETTING： This study was a randomized, controlled, animal experiment, performed at the State Key Laboratory of Oncology in Southern China between May 2006 and February 2007. MATERIALS： A total of 102 healthy, adult, Sprague Dawley rats were included. Ouabain and neostigmine （Sigma, USA）, as well as atropine （Tanabe Seiyaku, Japan）, were also used. METHODS： Varied doses of ouabain, neostigmine, and a combination of the two were intrathecally injected into rats. Six rats were allotted for each dose group. Intrathecal pretreatment with atropine was tested 10 minutes prior to intrathecal administration of neostigmine or the combination of ouabain and neostigmine. MAIN OUTCOME MEASURES： Tail-flick tests were performed to measure tail-flick latency （seconds） prior to and after administration. The response in the tail-flick test was expressed as the percentage of maximum possible effect （% MPE）, where % MPE = [tail-flick latency after administration （seconds） -mean baseline value for tail-flick latency]/[ 10 seconds - the mean baseline value for tail-flick latency （seconds）] x 100%. RESULTS： Rat spinal intrathecal administration of either ouabain or neostigmine alone produced antinociceptive effects in a dose-dependent manner. Intrathecally administration of neostigmine （0.05, 0.1, 0.3 μg ） in combination with ouabain （1 μ g ） produced enhanced antinociceptive effects, with a % MPE of 29%, 78%, and 95%, respectively （P 〈 0.05）. Intrathecally administration of 0.3μg neostigmine （% MPE： 45%）, in combination with 1 μ g ouabain （% MPE： 27%） produced potent antinociceptive effects （% MPE： 95%）. Intrathecally pre-injected atropine antagonized the antinociceptive effects of neostigmine （3 μg）, or a combination of ouabain （1 μg） and neostigmine （0.3 μg） （P 〈 0.01）. CONCLUSION： Rat spinal intrathecal administration of either ouabain or neostigmine alone produced dose-dependent andnociceptive effects. Ouabain enhanced the antinociceptive effects of neostigmine. Atropine antagonized the antinociceptive effects of neostigmine or the combination of ouabain and neostigmine. This occurs possibly due to the fact that atropine is a competitive antagonist of the muscarinic acetylcboline receptors.展开更多
Background: Anesthesiologists are responsible for the development of pain services in the current era. Hence ideal adjuvants that can be used with bupivacaine for stable intraoperative conditions and prolonging the po...Background: Anesthesiologists are responsible for the development of pain services in the current era. Hence ideal adjuvants that can be used with bupivacaine for stable intraoperative conditions and prolonging the postoperative analgesia with fewer side effects are being investigated. Opioids, despite useful as adjuvants, are associated with undesirable side effects. Aim of the work: The study was done to compare analgesic efficacy and hemodynamic of intrathecal injection of bupivacaine alone or with fentanyl, clonidine, and neostigmine in lower abdominal surgeries, over the first 24 postoperative hours, in a randomized, double-blind, and clinical trial. Methods: 100 Patients were randomized into four equal groups, 25 patients in each group;Group B patients received 2.5 ml of 0.5% hyperbaric bupivacaine and 0.5 ml of normal saline. Group BF patients received 2.5 ml of 0.5% hyperbaric bupivacaine with (25 mics) of fentanyl. Group BC patients received 2.5 ml of 0.5% hyperbaric bupivacaine with 0.5 ml (75 mics) of clonidine. Group BN patients received 2.5 ml of 0.5% hyperbaric bupivacaine with 0.1 ml of neostigmine (50 mics) and 0.4 ml of normal saline. Intrathecal anesthesia was done with a recording of parameters intraoperative and the post-operative period. Each patient was assessed for hemodynamic parameters and effective analgesia in operation, and presence of complications (nausea, vomiting, sedation and pruritus) visual analogue pain score (VAS) postoperatively by a blinded investigator in the post-anesthesia care unit (PACU) and at 1, 2, 3, 4, 8 12, 18 and 24 h postoperatively. Results: The postoperative analgesia is more effective with group BC (the gold standard) than group B, group BF, and group BN. As regard complications during the study in all groups, complications as nausea, and vomiting were mainly with group BN;hypotension was primarily in group BC. Conclusion: Bupivacaine clonidine, bupivacaine neostigmine, and bupivacaine fentanyl intrathecal anesthesia produced a longer duration of postoperative analgesia after lower abdominal surgery in patients than bupivacaine alone. Bupivacaine clonidine mixture had the most extended period of analgesia, but with hypotension. So bupivacaine fentanyl mixture with moderate duration of analgesia and minimal side effects is most safe for a patient.展开更多
With the introduction of the rocuronium and vecuronium binding agent sugammadex into clinical practice in the United States, its use for reversal of neuromuscular blockade will likely start in some institutions as a ...With the introduction of the rocuronium and vecuronium binding agent sugammadex into clinical practice in the United States, its use for reversal of neuromuscular blockade will likely start in some institutions as a “rescue” after failed reversal with neostigmine. However, sugammadex after neostigmine has not been extensively studied. Therefore, there is a question as to its effectiveness when used in this way especially in the airway compromised patients that the anesthesia provider will commonly face in this situation. Furthermore, there is a possibility of hemodynamic compromise. These two case reports demonstrate the safe and effective use of sugammadex after failed reversal with neostigmine.展开更多
To compare the analgesic and side effects of post-operative analgesia between epidural administration ofneostigmine (NEO) and morphine (MOR) or their combination in patients undergoing abdominal surgery. Methods: One ...To compare the analgesic and side effects of post-operative analgesia between epidural administration ofneostigmine (NEO) and morphine (MOR) or their combination in patients undergoing abdominal surgery. Methods: One hundredand two selective patients undergoing surgery were randomly divided into five groups at the end of the surgical procedure. GroupN1 (n=11) and Group N2(n =15) were administered epidurally with NEO 1 mg and 2 mg respectively, Group M1 (n=18)and Group M2 (n=55) were administered epidurally with MOR 1 mg and 2 mg respectively, Group M1 + N1 (n=17) was administered epidurally with the combination of MOR 1 mg and NEO 1 mg. Results: Single dose epidural administration of NEO (1mg and 2 mg) or MOR (1 mg and 2 mg) showed dose-dependent analgesic effects. The analgesic duration in Group N1 (4.7 ± 2.7 h) was significantly shorter than other four groups (P<0. 01). Group M1, M2 and M1 + N1 showed better analgesic effectsthan group N1 and N2 (16.1±8.7h) , with similar analgesic durations in Group M1, M2 and M1 + N1. me percentages of excellent, good and poor effects were 0%, 54.5 % and 45.5 % respectively in Group N1. The percentages of excellent and good effects were 100% in Group M2 and M1 + N1, but 83.3% in Group N2. The time to first use analgesic medication was similar inGroup M1, M2 and M1 + N1, but longer compared with Croup N1 and N2. The incidences of nausea and vomiting closelyresem-bled one another in Croup N1, N2 and M1 + N1, which were less than those in Group M1 and M2. The incidence of urinary retention was 51.2%, 25.0% and 31.3% in Group M2, M1 and M1 + N1, respectively, but 0% in Group N1 and N2. In GroupN2 two patients opened the bowel movement and one patient developed bradycardia (58 beats/min) at 45 min after receiving NEO.Conclusion: Epidural administration of NEO produces dose-dependent prolonged analgesic effects (similar to MOR) and the combination of MOR and NEO could produce analgesia with fewer side effects than administration of equivalent analgesic doses of eachdrug separately. me epidural administration of NEO 2 mg could provide satisfactory postoperative analgesia.展开更多
Background： The antagonistic actions of anticholinesterase drugs on non-depolarizing muscle relaxants are theoretically related to the activity of acetylcholinesterase （ACHE） in the neuromuscular junction （NMJ）. ...Background： The antagonistic actions of anticholinesterase drugs on non-depolarizing muscle relaxants are theoretically related to the activity of acetylcholinesterase （ACHE） in the neuromuscular junction （NMJ）. However, till date the changes of AChE activity in the NMJ during sepsis have not been directly investigated. We aimed to investigate the effects of sepsis on the antagonistic actions ofneostigmine on rocuronium （Roc） and the underlying changes of AChE activity in the NMJ in a rat model of cecal ligation and puncture （CLP）. Methods： A total of 28 male adult Sprague-Dawley rats were randomized to undergo a sham surgery （the sham group, n = 12） or CLP （the septic group, n = 16）. After 24 h, the time-response curves of the antagonistic actions of 0.1 or 0.5μmol/L of neostigmine on Roc （10 μmol/L）-depressed diaphragm twitch tension were measured. Meanwhile, the activity of AChE in the NMJ was detected using a modified Karnovsky and Roots method. The mRNA levels of the primary transcript and the type T transcript of AChE （AChET） in the diaphragm were determined by real-time reverse transcription-polymerase chain reaction. Results： Four of 16 rats in the septic group died within 24 h. The time-response curves of both two concentrations ofneostigmine in the septic group showed significant upward shifts from those in the sham group （P 〈 0.001 for 0.1 μmol/L; P = 0.009 for 0.5 μmol/L）. Meanwhile, the average optical density of AChE in the NMJ in the septic group was significantly lower than that in the sham group （0.517± 0.045 vs. 1.047 ±0.087, P 〈 0.001）. The AChE and AChET mRNA expression levels in the septic group were significantly lower than those in the sham group （P 0.002 for ACHE; P = 0.001 for AChEv）. Conclusions： Sepsis strengthened the antagonistic actions ofneostigmine on Roc-depressed twitch tension of the diaphragm by inhibiting the activity of AChE in the NMJ. The reduced content of AChE might be one of the possible causes of the decreased AChE activity in the NMJ.展开更多
Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation, and analyze the risk factors causing residual neuromuscular blockade by judging the degree ...Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation, and analyze the risk factors causing residual neuromuscular blockade by judging the degree of muscle relaxation according to clinical signs when after using rocuronium or cis-atracurium in general anesthesia.Methods: 500 adults were implemented with propofol-remifentanil intravenous anesthesia or sevoflurane inhalation anesthesia. Rocuronium and cis-atracurium were given, respectively. The TOFr was observed with blind method by TOF Watch SX monitor during anesthesia.Results: The mean TOFr=0.53±0.38 at the end of operation,including 275 cases of 0<TOFr<0.9 and 112 cases of TOFr=0. The mean TOFr=0.97±0.12 at extubation, including 60 cases of TOFr<0.9. The incidence of residual neuromuscular blockade at extubation showed an increasing trend with the increase of age or body mass index. The average TOFr value at extubation, which interval time over 10 min after neostigmine administration to extubation was significant higher than that of interval time less than 10 min.Conclusions:There has 12% patients with TOFr<0.9 when extubation by estimating rocuronium and cis-atracurium effect with clinical signs and experience, it has a hidden danger of residual neuromuscular blockade. The main risk factors to increasing the incidence of residual neuromuscular blockade are growing old and the short time of administrating muscle relaxants or neostigmine to extubation.展开更多
Background:Postoperative pulmonary complications often lead to increased mortality and financial burden.Residual paralysis plays a critical role in postoperative pulmonary complications.This meta-analysis was performe...Background:Postoperative pulmonary complications often lead to increased mortality and financial burden.Residual paralysis plays a critical role in postoperative pulmonary complications.This meta-analysis was performed to determine whether sugammadex overmatches neostigmine in reducing postoperative pulmonary complications.Methods:PubMed,Embase,Web of Science,Medline through Ovid,Cochrane Library,Wanfang,China National Knowledge Infrastructure,and Chinese BioMedical Literature Databases were searched from their inception to 24 June,2021.Random effects models were used for all analyses.Cochrane risk of bias tool was used to assess the quality of RCTs,while Newcastle Ottawa Quality Assessment Scale was used to assess for the quality of cohort studies.Results:Seventeen studies were included in the meta-analysis.Pooled data from cohort studies showed reversing neuromuscular blocking with sugammadex had less risk of compound postoperative pulmonary complications(relative risk[RR]:0.73;95%confidence interval[CI]:0.60-0.89;P=0.002;I^(2)=81%),pneumonia(RR:0.64;95%CI:0.48-0.86;I^(2)=42%)and respiratory failure(RR:0.48;95%CI:0.41-0.56;I^(2)=0%).However,pooled data from RCTs did not show any difference between the two groups in pneumonia(RR:0.58;95%CI:0.24-1.40;I^(2)=0%)and no respiratory failure was reported in the included RCTs.The difference was not found between sugammadex and neostigmine about atelectasis in pooled data from either RCTs(RR:0.85;95%CI:0.69-1.05;I^(2)=0%)or cohort studies(RR:1.01;95%CI:0.87-1.18;I^(2)=0%).Conclusion:The evidence of superiority of sugammadex was limited by the confounding factors in cohort studies and small scale of RCTs.Whether sugammadex precedes neostigmine in preventing pulmonary complications after surgery is still unknown.Well-designed RCTs with large scale are needed.Registration:PROSPERO(https://www.crd.york.ac.uk/PROSPERO/);CRD 42020191575.展开更多
基金the National Natural Science Foundation of China, No. 30571794,C03030301Sci-tech Development Program,No.303040077001
文摘BACKGROUND： It has been previously shown that intrathecal administration of either ouabain or neosdgmine can produce antinociceptive effects. Moreover, ouabain and neostigmine are differently associated with acetylcholine. OBJECTIVE： It has been hypothesized that intrathecal administration of ouabain, in combination with neostigmine, can produce antinociceptive synergistic effects. Atropine, as a competitive antagonist, was pre-injected to verify the mechanisms of action. DESIGN, TIME AND SETTING： This study was a randomized, controlled, animal experiment, performed at the State Key Laboratory of Oncology in Southern China between May 2006 and February 2007. MATERIALS： A total of 102 healthy, adult, Sprague Dawley rats were included. Ouabain and neostigmine （Sigma, USA）, as well as atropine （Tanabe Seiyaku, Japan）, were also used. METHODS： Varied doses of ouabain, neostigmine, and a combination of the two were intrathecally injected into rats. Six rats were allotted for each dose group. Intrathecal pretreatment with atropine was tested 10 minutes prior to intrathecal administration of neostigmine or the combination of ouabain and neostigmine. MAIN OUTCOME MEASURES： Tail-flick tests were performed to measure tail-flick latency （seconds） prior to and after administration. The response in the tail-flick test was expressed as the percentage of maximum possible effect （% MPE）, where % MPE = [tail-flick latency after administration （seconds） -mean baseline value for tail-flick latency]/[ 10 seconds - the mean baseline value for tail-flick latency （seconds）] x 100%. RESULTS： Rat spinal intrathecal administration of either ouabain or neostigmine alone produced antinociceptive effects in a dose-dependent manner. Intrathecally administration of neostigmine （0.05, 0.1, 0.3 μg ） in combination with ouabain （1 μ g ） produced enhanced antinociceptive effects, with a % MPE of 29%, 78%, and 95%, respectively （P 〈 0.05）. Intrathecally administration of 0.3μg neostigmine （% MPE： 45%）, in combination with 1 μ g ouabain （% MPE： 27%） produced potent antinociceptive effects （% MPE： 95%）. Intrathecally pre-injected atropine antagonized the antinociceptive effects of neostigmine （3 μg）, or a combination of ouabain （1 μg） and neostigmine （0.3 μg） （P 〈 0.01）. CONCLUSION： Rat spinal intrathecal administration of either ouabain or neostigmine alone produced dose-dependent andnociceptive effects. Ouabain enhanced the antinociceptive effects of neostigmine. Atropine antagonized the antinociceptive effects of neostigmine or the combination of ouabain and neostigmine. This occurs possibly due to the fact that atropine is a competitive antagonist of the muscarinic acetylcboline receptors.
文摘Background: Anesthesiologists are responsible for the development of pain services in the current era. Hence ideal adjuvants that can be used with bupivacaine for stable intraoperative conditions and prolonging the postoperative analgesia with fewer side effects are being investigated. Opioids, despite useful as adjuvants, are associated with undesirable side effects. Aim of the work: The study was done to compare analgesic efficacy and hemodynamic of intrathecal injection of bupivacaine alone or with fentanyl, clonidine, and neostigmine in lower abdominal surgeries, over the first 24 postoperative hours, in a randomized, double-blind, and clinical trial. Methods: 100 Patients were randomized into four equal groups, 25 patients in each group;Group B patients received 2.5 ml of 0.5% hyperbaric bupivacaine and 0.5 ml of normal saline. Group BF patients received 2.5 ml of 0.5% hyperbaric bupivacaine with (25 mics) of fentanyl. Group BC patients received 2.5 ml of 0.5% hyperbaric bupivacaine with 0.5 ml (75 mics) of clonidine. Group BN patients received 2.5 ml of 0.5% hyperbaric bupivacaine with 0.1 ml of neostigmine (50 mics) and 0.4 ml of normal saline. Intrathecal anesthesia was done with a recording of parameters intraoperative and the post-operative period. Each patient was assessed for hemodynamic parameters and effective analgesia in operation, and presence of complications (nausea, vomiting, sedation and pruritus) visual analogue pain score (VAS) postoperatively by a blinded investigator in the post-anesthesia care unit (PACU) and at 1, 2, 3, 4, 8 12, 18 and 24 h postoperatively. Results: The postoperative analgesia is more effective with group BC (the gold standard) than group B, group BF, and group BN. As regard complications during the study in all groups, complications as nausea, and vomiting were mainly with group BN;hypotension was primarily in group BC. Conclusion: Bupivacaine clonidine, bupivacaine neostigmine, and bupivacaine fentanyl intrathecal anesthesia produced a longer duration of postoperative analgesia after lower abdominal surgery in patients than bupivacaine alone. Bupivacaine clonidine mixture had the most extended period of analgesia, but with hypotension. So bupivacaine fentanyl mixture with moderate duration of analgesia and minimal side effects is most safe for a patient.
文摘With the introduction of the rocuronium and vecuronium binding agent sugammadex into clinical practice in the United States, its use for reversal of neuromuscular blockade will likely start in some institutions as a “rescue” after failed reversal with neostigmine. However, sugammadex after neostigmine has not been extensively studied. Therefore, there is a question as to its effectiveness when used in this way especially in the airway compromised patients that the anesthesia provider will commonly face in this situation. Furthermore, there is a possibility of hemodynamic compromise. These two case reports demonstrate the safe and effective use of sugammadex after failed reversal with neostigmine.
文摘To compare the analgesic and side effects of post-operative analgesia between epidural administration ofneostigmine (NEO) and morphine (MOR) or their combination in patients undergoing abdominal surgery. Methods: One hundredand two selective patients undergoing surgery were randomly divided into five groups at the end of the surgical procedure. GroupN1 (n=11) and Group N2(n =15) were administered epidurally with NEO 1 mg and 2 mg respectively, Group M1 (n=18)and Group M2 (n=55) were administered epidurally with MOR 1 mg and 2 mg respectively, Group M1 + N1 (n=17) was administered epidurally with the combination of MOR 1 mg and NEO 1 mg. Results: Single dose epidural administration of NEO (1mg and 2 mg) or MOR (1 mg and 2 mg) showed dose-dependent analgesic effects. The analgesic duration in Group N1 (4.7 ± 2.7 h) was significantly shorter than other four groups (P<0. 01). Group M1, M2 and M1 + N1 showed better analgesic effectsthan group N1 and N2 (16.1±8.7h) , with similar analgesic durations in Group M1, M2 and M1 + N1. me percentages of excellent, good and poor effects were 0%, 54.5 % and 45.5 % respectively in Group N1. The percentages of excellent and good effects were 100% in Group M2 and M1 + N1, but 83.3% in Group N2. The time to first use analgesic medication was similar inGroup M1, M2 and M1 + N1, but longer compared with Croup N1 and N2. The incidences of nausea and vomiting closelyresem-bled one another in Croup N1, N2 and M1 + N1, which were less than those in Group M1 and M2. The incidence of urinary retention was 51.2%, 25.0% and 31.3% in Group M2, M1 and M1 + N1, respectively, but 0% in Group N1 and N2. In GroupN2 two patients opened the bowel movement and one patient developed bradycardia (58 beats/min) at 45 min after receiving NEO.Conclusion: Epidural administration of NEO produces dose-dependent prolonged analgesic effects (similar to MOR) and the combination of MOR and NEO could produce analgesia with fewer side effects than administration of equivalent analgesic doses of eachdrug separately. me epidural administration of NEO 2 mg could provide satisfactory postoperative analgesia.
基金This study was supported by a grant from National Natural Science Foundation of China
文摘Background： The antagonistic actions of anticholinesterase drugs on non-depolarizing muscle relaxants are theoretically related to the activity of acetylcholinesterase （ACHE） in the neuromuscular junction （NMJ）. However, till date the changes of AChE activity in the NMJ during sepsis have not been directly investigated. We aimed to investigate the effects of sepsis on the antagonistic actions ofneostigmine on rocuronium （Roc） and the underlying changes of AChE activity in the NMJ in a rat model of cecal ligation and puncture （CLP）. Methods： A total of 28 male adult Sprague-Dawley rats were randomized to undergo a sham surgery （the sham group, n = 12） or CLP （the septic group, n = 16）. After 24 h, the time-response curves of the antagonistic actions of 0.1 or 0.5μmol/L of neostigmine on Roc （10 μmol/L）-depressed diaphragm twitch tension were measured. Meanwhile, the activity of AChE in the NMJ was detected using a modified Karnovsky and Roots method. The mRNA levels of the primary transcript and the type T transcript of AChE （AChET） in the diaphragm were determined by real-time reverse transcription-polymerase chain reaction. Results： Four of 16 rats in the septic group died within 24 h. The time-response curves of both two concentrations ofneostigmine in the septic group showed significant upward shifts from those in the sham group （P 〈 0.001 for 0.1 μmol/L; P = 0.009 for 0.5 μmol/L）. Meanwhile, the average optical density of AChE in the NMJ in the septic group was significantly lower than that in the sham group （0.517± 0.045 vs. 1.047 ±0.087, P 〈 0.001）. The AChE and AChET mRNA expression levels in the septic group were significantly lower than those in the sham group （P 0.002 for ACHE; P = 0.001 for AChEv）. Conclusions： Sepsis strengthened the antagonistic actions ofneostigmine on Roc-depressed twitch tension of the diaphragm by inhibiting the activity of AChE in the NMJ. The reduced content of AChE might be one of the possible causes of the decreased AChE activity in the NMJ.
基金Guangdong science and technology plan project (2013B31800248).
文摘Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation, and analyze the risk factors causing residual neuromuscular blockade by judging the degree of muscle relaxation according to clinical signs when after using rocuronium or cis-atracurium in general anesthesia.Methods: 500 adults were implemented with propofol-remifentanil intravenous anesthesia or sevoflurane inhalation anesthesia. Rocuronium and cis-atracurium were given, respectively. The TOFr was observed with blind method by TOF Watch SX monitor during anesthesia.Results: The mean TOFr=0.53±0.38 at the end of operation,including 275 cases of 0<TOFr<0.9 and 112 cases of TOFr=0. The mean TOFr=0.97±0.12 at extubation, including 60 cases of TOFr<0.9. The incidence of residual neuromuscular blockade at extubation showed an increasing trend with the increase of age or body mass index. The average TOFr value at extubation, which interval time over 10 min after neostigmine administration to extubation was significant higher than that of interval time less than 10 min.Conclusions:There has 12% patients with TOFr<0.9 when extubation by estimating rocuronium and cis-atracurium effect with clinical signs and experience, it has a hidden danger of residual neuromuscular blockade. The main risk factors to increasing the incidence of residual neuromuscular blockade are growing old and the short time of administrating muscle relaxants or neostigmine to extubation.
基金Sichuan Science and Technology Program(Nos.2020YFS0188 and 2020YJ0283)
文摘Background:Postoperative pulmonary complications often lead to increased mortality and financial burden.Residual paralysis plays a critical role in postoperative pulmonary complications.This meta-analysis was performed to determine whether sugammadex overmatches neostigmine in reducing postoperative pulmonary complications.Methods:PubMed,Embase,Web of Science,Medline through Ovid,Cochrane Library,Wanfang,China National Knowledge Infrastructure,and Chinese BioMedical Literature Databases were searched from their inception to 24 June,2021.Random effects models were used for all analyses.Cochrane risk of bias tool was used to assess the quality of RCTs,while Newcastle Ottawa Quality Assessment Scale was used to assess for the quality of cohort studies.Results:Seventeen studies were included in the meta-analysis.Pooled data from cohort studies showed reversing neuromuscular blocking with sugammadex had less risk of compound postoperative pulmonary complications(relative risk[RR]:0.73;95%confidence interval[CI]:0.60-0.89;P=0.002;I^(2)=81%),pneumonia(RR:0.64;95%CI:0.48-0.86;I^(2)=42%)and respiratory failure(RR:0.48;95%CI:0.41-0.56;I^(2)=0%).However,pooled data from RCTs did not show any difference between the two groups in pneumonia(RR:0.58;95%CI:0.24-1.40;I^(2)=0%)and no respiratory failure was reported in the included RCTs.The difference was not found between sugammadex and neostigmine about atelectasis in pooled data from either RCTs(RR:0.85;95%CI:0.69-1.05;I^(2)=0%)or cohort studies(RR:1.01;95%CI:0.87-1.18;I^(2)=0%).Conclusion:The evidence of superiority of sugammadex was limited by the confounding factors in cohort studies and small scale of RCTs.Whether sugammadex precedes neostigmine in preventing pulmonary complications after surgery is still unknown.Well-designed RCTs with large scale are needed.Registration:PROSPERO(https://www.crd.york.ac.uk/PROSPERO/);CRD 42020191575.
