Sugammadex for reversal of rocuronium-induced neuromuscular blockade in pediatric patients: A systematic review and meta-analysis

Abstract

Background: Previous studies have shown that sugammadex, a modified γ-cyclodextrin, is a well-tolerated agent for the reversal of neuromuscular blockade (NMB) induced by a steroidal neuromuscular blocking drug in adult patients. However, its use has not been reviewed in pediatric patients. The aim of this meta-analysis was to evaluate the efficacy and safety of sugammadex in the reversal of rocuronium-induced NMB during surgery under general anesthesia in pediatric patients.

Methods: A literature search was performed using the Pubmed, EMBASE: Drugs and pharmacology, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Analysis was conducted using RevMan 5.3. Data collected from different trials were pooled; the weighted mean difference or the pooled risk ratio and the corresponding 95% confidence interval (CI) were used for analysis, and heterogeneity (I) assessment was performed.

Results: Six randomized controlled trials comparing 253 pediatric patients (age range, 2-18 years) were included in the final analysis. The mean time taken to reach a train-of-four ratio of ≥0.9 was significantly shorter in the sugammadex groups (2 and 4 mg/kg) than in the control group (neostigmine or placebo), although the heterogeneity was high. The weighted mean differences of the 2 and 4 mg/kg sugammadex groups were -7.15 (95% CI: -10.77 to -3.54; I = 96%; P = 0.0001) and -17.32 (95% CI: -29.31 to -5.32; I = 98%; P = 0.005), respectively. The extubation time in the sugammadex group was shorter than that in the control group; the weighted mean difference of the sugammadex group was -6.00 (95% CI: -11.46 to -0.53; I = 99%; P = 0.03). There was no significant difference between the groups in terms of the incidence of postanesthetic adverse events; the pooled risk ratio was 0.67 (95% CI: 0.27-1.71; I = 59%; P = 0.41).

Conclusion: We suggest that sugammadex is fast and effective in reversing rocuronium-induced NMB in pediatric patients. Although there was no evidence of a higher incidence of adverse events with sugammadex compared to that with neostigmine or placebo, much more data regarding the safety of sugammadex in pediatric patients may be still required.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1

Meta-analysis flowchart. RCT = randomized controlled trial.

Figure 2

Time to reach a TOF ratio of ≥0.9 (minute) measured from the time of administration of (A) 2 mg/kg or (B) 4 mg/kg of sugammadex and a control drug (neostigmine or placebo). The experimental group was administered 2 mg/kg or 4 mg/kg of sugammadex. The control group was administered neostigmine or placebo. CI = confidence interval, IV = inverse variance, SD = standard deviation, TOF = train-of-four.

Figure 3

Extubation time (minute). The experimental group was administered 2 mg/kg or 4 mg/kg of sugammadex. The control group was administered neostigmine or placebo. CI = confidence interval, IV = Inverse variance, SD = standard deviation.

Figure 4

Incidence of postanesthetic adverse events (number of patients). The experimental group was administered 2 mg/kg or 4 mg/kg of sugammadex. The control group was administered neostigmine or placebo. CI = confidence interval, M-H = Mantel–Haenszel.