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. 2017 Aug 14;2017(8):CD012763. doi: 10.1002/14651858.CD012763

Comparison 3. Sugammadex (any dose) vs neostigmine (any dose).

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Risk of composite adverse events 28 2298 Risk Ratio (M‐H, Random, 95% CI) 0.60 [0.49, 0.74]
2 Composite adverse events: subgroup analysis for dosage 28 2298 Risk Ratio (M‐H, Random, 95% CI) 0.60 [0.49, 0.73]
2.1 Sugammadex 2 mg/kg vs neostigmine 0.04 mg/kg 1 21 Risk Ratio (M‐H, Random, 95% CI) 0.45 [0.05, 4.28]
2.2 Sugammadex 2 mg/kg vs neostigmine 0.05 mg/kg 12 1076 Risk Ratio (M‐H, Random, 95% CI) 0.52 [0.34, 0.80]
2.3 Sugammadex 2 mg/kg vs neostigmine 0.07 mg/kg 2 131 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.57, 1.44]
2.4 Sugammadex 2 mg/kg vs neostigmine 2.5 mg 1 40 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
2.5 Sugammadex 3 mg/kg vs neostigmine 0.03 mg/kg 1 90 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
2.6 Sugammadex 4 mg/kg vs neostigmine 0.05 mg/kg 4 333 Risk Ratio (M‐H, Random, 95% CI) 0.66 [0.49, 0.88]
2.7 Sugammadex 4 mg/kg vs neostigmine 0.07 mg/kg 3 197 Risk Ratio (M‐H, Random, 95% CI) 0.49 [0.25, 0.93]
2.8 Sugammadex, several doses vs neostigmine, several doses 4 410 Risk Ratio (M‐H, Random, 95% CI) 0.60 [0.40, 0.90]
3 Composite adverse events: subgroup analysis ‐ TIVA vs volatile anaesthetics 28 2298 Risk Ratio (M‐H, Random, 95% CI) 0.60 [0.49, 0.73]
3.1 TIVA 7 748 Risk Ratio (M‐H, Random, 95% CI) 0.51 [0.20, 1.31]
3.2 Volatile anaesthetic 20 1510 Risk Ratio (M‐H, Random, 95% CI) 0.64 [0.55, 0.73]
3.3 No information 1 40 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
4 Composite adverse events: sensitivity analysis ‐ excluding meeting abstracts 24 2091 Risk Ratio (M‐H, Random, 95% CI) 0.60 [0.49, 0.73]
5 Participants with ≥ adverse event 19 1766 Risk Ratio (M‐H, Random, 95% CI) 0.62 [0.48, 0.81]
6 Bradycardia: subgroup analysis ‐ atropine vs glycopyrrolate 11 1218 Risk Ratio (M‐H, Random, 95% CI) 0.16 [0.07, 0.34]
6.1 Atropine 6 667 Risk Ratio (M‐H, Random, 95% CI) 0.14 [0.05, 0.36]
6.2 Glycopyrrolate 5 551 Risk Ratio (M‐H, Random, 95% CI) 0.20 [0.06, 0.69]
7 PONV: subgroup analysis ‐ TIVA vs volatile anaesthetics 6 389 Risk Ratio (M‐H, Random, 95% CI) 0.52 [0.28, 0.97]
7.1 TIVA 1 94 Risk Ratio (M‐H, Random, 95% CI) 3.55 [0.15, 84.86]
7.2 Volatile anaesthetics 5 295 Risk Ratio (M‐H, Random, 95% CI) 0.48 [0.25, 0.91]
8 Desaturation 2 134 Risk Ratio (M‐H, Random, 95% CI) 0.23 [0.06, 0.83]
9 Procedural complications 2 168 Risk Ratio (M‐H, Random, 95% CI) 0.12 [0.02, 0.97]
10 Transitory oxygen supplementation 2 76 Risk Ratio (M‐H, Random, 95% CI) 0.24 [0.09, 0.66]
11 Not able to perform 5 second head‐lift after extubation 6 395 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.15, 0.78]
12 General muscle weakness after extubation 4 288 Risk Ratio (M‐H, Random, 95% CI) 0.61 [0.31, 1.18]
13 Nausea 9 719 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.44, 1.56]
14 Vomiting 4 297 Risk Ratio (M‐H, Random, 95% CI) 2.05 [0.50, 8.48]
15 Postprocedural nausea 2 168 Risk Ratio (M‐H, Random, 95% CI) 1.39 [0.27, 7.12]
16 Headache 4 388 Risk Ratio (M‐H, Random, 95% CI) 1.02 [0.48, 2.18]
17 Hypertension 3 287 Risk Ratio (M‐H, Random, 95% CI) 1.45 [0.23, 9.05]
18 Hypotension 4 465 Risk Ratio (M‐H, Random, 95% CI) 1.23 [0.38, 3.96]
19 Cough 3 200 Risk Ratio (M‐H, Random, 95% CI) 1.42 [0.42, 4.81]
20 Dry mouth 3 289 Risk Ratio (M‐H, Random, 95% CI) 0.44 [0.10, 1.87]
21 Dizziness 2 168 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.10, 9.23]
22 Tachycardia 3 338 Risk Ratio (M‐H, Random, 95% CI) 0.44 [0.09, 2.22]
23 Pruritus 2 175 Risk Ratio (M‐H, Random, 95% CI) 1.62 [0.20, 12.88]
24 Pyrexia 3 264 Risk Ratio (M‐H, Random, 95% CI) 1.43 [0.23, 8.91]
25 Shivering 3 190 Risk Ratio (M‐H, Random, 95% CI) 0.75 [0.40, 1.43]
26 Chills 2 166 Risk Ratio (M‐H, Random, 95% CI) 4.04 [0.46, 35.85]
27 Rash 5 701 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.17, 3.96]
28 Supraventricular extrasystoles 2 189 Risk Ratio (M‐H, Random, 95% CI) 0.32 [0.03, 3.05]
29 Laryngospasm 2 100 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.07, 1.65]
30 Increased upper airway secretion 2 442 Risk Ratio (M‐H, Random, 95% CI) 0.37 [0.09, 1.59]
31 Procedural hypertension 3 267 Risk Ratio (M‐H, Random, 95% CI) 1.65 [0.33, 8.21]
32 Procedural hypotension 2 391 Risk Ratio (M‐H, Random, 95% CI) 0.49 [0.02, 14.15]
33 Abdominal pain 2 196 Risk Ratio (M‐H, Random, 95% CI) 0.98 [0.10, 9.27]
34 Clinical signs of residual NMB 7 646 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
35 Clinical signs of inadequate reversal of NMB 4 368 Risk Ratio (M‐H, Random, 95% CI) 0.11 [0.01, 2.02]
36 Clinical signs of recurrence of residual NMB 13 1289 Risk Ratio (M‐H, Random, 95% CI) 0.74 [0.05, 10.74]
37 General muscle weakness at PACU discharge 5 410 Risk Ratio (M‐H, Random, 95% CI) 0.49 [0.12, 1.90]
38 Not able to perform 5 second head‐lift at PACU discharge 5 399 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
39 Overall signs of postoperative residual paralysis 15 1474 Risk Ratio (M‐H, Random, 95% CI) 0.40 [0.28, 0.57]
40 Risk of composite serious adverse events 10 959 Risk Ratio (M‐H, Random, 95% CI) 0.54 [0.13, 2.25]
41 Participants with ≥ 1 serious adverse event 10 959 Risk Ratio (M‐H, Random, 95% CI) 0.54 [0.13, 2.25]