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. 2021 Nov;9(22):1691.
doi: 10.21037/atm-21-5667.

Efficacy and safety of neostigmine for neuromuscular blockade reversal in patients under general anesthesia: a systematic review and meta-analysis

Wentao Ji #  1 , Xiaoting Zhang #  1 , Jia Liu #  1 , Guolin Sun  1 , Xiandong Wang  1 , Lulong Bo  1 , Xiaoming Deng  1
Affiliations

Efficacy and safety of neostigmine for neuromuscular blockade reversal in patients under general anesthesia: a systematic review and meta-analysis

Wentao Ji et al. Ann Transl Med. 2021 Nov.

Abstract

Background: Since the antagonistic effect of neostigmine on muscle relaxation is still controversial, this study aimed to evaluate the efficacy and safety of neostigmine for the reversal of neuromuscular blockade in patients recovering from general anesthesia.

Methods: Multiple databases, including PubMed, Web of Science, the Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI), were electronically searched up to August 2021. Relevant studies on the use of neostigmine for neuromuscular blockade reversal in patients under general anesthesia were retrieved. Two reviewers independently screened and extracted data from the retrieved studies, and assessed their risk of bias. Review Manager 5.2 was used to evaluate the efficacy and safety of neostigmine based on the included articles. Heterogeneity and related subgroup, sensitivity, and bias analyses were carried out.

Results: The analysis included 14 studies involving 2,109 patients, including 1,209 in the neostigmine group and 990 in the control group. Results from the random-effects model showed that neostigmine reduced the length of stay in the post-anesthesia care unit [mean difference (MD) =-17.73; 95% confidential interval (CI): -22.06 to -13.41; P<0.0001], the time to recovery of train-of-four ratio ≥0.9 (MD =-16.60; 95% CI: -23.67 to -9.52; P<0.0001), and the extubation time (MD =-16.69; 95% CI: -28.22 to -5.17; P=0.005). However, no difference was observed in adverse events between the neostigmine and control groups [odds ratio (OR) =0.97; 95% CI: 0.84-1.12; P=0.71]. Subgroup analyses adjusted for the dosage of neostigmine had no effect on the above results.

Conclusions: Neostigmine can effectively and safely enhance neuromuscular recovery from non-depolarizing muscle relaxants in patients under general anesthesia.

Keywords: Neostigmine; anesthesia; neuromuscular blockade.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/atm-21-5667). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of the study selection process for the meta-analysis.
Figure 2
Figure 2
Summary of quality assessment of the included studies. Red, yellow, and green indicate high, unclear, and low risk of bias, respectively.
Figure 3
Figure 3
Summary of the risk of bias assessment according to the Cochrane Collaboration’s tool. Red, yellow, and green indicate high, unclear, and low risk of bias, respectively.
Figure 4
Figure 4
Forest plots of the length of stay in the post-anesthesia care unit (PACU).
Figure 5
Figure 5
Forest plots for time to recovery of train-of-four ratio (TOFR) ≥0.9.
Figure 6
Figure 6
Forest plot of the extubation time.
Figure 7
Figure 7
Forest plot of adverse events.
Figure 8
Figure 8
Sensitivity analysis forest plots of the length of stay in the post-anesthesia care unit (PACU).
Figure 9
Figure 9
Publication bias funnel plot for the length of stay in the post-anesthesia care unit (PACU).
See this image and copyright information in PMC

Comment in

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