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Multicenter Study
. 2025 Jul;135(1):197-205.
doi: 10.1016/j.bja.2025.01.039. Epub 2025 Mar 14.

Pulmonary complications associated with sugammadex or neostigmine in patients recovering from advanced diagnostic or interventional bronchoscopy: a retrospective two-centre analysis

Ehab Farag  1 , Karan Shah  2 , Maged Argalious  3 , Basem Abdelmalak  3 , Thomas Gildea  4 , John Seif  3 , Shuyi Li  2 , Edward J Mascha  2 , Daniel I Sessler  5
Affiliations
Multicenter Study

Pulmonary complications associated with sugammadex or neostigmine in patients recovering from advanced diagnostic or interventional bronchoscopy: a retrospective two-centre analysis

Ehab Farag et al. Br J Anaesth. 2025 Jul.

Abstract

Background: Many diagnostic and interventional procedures are performed in bronchoscopy suites in high-risk patients. Minor impairment in respiratory muscle function caused by incomplete reversal of neuromuscular block can contribute to postoperative pulmonary complications (PPCs). We assessed whether there are fewer serious PPCs after diagnostic or therapeutic bronchoscopy when neuromuscular block is reversed with sugammadex rather than neostigmine.

Methods: This is a retrospective cohort study for bronchoscopy under general anaesthesia with the use of neuromuscular blockers between July 2016 and June 2022. The primary outcome was a composite of PPCs. The secondary outcome was hypoxaemia. We used inverse probability of treatment weighting (IPTW) to adjust for confounding, fitting weighted outcome regression models to evaluate the association between the treatment and outcomes.

Results: We analysed 8557 bronchoscopies across 6123 patients for the primary analysis. Adequate balance was achieved on all potential confounders after IPTW. The unweighted PPC incidence was 85/3830 (2.2%) for sugammadex and 93/4727 (2.0%) for neostigmine. The weighted PPC incidence was 2.7% for sugammadex and 1.9% for neostigmine. Sugammadex was associated with higher odds of experiencing the primary outcome of PPCs (odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.02-2.05; P=0.038), but not the secondary outcome of hypoxaemia (OR: 0.98; 95% CI: 0.81-1.20; P=0.878).

Conclusions: Sugammadex was associated with a higher risk of PPCs than neostigmine. However, the absolute difference observed (0.8%) might not be clinically meaningful. Randomised trials are needed to more accurately determine the effect of neuromuscular block reversal agent selection on respiratory complications.

Keywords: bronchoscopy; interventional pulmonology; neostigmine; neuromuscular block; postoperative pulmonary complications; sugammadex.

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Conflict of interest statement

Declaration of interest The authors declare that they have no conflicts of interest.

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