Cochrane corner: sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade.
Cochrane corner: sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade.
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DOI：
10.1213/ane.0b013e3181ce8d5e
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发表时间：
2010-04-01
影响因子：
5.7
通讯作者：
Chung, Frances
中科院分区：
文献类型：
--
作者：
Abrishami, Amir;Ho, Joyce;Chung, Frances
背景技术背景：舒更葡糖是第一种选择性松弛剂结合剂，已被研究用于逆转罗库和其他甾体非去极化神经肌肉阻滞剂（NMBA）诱导的神经肌肉阻滞。目的：评估舒更葡糖在逆转甾体非去极化神经肌肉阻滞剂（NMBA）诱导的神经肌肉阻滞和预防术后残留神经肌肉阻滞方面的有效性和安全性。搜索策略：我们检索了科克伦对照试验中心注册库（CENTRAL）（科克伦图书馆2008年第3期）、MEDLINE（1950年至2008年8月）和EMBASE（1980年至2008年8月）。此外，我们手工检索了相关文章和会议摘要的参考文献列表。选择标准：所有成年患者（≥ 18岁）的随机对照试验（RCT），比较sugammadex与安慰剂或其他药物，或比较不同剂量sugammadex。我们排除了非随机试验和健康志愿者的研究。数据收集和分析：我们独立进行试验纳入，质量评估和数据提取的决定。主要结果：共纳入18项随机对照试验，共1321例患者. 7项试验作为全文论文发表，11项试验仅作为会议摘要发表。所有纳入的试验都有足够的随机化和分配隐藏方法。结果表明，与安慰剂或新斯的明相比，sugammadex可以更快地逆转罗库诱导的神经肌肉阻滞，无论阻滞深度如何。我们分别在T2重现、强直后1 - 2次计数和罗库给药后3 - 5分钟确定了2、4和16 mg/kg sugammadex对罗库肌松的拮抗作用。关于维库溴铵和泮库溴铵的试验数量非常有限。严重不良事件发生在< 1%的所有接受药物治疗的患者中。sugammadex与安慰剂之间药物相关不良事件的发生率无显著差异（RR 1.20，95% CI 0.61 - 2.37; P=0.59，I2= 0%，5项RCT）。此外，sugammadex和新斯的明的不良事件发生率无显著差异（RR 0.98，95%CI 0.48 - 1.98; P=0.95，I2= 43%，3项RCT）。本综述未发现sugammadex、安慰剂或新斯的明之间不良反应的差异。这些结果需要在更大的患者人群中进行进一步的试验，并更加关注患者相关的结果。
BACKGROUND: Sugammadex is the first selective relaxant binding agent that has been studied for reversal of neuromuscular blockade induced by rocuronium and other steroidal non-depolarizing neuromuscular blocking agents (NMBAs).OBJECTIVES: To assess the efficacy and safety of sugammadex in reversing neuromuscular blockade induced by steroidal non-depolarizing NMBAs and in preventing postoperative residual neuromuscular blockade.SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE (1950 to August 2008), and EMBASE (1980 to August 2008). In addition, we handsearched reference lists of relevant articles and meeting abstracts. Furthermore, we contacted the medication's manufacturer for more information.SELECTION CRITERIA: All randomized controlled trials (RCTs) on adult patients (> or = 18 years old) in which sugammadex was compared with placebo or other medications, or in which different doses of sugammadex were compared with each other. We excluded non-randomized trials and studies on healthy volunteers.DATA COLLECTION AND ANALYSIS: We independently performed determination of trial inclusion, quality assessment, and data extraction. We applied standard meta- analytic techniques.MAIN RESULTS: We included18 RCTs (n=1321 patients). Seven trials were published as full-text papers, and 11 trials only as meeting abstracts. All the included trials had adequate methods of randomization and allocation concealment. The results suggest that, compared with placebo or neostigmine, sugammadex can more rapidly reverse rocuronium-induced neuromuscular blockade regardless of the depth of the block. We identified 2, 4, and 16 mg/kg of sugammadex for reversal of rocuronium-induced neuromuscular blockade at T2 reappearance , 1 to 2 post-tetanic counts, and 3 to 5 minutes after rocuronium, respectively. The number of trials are very limited regarding vecuronium and pancuronium. Serious adverse events occurred in < 1% of all patients who received the medication. There was no significant difference between sugammadex and placebo in terms of the prevalence of drug-related adverse events (RR 1.20, 95% CI 0.61 to 2.37; P=0.59, I2=0%, 5 RCTs). Also, no significant difference was found between sugammadex and neostigmine for adverse events (RR 0.98, 95% CI 0.48 to1.98; P=0.95, I2=43%, 3 RCTs).AUTHORS' CONCLUSIONS: Sugammadex was shown to be effective in reversing rocuronium-induced neuromuscular blockade. This review has found no evidence of a difference in the instance of unwanted effects between sugammadex, placebo or neostigmine. These results need to be confirmed by future trials on larger patient populations and with more focus on patient-related outcomes.