Medicina

Research

Jump to: Other

12 pages, 5894 KiB

Open AccessFeature PaperArticle

A Comparison of the Safety and Efficacy of Remimazolam and Dexmedetomidine for Sedation in Surgical Patients Under Regional Anesthesia: A Meta-Analysis of Randomized Controlled Trials

by Hyo-Seok Na, Sang-Hi Park, Bon-Wook Koo, Seunguk Bang and Hyun-Jung Shin

Medicina 2025, 61(4), 726; https://doi.org/10.3390/medicina61040726 - 14 Apr 2025

Viewed by 59

Abstract

Background and Objectives: This meta-analysis compares the safety and efficacy of remimazolam and dexmedetomidine for sedation during regional anesthesia, focusing on respiratory and hemodynamic outcomes. Materials and Methods: A systematic search of CENTRAL, Embase, PubMed, Scopus, and Web of Science up [...] Read more.

Background and Objectives: This meta-analysis compares the safety and efficacy of remimazolam and dexmedetomidine for sedation during regional anesthesia, focusing on respiratory and hemodynamic outcomes. Materials and Methods: A systematic search of CENTRAL, Embase, PubMed, Scopus, and Web of Science up to November 2024 identified randomized controlled trials (RCTs) comparing remimazolam with dexmedetomidine. Outcomes included respiratory depression (primary outcome), bradycardia, hypotension, hypertension, respiratory and heart rates, mean arterial pressure, sedation onset time, emergence time, and postoperative nausea and vomiting (PONV). Effect sizes were calculated as relative risks (RRs) or mean differences (MDs) using random-effects models. Results: Five RCTs involving 439 participants were included. Remimazolam did not significantly increase respiratory depression risk compared to dexmedetomidine (RR: 1.36, 95% CI [0.39, 4.71], p = 0.6305, I² = 44%). Bradycardia incidence was lower with remimazolam (RR: 0.15, 95% CI [0.06, 0.39], p = 0.0001, I² = 0%). Remimazolam showed faster sedation onset (MD: −6.04 min, 95% CI [−6.99, −5.09], p = 0.0000, I² = 68%). Both drugs demonstrated similar occurrences of hypotension and hypertension, respiratory rates, mean arterial pressures, emergence times, and incidences of PONV. Conclusions: Remimazolam offers comparable safety and efficacy to dexmedetomidine, with advantages such as lower bradycardia risk and faster sedation onset. These findings support remimazolam as a viable sedative option during regional anesthesia, although further large-scale studies are warranted to confirm these results and optimize sedation practices. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

9 pages, 836 KiB

Open AccessArticle

Effect of Remimazolam and Propofol on Blood Glucose and Serum Inflammatory Markers in Patients with Type 2 Diabetes: A Clinical Trial with Prospective Randomized Control

by Sang Hun Kim, Sang Min Yoon, Ji Hye Ahn and Yoon Ji Choi

Medicina 2025, 61(3), 523; https://doi.org/10.3390/medicina61030523 - 17 Mar 2025

Viewed by 235

Abstract

Background and Objectives: Patients with type 2 diabetes are at a higher risk of postoperative complications, such as infections, delayed wound healing, and increased mortality compared to non-diabetic patients. Materials and Methods: This prospective randomized study aims to compare the effects of two anesthetics, [...] Read more.

Background and Objectives: Patients with type 2 diabetes are at a higher risk of postoperative complications, such as infections, delayed wound healing, and increased mortality compared to non-diabetic patients. Materials and Methods: This prospective randomized study aims to compare the effects of two anesthetics, remimazolam and propofol, on blood glucose levels and immune function in diabetic patients undergoing surgery. Seventy-four diabetic patients undergoing general anesthesia were randomly assigned to receive either remimazolam or propofol. Plasma blood glucose levels, anti-inflammatory markers, and insulin levels were measured during the perioperative period. Results: No statistically significant differences were observed between the remimazolam and propofol groups in terms of neutrophil-to-lymphocyte ratio, anti-inflammatory markers, or glucose levels during the perioperative period (p value > 0.05). Conclusions: These results suggest that there is no difference between propofol and remimazolam in immune function deterioration that occurs due to surgical stress. This study is limited by its small sample size, and in future, larger trials could be conducted to find differences in the effects of blood sugar levels and serum inflammatory markers between the two groups. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

10 pages, 539 KiB

Open AccessArticle

The Effects of Remimazolam and Inhalational Anesthetics on the Incidence of Postoperative Hyperactive Delirium in Geriatric Patients Undergoing Hip or Femur Surgery Under General Anesthesia: A Retrospective Observational Study

by Jimin Kim, Sangseok Lee, Byung Hoon Yoo, Yun Hee Lim and In-Jung Jun

Medicina 2025, 61(2), 336; https://doi.org/10.3390/medicina61020336 - 14 Feb 2025

Viewed by 676

Abstract

Background and Objectives: Postoperative delirium (POD) is a transient but significant complication in geriatric patients following hip or femur surgery. POD occurs in 19–65% of patients after hip surgeries, with notable risks associated with augmented morbidity, mortality, and prolonged hospitalization. The perioperative [...] Read more.

Background and Objectives: Postoperative delirium (POD) is a transient but significant complication in geriatric patients following hip or femur surgery. POD occurs in 19–65% of patients after hip surgeries, with notable risks associated with augmented morbidity, mortality, and prolonged hospitalization. The perioperative administration of benzodiazepines, particularly midazolam, is associated with an increased incidence of POD. Remimazolam, a novel ultra-short-acting benzodiazepine, has potential benefits, such as hemodynamic stability and ease of reversal, but its effect on POD occurrence remains unclear. Materials and Methods: This retrospective study investigated patients who were aged 65 years old and older who underwent hip or femur surgery. Following the application of exclusion criteria, 502 patients were grouped according to whether anesthesia was maintained with remimazolam (R group) or sevoflurane (S group). Data regarding patients’ baseline characteristics, anesthetic details, and postoperative outcomes, including the incidence of POD, were gathered and analyzed. Propensity score matching and logistic regression were conducted to identify factors associated with POD and compare outcomes between the two groups. Results: Among the 502 patients, POD was observed in 161 (32%). The POD incidence was not statistically significantly different between the groups (p = 1.000). A multivariable logistic regression analysis indicated that remimazolam was not a determinant of POD (p = 0.860), whereas being male and polypharmacy were (p = 0.022; p = 0.047). Initial disparities in age and comorbid conditions between the groups were rectified through matching, demonstrating that remimazolam had a similar POD risk to sevoflurane. Conclusions: This study showed that remimazolam did not exacerbate the risk of POD in elderly patients undergoing hip or femur surgery. Remimazolam is a reliable anesthetic option for this vulnerable demographic. Also, this study’s results indicated that polypharmacy and being male are POD risk factors, suggesting that meticulous perioperative medication management may help alleviate the risk of POD. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

14 pages, 509 KiB

Open AccessArticle

Intraoperative Dexmedetomidine Use for Enhanced Recovery after Surgery (ERAS) in Cardiac Surgery—Single Center Retrospective Observational Cohort Study

by Axel Kerroum, Lorenzo Rosner, Emmanuelle Scala, Matthias Kirsch, Piergiorgio Tozzi, Cécile Courbon, Marco Rusca, Silvijus Abramavičius, Povilas Andrijauskas, Carlo Marcucci and Valentina Rancati

Medicina 2024, 60(7), 1036; https://doi.org/10.3390/medicina60071036 - 25 Jun 2024

Cited by 1 | Viewed by 2059

Abstract

Background and Objectives: Dexmedetomidine, an alpha-2 agonist, is used as an adjunct to anesthesia in enhanced recovery after surgery (ERAS) programs. One of its advantages is the opioid-sparing effect which can facilitate early extubation and recovery. When the ERAS cardiac society was [...] Read more.

Background and Objectives: Dexmedetomidine, an alpha-2 agonist, is used as an adjunct to anesthesia in enhanced recovery after surgery (ERAS) programs. One of its advantages is the opioid-sparing effect which can facilitate early extubation and recovery. When the ERAS cardiac society was set in 2017, our facility was already using the ERAS program, in which the “fast-track Anesthesia” was facilitated by the intraoperative infusion of dexmedetomidine. Our objective is to share our experience and investigate the potential impact of intraoperative dexmedetomidine use as a part of the ERAS program on patient outcomes in elective cardiac surgery. Materials and Methods: An observational retrospective cohort study was conducted at a university hospital in Switzerland. The patients who underwent elective cardiac surgery with cardiopulmonary bypass between 1 June 2017 and 31 August 2018 were included in this analysis (n = 327). Regardless of the surgery type, all the patients received a standardized fast-track anesthesia protocol inclusive of dexmedetomidine infusion, reduced opioid dose, and parasternal nerve block. The primary outcome was the postoperative time when the criteria for extubation were met. Three groups were identified: group 0—(extubated in the operating room), group < 6 (extubated in less than 6 h), and group > 6 (extubated in >6 h). The secondary outcomes were adverse events, length of stay in ICU and in hospital, and total hospitalization costs. Results: Dexmedetomidine was well-tolerated, with no significant adverse events reported. Early extubation was performed in 187 patients (57%). Group 3 had a significantly longer length of stay in the ICU (median: 70 h vs. 25 h) and in hospital (17 vs. 12 days), and consequently higher total hospitalization costs (CHF 62,551 vs. 38,433) compared to the net data from the other two groups (p < 0.0001). Conclusions: Our findings suggest that dexmedetomidine can be safely used as part of the opioid-sparing anesthesia protocol in patients undergoing elective cardiac surgery with cardiopulmonary bypass with the potential to facilitate early extubation, shorter ICU and hospital stays, and reduced hospitalization costs. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

12 pages, 1556 KiB

Open AccessArticle

Impact of Intraoperative Nefopam on Postoperative Pain, Opioid Use, and Recovery Quality with Parietal Pain Block in Single-Port Robotic Cholecystectomy: A Prospective Randomized Controlled Trial

by So Yeon Lee, Dong Hyun Kim, Jung Hyun Park and Min Suk Chae

Medicina 2024, 60(6), 848; https://doi.org/10.3390/medicina60060848 - 23 May 2024

Cited by 1 | Viewed by 2734

Abstract

Background and Objectives: This study explored how nefopam, a non-opioid analgesic in a multimodal regimen, impacts postoperative pain, opioid use, and recovery quality in single-port robot-assisted laparoscopic cholecystectomy (RALC) patients with a parietal pain block, addressing challenges in postoperative pain management. Materials [...] Read more.

Background and Objectives: This study explored how nefopam, a non-opioid analgesic in a multimodal regimen, impacts postoperative pain, opioid use, and recovery quality in single-port robot-assisted laparoscopic cholecystectomy (RALC) patients with a parietal pain block, addressing challenges in postoperative pain management. Materials and Methods: Forty patients scheduled for elective single-port RALC were enrolled and randomized to receive either nefopam or normal saline intravenously. Parietal pain relief was provided through a rectus sheath block (RSB). Postoperative pain was assessed using a numeric rating scale (NRS) in the right upper quadrant (RUQ) of the abdomen, at the umbilicus, and at the shoulder. Opioid consumption and recovery quality, measured using the QoR-15K questionnaire, were also recorded. Results: The 40 patients had a mean age of 48.3 years and an average body mass index (BMI) of 26.2 kg/m². There were no significant differences in the pre- or intraoperative variables between groups. Patients receiving nefopam reported significantly lower RUQ pain scores compared to the controls, while the umbilicus and shoulder pain scores were similar. Rescue fentanyl requirements were lower in the nefopam group in both the PACU and ward. The QoR-15K questionnaire scores for nausea and vomiting were better in the nefopam group, but the overall recovery quality scores were comparable between the groups. Conclusions: Nefopam reduces RUQ pain and opioid use post-single-port RALC with a parietal pain block without markedly boosting RSB’s effect on umbilicus or shoulder pain. It may also better manage postoperative nausea and vomiting, underscoring its role in analgesia strategies for this surgery. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

10 pages, 777 KiB

Open AccessArticle

The Effect of Brief Warming during Induction of General Anesthesia and Warmed Intravenous Fluid on Intraoperative Hypothermia in Patients Undergoing Urologic Surgery

by Ye-Ji Oh and In-Jung Jun

Medicina 2024, 60(5), 747; https://doi.org/10.3390/medicina60050747 - 30 Apr 2024

Cited by 1 | Viewed by 1987

Abstract

Background and Objectives: Transurethral urologic surgeries frequently lead to hypothermia due to bladder irrigation. Prewarming in the preoperative holding area can reduce the risk of hypothermia but disrupts surgical workflow, preventing it from being of practical use. This study explored whether early [...] Read more.

Background and Objectives: Transurethral urologic surgeries frequently lead to hypothermia due to bladder irrigation. Prewarming in the preoperative holding area can reduce the risk of hypothermia but disrupts surgical workflow, preventing it from being of practical use. This study explored whether early intraoperative warming during induction of anesthesia, known as peri-induction warming, using a forced-air warming device combined with warmed intravenous fluid could prevent intraoperative hypothermia. Materials and Methods: Fifty patients scheduled for transurethral resection of the bladder (TURB) or prostate (TURP) were enrolled and were randomly allocated to either the peri-induction warming or control group. The peri-induction warming group underwent whole-body warming during anesthesia induction using a forced-air warming device and was administered warmed intravenous fluid during surgery. In contrast, the control group was covered with a cotton blanket during anesthesia induction and received room-temperature intravenous fluid during surgery. Core temperature was measured upon entrance to the operating room (T₀), immediately after induction of anesthesia (T₁), and in 10 min intervals until the end of the operation (T_end). The incidence of intraoperative hypothermia, change in core temperature (T₀–T_end), core temperature drop rate (T₀–T_end/[duration of anesthesia]), postoperative shivering, and postoperative thermal comfort were assessed. Results: The incidence of intraoperative hypothermia did not differ significantly between the two groups. However, the peri-induction warming group exhibited significantly less change in core temperature (0.61 ± 0.3 °C vs. 0.93 ± 0.4 °C, p = 0.002) and a slower core temperature drop rate (0.009 ± 0.005 °C/min vs. 0.013 ± 0.004 °C/min, p = 0.013) than the control group. The peri-induction warming group also reported higher thermal comfort scores (p = 0.041) and less need for postoperative warming (p = 0.034) compared to the control group. Conclusions: Brief peri-induction warming combined with warmed intravenous fluid was insufficient to prevent intraoperative hypothermia in patients undergoing urologic surgery. However, it improved patient thermal comfort and mitigated the absolute amount and rate of temperature drop. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

9 pages, 936 KiB

Open AccessArticle

Comparison of the Effectiveness of the Miller Laryngoscope and the McGrath-MAC Video Laryngoscope in Direct Visualization of the Glottic Opening

by Gamze Küçükosman, Keziban Bollucuoğlu, Mahmut Ava and Hilal Ayoğlu

Medicina 2024, 60(1), 62; https://doi.org/10.3390/medicina60010062 - 28 Dec 2023

Cited by 2 | Viewed by 2742

Abstract

Background and Objective: Placing the laryngoscope blade directly under the epiglottis (known as the direct view (DV) method) during videolaryngoscopy offers a superior view of the glottis when compared to the indirect method of lifting the epiglottis by positioning the Macintosh blade [...] Read more.

Background and Objective: Placing the laryngoscope blade directly under the epiglottis (known as the direct view (DV) method) during videolaryngoscopy offers a superior view of the glottis when compared to the indirect method of lifting the epiglottis by positioning the Macintosh blade tip over the vallecula. While there are few studies comparing glottic views using Miller and Macintosh blades in pediatric patients, we have not come across such a study in adults. In this study, we aimed to compare the effectiveness and hemodynamic responses of the Miller laryngoscope and the McGrath-MAC videolaryngoscope (VL) in visualizing the glottic opening using the DV method. Material and Methods: A prospective study was conducted between August and December 2022 at XXX Hospital on 85 patients scheduled for surgical procedures involving endotracheal intubation. Patients were divided into two groups: Miller laryngoscope (Group M) and McGrath-MAC videolaryngoscope (Group VL) and intubated using the direct lifting method of the epiglottis. Hemodynamic responses before and after induction, as well as during laryngoscopy, intubation time, number of attempts, Cormack and Lehane (C&L) score, percentage of glottic opening (POGO), duration of the view of the opening, and need for external laryngeal pressure during intubation were recorded. Results: Both laryngoscopes showed similar effectiveness in terms of POGO and C&L score when used with the direct lifting method of the epiglottis. The median POGO values according to the DV method were 80% in Group M and 70% in Group VL (p = 0.099). Hemodynamic responses, intubation time, number of attempts, duration of view of the glottis opening, and the need for external laryngeal pressure were similar between the groups. Conclusions: Due to its ability to provide effective intubation conditions, we believe that the McGrath-MAC VL, when used with the indirect view method, can also be utilized in anesthesia practices alongside the DV method. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

9 pages, 731 KiB

Open AccessArticle

Monitored Anesthesia Care in Minimally Invasive Spine Surgery—A Retrospective Case Series Study

by Hyo Jin Kim, Seongho Park, Yunhee Lim and Si Ra Bang

Medicina 2024, 60(1), 43; https://doi.org/10.3390/medicina60010043 - 26 Dec 2023

Cited by 1 | Viewed by 2151

Abstract

Background and Objectives: Minimally invasive spine surgery (MISS) under monitored anesthesia care (MAC) has emerged as a treatment modality for spinal radiculopathy. It is essential to secure the airway and guarantee spontaneous respiration without endotracheal intubation during MISS in a prone position. Materials [...] Read more.

Background and Objectives: Minimally invasive spine surgery (MISS) under monitored anesthesia care (MAC) has emerged as a treatment modality for spinal radiculopathy. It is essential to secure the airway and guarantee spontaneous respiration without endotracheal intubation during MISS in a prone position. Materials and Methods: To evaluate the feasibility and safety of MAC with dexmedetomidine during MISS, we retrospectively reviewed clinical cases. A retrospective review of medical records was conducted between September 2015 and June 2016. A total of 17 patients undergoing MISS were included. Vital signs were analyzed every 15 min. The depth of sedation was assessed using the bispectral index (BIS) and the frequency of rescue sedatives. Adverse events during anesthesia, including bradycardia, hypotension, respiratory depression, postoperative nausea, and vomiting, were evaluated. Results: All cases were completed without the occurrence of airway-related complications. None of the patients needed conversion to general anesthesia. The median maintenance dosage of dexmedetomidine for adequate sedation was 0.40 (IQR 0.40–0.60) mcg/kg/hr with a median loading dose of 0.70 (IQR 0.67–0.82) mcg/kg. The mean BIS during the main procedure was 76.46 ± 10.75. Rescue sedatives were administered in four cases (23.6%) with a mean of 1.5 mg intravenous midazolam. After dexmedetomidine administration, hypotension and bradycardia developed in six (35.3%) and three (17.6%) of the seventeen patients, respectively. Conclusions: MAC using dexmedetomidine is a feasible anesthetic method for MISS in a prone position. Hypotension and bradycardia should be monitored carefully during dexmedetomidine administration. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

11 pages, 5355 KiB

Open AccessArticle

Precise Terminology and Specified Catheter Insertion Length in Ultrasound-Guided Infraclavicular Central Vein Catheterization

by Ainius Žarskus, Dalia Zykutė, Saulius Lukoševičius, Antanas Jankauskas, Darius Trepenaitis and Andrius Macas

Medicina 2024, 60(1), 28; https://doi.org/10.3390/medicina60010028 - 23 Dec 2023

Viewed by 1332

Abstract

Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length [...] Read more.

Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length and possibly to rename the punctuated vessel emerges. Although naming a particular anatomical structure is a nomenclature issue, a suboptimal catheter position can be associated with multiple life-threatening complications and must be avoided. The main study objective is to determine the optimal catheter insertion length by the most proximal ultrasound-guided, in-plane infraclavicular central vein approach, to compare results with the anatomical landmark technique based on subclavian vein catheterization and to clarify the punctuated anatomical structure. Materials and Methods: 109 patients were enrolled in this study. All procedures were performed according to the same catheterization protocol. In order to determine optimal insertion length, chest X-ray scans with an existing catheter were performed. The definition of punctuated vessel was based on computer tomography and evaluated by radiologists. Independent predictors for optimal insertion length were identified, prediction equations were generated. Results: The optimal catheter insertion length is approximately 1.5 cm longer than estimated by Pere’s formula and can be accurately calculated based on anthropometric data. Computed tomography revealed: five cases with subclavian vein puncture and three cases with axillary vein puncture. Conclusions: Even the most proximal ultrasound-guided infraclavicular central vein access does not guarantee subclavian vein catheterization. A more accurate term could be infraclavicular central venous access, with the implication that the entry point could be through either subclavian or axillary veins. The optimal insertion length is approximately 1.5 cm deeper than the length determined for the anatomical landmark technique based on subclavian vein catheterization. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

Other

Jump to: Research

15 pages, 1659 KiB

Open AccessSystematic Review

Comparison of the Safety and Efficacy of Remimazolam and Propofol for Sedation in Adults Undergoing Colonoscopy: A Meta-Analysis of Randomized Controlled Trials

by Bon-Wook Koo, Hyo-Seok Na, Sang-Hi Park, Seunguk Bang and Hyun-Jung Shin

Medicina 2025, 61(4), 646; https://doi.org/10.3390/medicina61040646 - 1 Apr 2025

Viewed by 88

Abstract

Background and Objectives: This meta-analysis evaluates the safety and efficacy of remimazolam versus propofol for sedation during colonoscopy, focusing on hemodynamic and respiratory outcomes. Materials and Methods: A comprehensive search of CENTRAL, Embase, PubMed, Scopus, and Web of Science up to [...] Read more.

Background and Objectives: This meta-analysis evaluates the safety and efficacy of remimazolam versus propofol for sedation during colonoscopy, focusing on hemodynamic and respiratory outcomes. Materials and Methods: A comprehensive search of CENTRAL, Embase, PubMed, Scopus, and Web of Science up to January 2025 identified randomized controlled trials (RCTs). Outcomes included hypotension (primary outcome), bradycardia, respiratory depression, injection pain, sedation onset time, emergence time, procedure success rate, and recovery room stay. Effect sizes were reported as relative risks (RR) or mean differences (MD) using random-effects models. Results: Fourteen RCTs with 3290 participants were included. Remimazolam significantly reduced the risk of hypotension (RR: 0.44, 95% CI [0.39, 0.51], p = 0.0000), bradycardia (RR: 0.36, 95% CI [0.25, 0.53], p = 0.0000), respiratory depression (RR: 0.32, 95% CI [0.22, 0.45], p = 0.0000), and injection pain (RR: 0.14, 95% CI [0.09, 0.24], p = 0.0000) compared to propofol. Remimazolam had slower sedation onset (MD: 15.97 s, 95% CI [8.30, 23.64], p = 0.0000) but allowed faster emergence (MD: −0.91 min, 95% CI [−1.69, −0.13], p = 0.023) and shorter recovery room stays (MD: −2.20 min, 95% CI [−3.23, −1.17], p = 0.0000). Both drugs had similar procedure success rates. Conclusions: Remimazolam demonstrates superior safety and efficacy compared to propofol, reducing risks of hypotension, bradycardia, respiratory depression, and injection pain while enabling faster recovery. These findings support remimazolam as a viable sedative for colonoscopy, though further large-scale studies are needed to confirm these results. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

15 pages, 2055 KiB

Open AccessSystematic Review

The Efficacy and Adverse Effects of Sugammadex and Neostigmine in Reversing Neuromuscular Blockade Inpatients with Obesity Undergoing Metabolic and Bariatric Surgery: A Systematic Review with Meta-Analysis and Trial Sequential Analysis

by Shuangwen Wang, Yanjie Dong, Shuangcheng Wang, Yang Han and Qian Li

Medicina 2024, 60(11), 1842; https://doi.org/10.3390/medicina60111842 - 8 Nov 2024

Viewed by 1470

Abstract

Background and Objectives: Metabolic and bariatric surgery (MBS) is practiced worldwide. Sugammadex was proven to have multiple benefits in reversing neuromuscular blockade (NMB) for patients with obesity undergoing MBS, but its effects on complications of various systems are not clear and concrete. [...] Read more.

Background and Objectives: Metabolic and bariatric surgery (MBS) is practiced worldwide. Sugammadex was proven to have multiple benefits in reversing neuromuscular blockade (NMB) for patients with obesity undergoing MBS, but its effects on complications of various systems are not clear and concrete. Materials and Methods: This systematic review and meta-analysis was conducted as per the PRISMA guidelines and registered on the PROSPERO database (CRD42023491171). A systematic search was conducted in multiple databases for studies comparing sugammadex with neostigmine in MBS. Continuous data are reported as mean differences (MDs) and 95% confidence intervals (CIs). Dichotomous data are reported as relative risks (RRs) and 95% CIs. A two-sided p < 0.05 was considered statistically significant. Trial sequential analysis (TSA) was performed to evaluate the reliability of the conclusions. Results: Nine studies with 633 patients met the inclusion criteria. Compared with those from the neostigmine group, patients from the sugammadex group were characterized by a significantly shorter recovery time from the administration of the study drug to a train-of-four (TOF) ratio of ≥90% (MD [95% CI]: −15.40 [−26.64; −4.15]; I² = 96.6%; p = 0.0073; n = 380; random effects model), a lower risk of postoperative residual curarization (PORC) (RR [95% CI]: 0.18 [0.09; 0.38]; p < 0.0001; I² = 27.9%; n = 344; common effect model), postoperative nausea and vomiting (PONV) (RR [95% CI]: 0.67 [0.48; 0.93]; p = 0.0164; I² = 0%; n = 335; common effect model), and cardiovascular complications (RR [95% CI]: 0.48 [0.26; 0.88]; p = 0.0186; I² = 14.7%; n = 178; common effect model). TSA confirmed the conclusions regarding the recovery time and PORC risk. Conclusions: In conclusion, our systemic review and meta-analysis with TSA revealed that sugammadex provided a faster and more reliable choice to reverse NMB in patients with obesity undergoing MBS, with a lower risk of PORC. Sugammadex reduced the risk of cardiovascular complications and postoperative nausea and vomiting. However, the conclusions were not confirmed, and, so, further studies may be necessary. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Anesthesia and Analgesia in Surgical Practice

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (11 papers)

Research

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI