2025 FSA Podium and Poster Abstracts

INTRODUCTION

The choice of neuromuscular blockade reversal agent may influence postoperative cognitive recovery. Cholinesterase inhibitors, such as neostigmine, in conjunction with anticholinergics like atropine and glycopyrrolate, have the potential to disrupt central cholinergic transmission, and consequently impairing cognitive function in the postoperative period, although the extent of this effect remains uncertain. In contrast, sugammadex offers a rapid and selective reversal of aminosteroid neuromuscular blockers without affecting the cholinergic system. This study aims to assess the hypothesis that patients receiving sugammadex for neuromuscular blockade reversal exhibit superior cognitive recovery in the postoperative period.

METHODS

We performed a systematic search of PubMed, EMBASE, and Cochrane databases to identify randomized controlled trials (RCTs) and observational studies comparing sugammadex and neostigmine (± anticholinergics) for neuromuscular blockade reversal in adults undergoing elective surgery under general anesthesia. Studies published until January 2025 that reported cognitive recovery as an outcome and assessed it using the Mini-Mental State Examination (MMSE) or the cognitive domain of the Postoperative Quality Recovery Scale (PQRS) were included. Continuous and dichotomous outcomes were standardized using the Practical Meta-Analysis Effect Size Calculator (Version 2023.11.27; Wilson, D. B., 2023) to compute standardized mean differences (SMD) and standard errors (SE). Meta-analysis was performed using the generic inverse variance method in RevMan (Version 5.4; Cochrane Collaboration, 2023) to estimate pooled effect sizes with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic, with a p-value < 0.05 considered statistically significant.

RESULTS

Eight studies, including six randomized controlled trials (RCTs) and two observational studies, were included in the analysis, with a total of 996 patients (497 receiving sugammadex and 499 receiving neostigmine). Early postoperative cognitive recovery (40–60 minutes) showed a statistically significant improvement in the sugammadex group compared to the neostigmine group (SMD 0.22; 95% CI [0.07, 0.36]; p = 0.004). However, no significant differences in cognitive recovery were observed between the two groups at other postoperative time points: immediate postoperative (≤15 minutes) (SMD 0.10; 95% CI [-0.10, 0.30]; p = 0.32); intermediate postoperative (1 day after surgery) (SMD 0.15; 95% CI [-0.13, 0.43]; p = 0.29); and late postoperative (3–7 days) (SMD -0.17; 95% CI [-0.46, 0.12]; p = 0.24).

CONCLUSION

In conclusion, sugammadex showed a significant improvement in early postoperative cognitive recovery (40–60 minutes) compared to neostigmine, but no differences were observed at immediate (≤15 minutes), intermediate (1 day), or late (3–7 days) postoperative time points. This suggests that sugammadex may offer short-term cognitive benefits, but its effects are comparable to neostigmine over the broader recovery period.