Efficacy and safety of sugammadex sodium in reversing rocuronium-induced neuromuscular blockade in children: An updated systematic review and meta-analysis

OBJECTIVE: In response to the differences in pharmacodynamic and pharmacokinetic characteristics of neuromuscular blocking agents between children and adults and limited studies which existing meta-analyses included, this study will update the safety and efficacy of sugammadex (Sug) sodium in reversing rocuronium-induced neuromuscular blockade in children. METHODS: Five electronic databases were searched for clinical trials on the safety and efficacy of Sug sodium in reversing rocuronium-induced neuromuscular block in children. A random-effects model was used to calculate the standardized mean difference (SMD) for primary outcomes. The relative risk (RR) was calculated for secondary outcomes. RESULTS: As of 2022-11-03, 18 out of 236 studies included 724 children in the intervention group and 478 children in the control group for meta-analysis. The results showed that compared with the control group, the time required for Train-of-Four Ratio (TOFR) to return to 0.9 and the extubation time were shortened in both 2 mg/kg and 4 mg/kg of Sug sodium, with statistically significant differences (TOFR ≥0.9: 2 mg/kg: SMD = −2.90; 95%CI: −3.75, −2.04; 4 mg/kg: −3.31; −4.79, −1.84; extubation time: 2 mg/kg: −2.95; −4.04, −1.85; 4 mg/kg: −1.57; −1.90, −1.23). Compared with the control group, the total incidence of adverse effects in the Sug group was lower (RR = 0.44; 0.24,0.82). CONCLUSIONS: This review and meta-analysis suggest that Sug sodium is more effective and safer in reversing rocuronium-induced neuromuscular blockade in children than traditional antagonistic regimens or placebos.