Comparing sugammadex to neostigmine and their effects on delirium and postoperative cognitive function: A systematic review.
Andrew Slowgrove, Celeste Ng, Alexandra Tebbett
PMID 41181982WHAT IT FOUND
Sugammadex did not reduce postoperative delirium or cognitive dysfunction compared with neostigmine.
One small study reported better recovery scores, but the authors said they were unlikely clinically important.
Key findings
01Four of the five included studies found no statistical or clinical difference in postoperative cognitive function between sugammadex and neostigmine.
02In the Rössler cohort, postoperative delirium incidence after propensity weighting was 0.82% with neostigmine and 1.09% with sugammadex, with an odds ratio of 1.33 and a p-value of 0.147.
03Only the 21-patient observational study reported better cognitive recovery with sugammadex at 30 days, but its authors said the differences were unlikely clinically important.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only five studies were suitable for inclusion, and they used different cognitive tests and patient groups, so the review could not combine them in a meta-analysis. The only study with better cognitive recovery scores had 21 patients, and its authors said the differences were unlikely clinically important. Several studies had confounders, including surgery type, anaesthetic drugs, reversal doses, and whether patients had cardiac surgery, which could affect delirium or cognitive outcomes. One randomised trial recruited 128 patients but 41 dropped out, leaving 87 analysed, which weakens its evidence. Delirium screening was not uniform, and hypoactive delirium may have been missed if symptoms were not actively looked for.
Declared interests
The review authors declared no conflicts of interest and received no funding. One included study was funded by Merck Sharp & Dohme Spain and CEU Cardenal Herrera University.
The easy way to misread this
Do not conclude sugammadex prevents postoperative delirium or cognitive decline. The overall evidence showed no meaningful difference, and the one study with better recovery scores had only 21 patients and its authors said the differences were unlikely clinically important.