Observational studyBritish journal of anaesthesia2025
Association of sugammadex, neostigmine, or pyridostigmine for reversal of neuromuscular block with postoperative bradycardia: a multicentre, retrospective observational study.
Observational study in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Corrections and comments
- Erratum issued
Authors and funding
13 authors.
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Abstract
backgroundThe aim of this study was to evaluate the risk of bradycardia after sugammadex administration for reversal of neuromuscular block compared with neostigmine and pyridostigmine.
methodsThis multicentre retrospective observational study included adult patients who underwent surgery under general anaesthesia between 2011 and 2021 in three university hospitals in Korea. The risk of bradycardia, defined as relative (≥10%, ≥20%, ≥30%, or ≥40%) or absolute (≥5, ≥10, ≥15, or ≥20 beats min
resultsA total of 359 414 patients were analysed; sugammadex, neostigmine, and pyridostigmine were administered in 107 018, 97 754, and 154 642 patients, respectively. The overall incidence of bradycardia in the sugammadex group was similar to that of the neostigmine group. Specifically, the risk of a ≥20% decrease in HR was not significantly different between the sugammadex and neostigmine groups (9.8% vs 10.2%; odds ratio [95% confidence interval]: 1.00 [0.97-1.03]), though it was significantly higher in the sugammadex group than in the pyridostigmine group (9.8% vs 5.8%; 1.93 [1.87-1.98]). Restricted cubic spline curves suggested a linear increase in the risk of a ≥20% decrease in HR as the dose of sugammadex increased.
conclusionsThe incidence of bradycardia after sugammadex administration was low, and its adjusted risk was not significantly different from that of neostigmine, the most commonly used acetylcholinesterase inhibitor for reversal of neuromuscular block.
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