Evidence map›Paper›PMID 40819345›Full record

ArticleAnnals of medicine2025

Sugammadex versus neostigmine on postoperative adverse respiratory events in elderly patients undergoing lung resection: study protocol for a randomized controlled trial.

Yuxin Wang, Xiang Li, Huimin Deng, Di Feng, Liuyuan Zhao, Feihong Lin, Tian Jin, Sheng Wang, Xin Lv, Juan Wei

Abstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Yuxin WangDepartment of Anesthesiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Xiang LiDepartment of Anesthesiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Huimin DengDepartment of Anesthesiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Di FengDepartment of Anesthesiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Liuyuan ZhaoDepartment of Anesthesiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Feihong LinDepartment of Anesthesiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Tian JinDepartment of Anesthesiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Sheng WangDepartment of Anesthesiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Xin LvDepartment of Anesthesiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
Juan WeiDepartment of Anesthesiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.ORCID 0000-0001-8665-2621

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundElderly patients undergoing lung resection are particularly susceptible to postoperative adverse respiratory events (AREs), due to age-related physiological decline and a higher incidence of residual neuromuscular blockade (RNMB). Sugammadex is a selective relaxant binding agent that enables rapid and complete reversal of aminosteroid neuromuscular blocking agents such as rocuronium, offering potential advantages over traditional acetylcholinesterase inhibitors like neostigmine. However, evidence directly comparing the impact of sugammadex versus neostigmine on clinically relevant respiratory outcomes, particularly AREs in elderly patients undergoing lung resection remains limited. METHODS AND ANALYSIS: This is a prospective, double-blinded, randomized controlled clinical trial involving 530 elderly patients (≥65 years old) scheduled for video-assisted thoracoscopic lung surgery requiring one-lung ventilation. Patients will be 1:1 randomized to receive sugammadex or neostigmine for neuromuscular blockade reversal. The primary outcome is a composite of AREs occurring in the post-anaesthesia care unit (PACU). Secondary outcomes include time from neuromuscular to extubation, the composite of ARE and rescue measures, PACU length of stay, postoperative pulmonary and extra-pulmonary complications, unplanned intensive care unit (ICU) admission, chest drainage tube duration, hospital length of stay, and mortality. All patients will be followed up until 30 days after surgery. The primary analysis will be conducted on a modified intention-to-treat basis. DISCUSSION: This trial is designed to address a critical gap in perioperative care for elderly patients undergoing lung resection by directly comparing sugammadex and neostigmine in terms of clinically meaningful respiratory outcomes. While previous studies have primarily focused on pharmacokinetic profiles or surrogate markers such as train-of-four recovery time, evidence regarding the impact of these agents on postoperative AREs remains limited. Given the growing elderly surgical population and the high incidence of RNMB and pulmonary complications in this group, the findings of this study will offer valuable insight into optimizing neuromuscular blockade reversal strategies.

trial registrationThis study is registered at Chinese clinical trial registry (ChiCTR2400094005).

Indexed as

NeostigminePneumonectomyPostoperative ComplicationsSugammadexAgedAged, 80 and overAnesthesia Recovery PeriodCholinesterase InhibitorsDouble-Blind MethodFemaleHumansMaleNeuromuscular BlockadeOne-Lung VentilationProspective StudiesRandomized Controlled Trials as TopicCholinesterase InhibitorsNeostigmineRocuroniumSugammadexAdverse respiratory eventselderlylung resectionneostigminesugammadex

Identifiers

PMID40819345
PMCPMC12360052

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.