Trial reportDrug design, development and therapy2025
Sugammadex versus Neostigmine Reversal After Thoracoscopic Thymectomy in Myasthenia Gravis: A Multicenter, Randomized Controlled Trial.
Trial report in Drug design, development and therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
Purpose: Rapid and complete reversal of residual neuromuscular blockade (rNMB) is essential for safe postoperative recovery in patients with myasthenia gravis (MG) undergoing video-assisted thoracoscopic (VATS) thymectomy. Although sugammadex provides a novel approach for reversing rocuronium-induced neuromuscular blockade, its efficacy in this high-risk population under routine-practice conditions-where reversal timing relies on clinical judgment-remains incompletely characterized. This multicenter randomized controlled trial (RCT) compared the efficacy of sugammadex versus neostigmine for reversing rNMB in patients with mild MG undergoing VATS thymectomy, specifically under this pragmatic, experience-guided scenario. Patients and Methods: In this prospective, superiority-design RCT, MG patients scheduled for VATS thymectomy were randomized 1:1 to receive either sugammadex (2 mg/kg) or neostigmine (0.05 mg/kg with atropine 0.02 mg/kg) for reversal of rocuronium-induced neuromuscular blockade. All patients received a standard induction dose of rocuronium (0.6 mg/kg). The attending anesthesiologist, blinded to both the reversal agent and all quantitative neuromuscular monitoring data, managed blockade using a minimal-dose strategy (boluses only for clinical signs of inadequate block). This blinded anesthesiologist determined reversal timing based on clinical judgment, with administration contingent upon independent verification of a TOF count ≥ 2. The primary outcome was recovery time (interval from reversal agent administration to normalized TOF ratio of ≥ 0.9), analyzed with the Mann-Whitney Results: Among 62 randomized patients (31 per group), all patients received reversal at a train-of-four (TOF) count of ≥2 (median count at reversal: 3 in both groups). Sugammadex achieved significantly faster recovery (median 2.62 [IQR 1.83-3.28] minutes; range 0.92-5.80 minutes) versus neostigmine (14.63 [12.22-16.30] minutes; range 10.97-28.81 minutes), with an estimated median difference of 12.01 minutes (95% CI: 9.50-14.52; Conclusion: In patients with MG undergoing VATS thymectomy, this pragmatic trial simulating routine practice demonstrates that sugammadex provides faster and more reliable reversal of moderate neuromuscular blockade (median TOF count 3) than neostigmine, leading to clinically meaningful reductions in recovery time (by 12.01 minutes), extubation time, and rNMB incidence.
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