The effect of neuromuscular blocking reversal agents on perioperative neurocognitive function after general anaesthesia: a systematic review and meta-analysis.

Summary

Across 10 RCTs (n=1705), sugammadex reduced early PND versus neostigmine (RR 0.67) without increasing adverse events, while accelerating TOF recovery. This suggests a neurocognitive advantage to sugammadex in the immediate postoperative period.

Key Findings

• Systematic review and meta-analysis of 10 RCTs including 1705 patients under general anesthesia.
• Sugammadex reduced early postoperative PND compared with neostigmine (RR 0.67; 95% CI 0.48–0.94).
• No increase in adverse events (e.g., PONV, mortality); faster recovery to TOF ≥0.9.

Clinical Implications

When risk of early PND is a concern (e.g., older adults, cognitive vulnerability), clinicians may favor sugammadex over neostigmine, considering cost and availability.

Limitations

• Heterogeneity in PND definitions and neurocognitive tests; follow-up restricted to ≤7 days.
• Potential publication bias; limited trials directly comparing the same regimens.

Future Directions

Longer-term RCTs assessing sustained neurocognitive outcomes, cost-effectiveness, and subgroup effects (e.g., frailty, baseline cognitive impairment).