British journal of anaesthesia最新文献

{"title":"Direct inhibition of cystathionine-β-synthase by isoflurane contributes to delayed neurocognitive recovery after isoflurane general anaesthesia in mice","authors":"Feifei Xu ,&nbsp;Peng Zhang ,&nbsp;Huiqing Liu ,&nbsp;Rui Wang ,&nbsp;Ze Fan ,&nbsp;Yuan Gao ,&nbsp;Zhihong Lu ,&nbsp;Peilin Cong ,&nbsp;Haixia Chen ,&nbsp;Jinghao Wang ,&nbsp;Hailong Dong ,&nbsp;Lize Xiong ,&nbsp;Guangchao Zhao","doi":"10.1016/j.bja.2025.03.044","DOIUrl":"10.1016/j.bja.2025.03.044","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative neurocognitive disorders (PND) are severe complications of surgery and other invasive procedures. However, the underlying mechanisms by which general anaesthetics contribute to PND remain largely unknown. Based on our findings of a link between hyperhomocysteinaemia and increased risk of PND, we investigated functional alterations in cystathionine-β-synthase (CBS) and its role in memory function after general anaesthesia.</div></div><div><h3>Methods</h3><div>Mice were subjected to isoflurane 1.4 vol% anaesthesia for 2 h, and the levels of homocysteine, homocysteine-associated enzyme expression, and CBS activity were measured using ELISA. The time course of memory reconstruction after general anaesthesia was evaluated using the contextual fear conditioning test. WaterLOGSY was used to examine the interaction between isoflurane and CBS. A hydrogen sulfide (H₂S) probe, AZ-NO₂, was used for H₂S bioimaging, and RNA sequencing, sulfhydrome detection, and <em>in vivo</em> electrophysiological recordings were performed to explore the underlying mechanisms.</div></div><div><h3>Results</h3><div>The decline in cognitive function persisted for at least 8 h after isoflurane anaesthesia, which is attributed to the selective homocysteine accumulation in the brain via direct inhibition of CBS activity by isoflurane. Activation of CBS alleviates the reduction of H₂S and alters the sulfhydration of synaptic-related proteins, ultimately accelerating the restoration of neuronal firing rates in the hippocampus (saline, 1.42 [0.49] <em>vs</em> NaHS, 2.45 [0.68] Hz). Pretreatment with S-adenosylmethionine (SAM, CBS activator) could increase the freezing time of mice after isoflurane anaesthesia (control 4.86 [3.30]% <em>vs</em> SAM, 9.89 [3.03]%).</div></div><div><h3>Conclusions</h3><div>Isoflurane contributes to delayed cognitive recovery after isoflurane anaesthesia in mice by directly inhibiting CBS activity, providing novel insights into the involvement of isoflurane in PNDs and their underlying mechanisms.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Pages 360-374"},"PeriodicalIF":9.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of prevention effectiveness in postoperative neurocognitive disorder and delayed neurocognitive recovery research: a systematic review with meta-regression of randomised trials","authors":"Niloy K. Lahiri ,&nbsp;Nikola Vuckovic ,&nbsp;Angad S. Sidhu ,&nbsp;Jiangqiong Li ,&nbsp;Yanhua Sun ,&nbsp;Semanti Naiken ,&nbsp;Samantha J. Curtis ,&nbsp;Emma Bisch ,&nbsp;Ryan Bolda ,&nbsp;Prabhnoor S. Nagra ,&nbsp;Gary Mann ,&nbsp;Aiden E. Gonzales ,&nbsp;Leah Smith ,&nbsp;Brendan P. Anderson ,&nbsp;Ziyue Liu ,&nbsp;David C. Adams ,&nbsp;Lingzhong Meng","doi":"10.1016/j.bja.2025.04.021","DOIUrl":"10.1016/j.bja.2025.04.021","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative neurocognitive disorder and delayed neurocognitive recovery (pNCD/dNCR) are common yet unresolved complications after surgery.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature search in resources of Ovid MEDLINE, EMBASE, Web of Science, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> and multivariable meta-regression analyses of RCTs to identify trial-level characteristics associated with prevention effectiveness in pNCD/dNCR research. Trials investigating pNCD/dNCR prevention in adult surgical patients were eligible. Trials performed in paediatric patients or assessing cognitive changes on the same day of surgery were excluded. Effectiveness associated with trial-level characteristics was assessed using ratio of odds ratio (OR) and 95% confidence interval (CI).</div></div><div><h3>Results</h3><div>We analysed 187 eligible trials. Trials originating from the USA/Canada (ratio of OR, 3.04; 95% CI, 1.62–5.73; <em>P</em>=0.001), Europe/Australia/New Zealand (1.58; 1.04–2.40; <em>P</em>=0.033), and other regions (2.0; 1.19–3.36; <em>P</em>=0.009) were associated with reduced effectiveness compared with trials from China. Higher pNCD/dNCR incidence in control groups was associated with greater effectiveness (0.98; 0.97–0.99; <em>P</em>&lt;0.001). Trials involving volatile anaesthetics (2.12; 1.16–3.86; <em>P</em>=0.014) were associated with reduced effectiveness compared with dexmedetomidine and abdominal surgery, respectively. Registered trials exhibited enhanced effectiveness (0.69; 0.50–0.95; <em>P</em>=0.022), whereas those with power analyses reported reduced effectiveness (1.43; 1.06–1.94; <em>P</em>=0.021). Trials with a high risk of bias in the selection of the reported result were associated with reduced effectiveness (2.99; 1.04–8.59; <em>P</em>=0.041). Dexmedetomidine was the most studied intervention, showing potential benefits, though evidence certainty was very low.</div></div><div><h3>Conclusions</h3><div>Trial-level characteristics were significantly associated with prevention effectiveness in pNCD/dNCR research. Identifying and addressing the underlying causes of regional differences might enhance the quality and consistency of future trials on a global level.</div></div><div><h3>Systematic review protocol</h3><div>PROSPERO (CRD42024543584).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Pages 340-359"},"PeriodicalIF":9.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of sugammadex, neostigmine, or pyridostigmine for reversal of neuromuscular block with postoperative bradycardia: a multicentre, retrospective observational study.","authors":"Hye-Bin Kim, Ah-Ran Oh, Jungchan Park, Heezoo Kim, Hyo Sung Kim, Dong Ju Lee, In Jung Kim, Jaeyeon Chung, Youn Joung Cho, Yunseok Jeon, Jae-Woo Ju, Karam Nam","doi":"10.1016/j.bja.2025.04.046","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.046","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to evaluate the risk of bradycardia after sugammadex administration for reversal of neuromuscular block compared with neostigmine and pyridostigmine.</p><p><strong>Methods: </strong>This 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^-1) decreases in heart rate (HR) from baseline within 30 min after the administration of sugammadex, neostigmine, or pyridostigmine was compared using logistic regression with stabilised inverse probability of treatment weighting.</p><p><strong>Results: </strong>A 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.</p><p><strong>Conclusions: </strong>The 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.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversing the triad of anaesthesia in a cannot intubate, cannot oxygenate emergency. Comment on Br J Anaesth 2024; 133: 190-2.","authors":"Huw Garland, Graham Ladds","doi":"10.1016/j.bja.2025.04.044","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.044","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction models for postoperative pulmonary complications: a systematic review and meta-analysis.","authors":"Zhiyu Huang, Yang Han, Huijia Zhuang, Jingyao Jiang, Cheng Zhou, Hai Yu","doi":"10.1016/j.bja.2025.04.025","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.025","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pulmonary complications (PPCs) increase mortality, hospital stays, and healthcare costs. Multivariable prediction models can guide patient care by identifying high-risk patients. The discriminative ability and potential for clinical impact of PPC prediction models remains unclear.</p><p><strong>Methods: </strong>We systematically searched Cochrane, Embase, and PubMed (up to June 2024) for studies developing or validating prediction models for PPCs that reported c-statistic. The primary outcome was the c-statistic of prediction models for composite PPCs, and the secondary outcome was the c-statistic for individual PPCs, including pneumonia, respiratory failure, reintubation, and others. Data were extracted using the CHARMS checklist, and bias was assessed with PROBAST. For models with data from three or more cohorts, discrimination was synthesised by pooling c-statistic using Bayesian meta-analysis, with heterogeneity assessed through prediction intervals.</p><p><strong>Results: </strong>A total of 123 studies were included, covering 116 prediction models for PPCs, with 14 models (1 004 029 patients) eligible for meta-analysis. The c-statistic of all models ranged from 0.614 to 0.996 (median 0.80), with 50% of models self-reporting good (c-statistic >0.8) discrimination. In meta-analysis, the ARISCAT PPC score (summary c-statistic 0.76, 95% CI 0.67-0.86), Xue's model (0.82, 0.75-0.89), and CARDOT score (0.73, 0.61-0.85) demonstrated moderate (c-statistic 0.7-0.8) to good discrimination for composite PPCs; the DAGDA score (0.81, 0.74-0.88), Wang's model (0.78, 0.70-0.86), and Jin's model (0.75, 0.68-0.82) for postoperative pneumonia; and Yoon's model (0.90, 0.84-0.96) and Nizamuddin's model (0.85, 0.78-0.92) for postoperative respiratory failure. The reliability of these models, however, is currently limited by the lack of external validation cohorts. Overall, 90.2% of models were assessed as having a high risk of bias.</p><p><strong>Conclusions: </strong>Many prediction models postoperative pulmonary complications have been developed, but the clinical utility of the vast majority remains uncertain.</p><p><strong>Clinical trial registration: </strong>PROSPERO database (CRD42024580216).</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding patient perceptions, knowledge, and experience of perioperative allergic reactions: a qualitative interview study.","authors":"Louise Savic, Anoop Mistry, Sinisa Savic, Gururaj Arumugakani, Rupert Pearse, Lene Heise Garvey, Philp M Hopkins, Nikki Rousseau","doi":"10.1016/j.bja.2025.03.041","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.041","url":null,"abstract":"<p><strong>Background: </strong>Life-threatening allergic reactions can occur during surgery and anaesthesia. Patients' perceptions, knowledge, and experience of these events are largely unreported. Better understanding of patient perspectives might influence the design of future treatment pathways.</p><p><strong>Methods: </strong>Adult patients (≥18 yr) referred to the Yorkshire Perioperative Allergy Clinic for investigation were invited to semi-structured interviews 1 week before and 1 week after their clinic visit. Patients were recruited until thematic saturation was achieved. Codebook thematic analysis of transcripts was conducted in a continuous, iterative process.</p><p><strong>Results: </strong>We recruited 11 patients (22 interviews). We identified four key themes: (1) impact of being 'absent' (unconscious) during the reaction; (2) implications of the allergic reaction for the patient; (3) understanding of allergy and allergy testing; (4) perception of vulnerability during future surgery. For many, being 'absent' made it harder to process the event; for others this was protective. Many developed a profound sense of vulnerability affecting daily life. Other health concerns interacted with and modified the impact of the event. Understanding of allergy was generally poor; several patients had inaccurate recall of their diagnosis. Despite anxiety about future surgery, patients often appeared ambivalent about the need to tell healthcare professionals about their diagnosis, believing 'the system' would act on their behalf.</p><p><strong>Conclusions: </strong>Perioperative allergic events cause persistent anxiety, significantly impacting quality of life. Misunderstanding around the allergy diagnosis and its implications exposes patients to substantial risk during future surgery. There is a need for greater patient awareness to reduce this risk.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of accelerometry to measure the impact of remifentanil on sleep after mitral valve repair surgery","authors":"Janelle M. Wagnild ,&nbsp;Rebecca H. Maier ,&nbsp;Emmanuel Ogundimu ,&nbsp;Chris Bayliss ,&nbsp;Enoch F. Akowuah","doi":"10.1016/j.bja.2025.04.043","DOIUrl":"10.1016/j.bja.2025.04.043","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 1","pages":"Pages 281-283"},"PeriodicalIF":9.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The amnesic effects of propofol on functional connectivity in the hippocampus determined by functional magnetic resonance imaging in volunteers.","authors":"David Lindsay, Ram M Adapa, David K Menon, Emmanuel A Stamatakis","doi":"10.1016/j.bja.2025.04.032","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.032","url":null,"abstract":"<p><strong>Background: </strong>One of the primary actions of general anaesthetic agents, apart from inducing a state of unconsciousness, is reversible impairment of memory formation during the period of administration. Failure to induce and maintain amnesia can result in recall of accidental intraoperative awareness and contribute to adverse psychological health outcomes. The precise mechanisms of action by which general anaesthetics achieve their amnesic effects are not fully understood. To this end, we focused on the hippocampus, a region critical for the formation of new episodic explicit long-term memories of the type normally inhibited by general anaesthetics.</p><p><strong>Methods: </strong>We enrolled 25 healthy adult volunteers who underwent functional magnetic resonance neuroimaging (fMRI) whilst sedated with a plasma target-controlled infusion of the anaesthetic agent propofol. The functional connectivity (synchronised neuronal activity with other brain regions) of the hippocampus and microanatomical hippocampal subregions was assessed at baseline, under sedation, and during recovery. Serial plasma propofol concentrations and responses to an auditory stimulus semantic decision task were measured. Post-scanning memory testing was conducted, and memory performance was related to the fMRI data.</p><p><strong>Results: </strong>Functional connectivity changes associated with an amnesic but subhypnotic depth of propofol sedation were predominantly characterised by a reduced connectivity signature of the hippocampus stratum radiatum, stratum lacunosum, stratum moleculare, CA1 stratum pyramidalis, and CA4/dentate gyrus subfields with the precuneus.</p><p><strong>Conclusions: </strong>We provide evidence for differential actions of propofol on hippocampal subdivisions and limbic circuits related to amnesic efficacy, which suggests a more significant role of the precuneus in long-term memory consolidation than previously thought.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving medication safety in the perioperative setting: development of a medication use process.","authors":"Almudena Ribed, Álvaro Giménez-Manzorro, Ana de Lorenzo-Pinto, Beatriz Torroba-Sanz, M D Ginel-Feito, P Cabrerizo-Torrente, M L Martín Barbero, Ana Herranz, María Sanjurjo","doi":"10.1016/j.bja.2025.04.034","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.034","url":null,"abstract":"<p><strong>Background: </strong>Medication errors are highly prevalent in the perioperative setting. The objectives of this study were to re-engineer the medication use process in the perioperative setting and to draft safety recommendations to improve safe medication use in daily practice.</p><p><strong>Methods: </strong>A group coordinated by medical centre management and composed of pharmacists, surgeons, anaesthesiologists, nurses, and information technicians was formed in 2020. A failure mode and effects analysis was performed to assess the perioperative use of drugs in surgical patients from preadmission to discharge, and 25 failure modes were identified. A bibliographic review was carried out to detect and prioritise safety strategies according to the failure modes detected. The risk priority number was calculated before and after implementation of the safety strategies.</p><p><strong>Results: </strong>A new medication use process was defined and eight safety strategies were implemented to improve perioperative drug safety. These strategies included implementation of automated dispensing cabinets, preparation of general anaesthesia trays with ready-to-administer medications, development and implementation of a one-step computerised provider order entry system for prescribing and administration in the operating room with barcode registration technology, implementation of a pharmaceutical care programme for surgical patients based on medication reconciliation at all transitions of care, and implementation of new alerts in the clinical decision support system linked to computerised provider order entry to improve pain, anticoagulation, and antibiotic management during surgical follow-up. The risk priority number for critical failure modes changed from 229.5 to 62.8 after implementation of the safety strategies, corresponding to a 72.9% decrease (P=0.016).</p><p><strong>Conclusions: </strong>A new process was implemented based on integrated multidisciplinary care and a strong commitment to technology that promotes safe medication use throughout the perioperative setting.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of adamgammadex for reversing rocuronium-induced deep neuromuscular block: a multicentre, randomised, double-blind, positive-controlled phase III trial","authors":"Yanhua Zhao ,&nbsp;Yuqing Ren ,&nbsp;Wenqin Xie ,&nbsp;Yulan Wang ,&nbsp;Yishan Lei ,&nbsp;Yingxia Zhu ,&nbsp;Xiaoqing Zhang ,&nbsp;Xiaozhi Wu ,&nbsp;Xiaoming Guo ,&nbsp;Yingying Jiang ,&nbsp;Saiying Wang ,&nbsp;Qian Lei ,&nbsp;Jiyue You ,&nbsp;Yonghao Yu ,&nbsp;Yinhui Zhou ,&nbsp;Wenjuan Zhou ,&nbsp;Guohai Xu ,&nbsp;Chang Li ,&nbsp;Zhengfeng Gu ,&nbsp;Foquan Luo ,&nbsp;Weifeng Yu","doi":"10.1016/j.bja.2025.04.031","DOIUrl":"10.1016/j.bja.2025.04.031","url":null,"abstract":"<div><h3>Background</h3><div>Adamgammadex, a newly developed modified γ-cyclodextrin derivative, has demonstrated efficacy in reversing deep rocuronium-induced neuromuscular block in early clinical trials.</div></div><div><h3>Methods</h3><div>This multicentre, randomised, double-blind, positive-controlled, noninferiority phase III clinical trial aimed to investigate the efficacy and safety of adamagammadex compared with sugammadex in reversing deep rocuronium-induced neuromuscular block. In total, 321 patients were randomly assigned to either the adamgammadex 8 mg kg⁻¹ group or the sugammadex 4 mg kg⁻¹ group. The primary outcome was the success rate of antagonism, defined as recovery of the train-of-four ratio (TOFR) to 0.9 within 10 min. Standard safety data were collected throughout the trial period.</div></div><div><h3>Results</h3><div>For the primary efficacy outcome, the success rate for recovery of TOFR to 0.9 was 98.7% in the adamgammadex group and 100% in the sugammadex group, with an observed difference of –1.3% (95% confidence interval [CI] –4.6%, 1.2%). The lower limit of –4.6% was higher than the noninferiority margin of –10%. For the key secondary efficacy outcomes, the median (interquartile range) time from administration of adamgammadex or sugammadex to recovery of TOFR to 0.9 was 2.5 (2.0, 3.2) min and 2.2 (1.7, 2.7) min, respectively. The difference was 0.5 min (95% CI 0.3, 0.7), and the upper limit of 0.7 min was lower than the noninferiority margin of 5 min. We observed no inferiority in secondary efficacy outcomes. There was no significant difference in the safety profile between adamgammadex and sugammadex.</div></div><div><h3>Conclusions</h3><div>Adamgammadex was noninferior to sugammadex in reversing deep neuromuscular block from rocuronium.</div></div><div><h3>Clinical trial registration</h3><div>Chinese Clinical Trial Registry (ChiCTR2200056471, registered February 6, 2022; <span><span>https://www.chictr.org.cn/showproj.html?proj=141077</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Pages 331-339"},"PeriodicalIF":9.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}