Sugammadex versus cholinesterase inhibitors to antagonize respiratory dysfunction after neuromuscular blockade in patients undergoing pulmonary surgery: a systematic review and meta-analysis.

Objective: The incidence of respiratory dysfunction associated with postoperative residual curarization (PORC) after thoracic surgery is high, even affecting the prognosis. There is no consensus on whether sugammadex is beneficial. This study aimed to elucidate the effect of sugammadex in the management of PORC-related respiratory dysfunction following thoracic surgery.

Methods: PubMed, Embase, Cochrane Library, and Web of Science were searched from database inception to January 2025 for studies on respiratory outcomes after thoracic surgery when sugammadex was used as an antagonist. The pooled risk ratio or weighted mean difference was used to evaluate the outcomes.

Results: Among 1398 studies searched, 11 studies were finally included, involving 1445 subjects. The results showed that sugammadex could reduce the incidence of postoperative respiratory complications (RR = 0.77, 95% CI: 0.66-0.90), particularly atelectasis (RR = 0.61, 95% CI: 0.47-0.79) and pneumonia (RR = 0.64, 95% CI: 0.46-0.91). In addition, according to the subgroup analysis by age, surgery type, anesthesia duration, and body mass index, sugammadex was associated with a shortened extubation period (P ≤ 0.005).

Conclusion: Compared with traditional muscle relaxant antagonists, the use of sugammadex after thoracic surgery can help reverse the respiratory dysfunction related to residual muscle relaxants and reduce the risk of atelectasis, pneumonia, and reintubation. However, there is no difference in the risk of pleural effusion and pneumothorax. Except for post-anesthesia care unit duration, the differences in hospitalization and chest tube dwelling duration between the two groups remain to be clarified.