A Comparative Study of Sugammadex and Neostigmine: A Bibliometric Analysis of the Past 15 Years

Sugammadex is a novel selective relaxant binding agent for aminosteroid neuromuscular blocking agents (NMBAs). However, existing literature reveals major knowledge gaps regarding its current applications and emerging research trends. Therefore, this study employed bibliometric analysis to map the evolutionary trajectory and research frontiers in sugammadex studies over the past 15 years.

Publications on sugammadex (2009-2024) along with neostigmine studies (1993-2008) were retrieved from the Web of Science Core Collection. Data aggregation was performed using Microsoft Excel, while bibliometric visualizations were generated through the Bibliometrix package in R software. Additional network analyses were conducted using VOSviewer and CiteSpace.

The analysis encompassed 765 articles. Sugammadex-related research exhibited a notable upward trend, particularly from 2017 to 2021. The United States of America (USA) emerged as the most productive country in publication output (186 articles) and demonstrated superior quality (h-index: 16). Among institutions, Merck & Co. contributed the highest number of publications (74). Similar to neostigmine, key research areas for sugammadex have included: pharmacokinetics and pharmacodynamics, adverse reactions, clinical applications, and specific patient populations. This focus is evidenced by substantial common references and keywords.

Sugammadex surpasses neostigmine in rapidly, effectively, and safely reversing NMB induced by rocuronium/vecuronium across all depths. Its use expands to reversing residual NMB from NMBAs in various patient groups (hepatic/renal impairment, obese, neuromuscular disease, elderly, pediatric) and scenarios like difficult airways. Future research will focus on adverse reactions, effects in special populations, establishing quantitative NMB monitoring standards, and understanding NMBA antagonism failure mechanisms.