Comparing sugammadex to neostigmine and their effects on delirium and postoperative cognitive function: A systematic...

Sugammadex is a relatively new therapeutic agent that reverses neuromuscular blockade. Compared to neostigmine, it is hypothesised that sugammadex could have a beneficial effect on postoperative cognitive function, benefitting postoperative recovery.

To compare the effects of both sugammadex and neostigmine on delirium and postoperative cognitive dysfunction.

A systematic search of all relevant randomised controlled trials and observational cohort studies was performed in October 2024, utilising the following inclusion criteria: incidence of delirium and postoperative cognitive dysfunction following administration of neostigmine or sugammadex, adult patients, patients given rocuronium or vecuronium, English language studies, papers since the introduction of sugammadex (2008). CASP and Cochrane risk-of-bias tools were utilised for study appraisal, with a narrative synthesis of the results.

Five studies, reporting interventions in 49,910 patients, met the review criteria and were included. Of these, four showed no difference in cognitive function between sugammadex and neostigmine. One cohort study of 21 patients showed favourable outcomes postoperatively in the sugammadex group.

This systematic review suggests the possibility of a very limited neurological protective role of sugammadex compared to neostigmine, but no clinical significance was reported. Only a limited number of studies were available, suggesting the need for further research.