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已发表论文
胸腔镜下胸腺切除术后重症肌无力患者使用舒更葡糖钠与新斯的明拮抗的对比研究：一项多中心随机对照试验
Authors Hu C, Liu S, Xi C, Du Y, Su S, Wang Y, Wu L, Chen H, Wang G
Received 13 October 2025
Accepted for publication 23 December 2025
Published 30 December 2025 Volume 2025:19 Pages 11965—11976
DOI https://doi.org/10.2147/DDDT.S573927
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Anastasios Lymperopoulos
Chunhua Hu,1 Shijiang Liu,2 Chunhua Xi,1 Yingjie Du,1 Shaofei Su,3 Yue Wang,1 Lili Wu,1 Hongya Chen,1 Guyan Wang1
1Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, People’s Republic of China; 3Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
Correspondence: Guyan Wang, Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaominxiang Road, Dongcheng District, Beijing, 100730, People’s Republic of China, Tel +86 010 58268010, Email guyanwang2006@163.com
Purpose: Rapid and complete reversal of residual neuromuscular blockade (rNMB) is essential for safe postoperative recovery in patients with myasthenia gravis (MG) undergoing video-assisted thoracoscopic (VATS) thymectomy. Although sugammadex provides a novel approach for reversing rocuronium-induced neuromuscular blockade, its efficacy in this high-risk population under routine-practice conditions—where reversal timing relies on clinical judgment—remains incompletely characterized. This multicenter randomized controlled trial (RCT) compared the efficacy of sugammadex versus neostigmine for reversing rNMB in patients with mild MG undergoing VATS thymectomy, specifically under this pragmatic, experience-guided scenario.
Patients and Methods: In this prospective, superiority-design RCT, MG patients scheduled for VATS thymectomy were randomized 1:1 to receive either sugammadex (2 mg/kg) or neostigmine (0.05 mg/kg with atropine 0.02 mg/kg) for reversal of rocuronium-induced neuromuscular blockade. All patients received a standard induction dose of rocuronium (0.6 mg/kg). The attending anesthesiologist, blinded to both the reversal agent and all quantitative neuromuscular monitoring data, managed blockade using a minimal-dose strategy (boluses only for clinical signs of inadequate block). This blinded anesthesiologist determined reversal timing based on clinical judgment, with administration contingent upon independent verification of a TOF count ≥ 2. The primary outcome was recovery time (interval from reversal agent administration to normalized TOF ratio of ≥ 0.9), analyzed with the Mann–Whitney U-test. Secondary outcomes included extubation time, operating room stay duration, and incidence of rNMB at extubation and post-anesthesia care unit (PACU) arrival.
Results: Among 62 randomized patients (31 per group), all patients received reversal at a train-of-four (TOF) count of ≥ 2 (median count at reversal: 3 in both groups). Sugammadex achieved significantly faster recovery (median 2.62 [IQR 1.83– 3.28] minutes; range 0.92– 5.80 minutes) versus neostigmine (14.63 [12.22– 16.30] minutes; range 10.97– 28.81 minutes), with an estimated median difference of 12.01 minutes (95% CI: 9.50– 14.52; P < 0.001). The sugammadex group also demonstrated: shorter extubation time (P < 0.001), reduced operating room (OR) stay (P < 0.001), and lower incidence of rNMB at extubation and PACU arrival (both P < 0.01). The incidence of postoperative complications was similar between groups.
Conclusion: In patients with MG undergoing VATS thymectomy, this pragmatic trial simulating routine practice demonstrates that sugammadex provides faster and more reliable reversal of moderate neuromuscular blockade (median TOF count 3) than neostigmine, leading to clinically meaningful reductions in recovery time (by 12.01 minutes), extubation time, and rNMB incidence.
Keywords: sugammadex, neostigmine, residual neuromuscular blockade, myasthenia gravis
1Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, People’s Republic of China; 3Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
Correspondence: Guyan Wang, Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaominxiang Road, Dongcheng District, Beijing, 100730, People’s Republic of China, Tel +86 010 58268010, Email guyanwang2006@163.com
Purpose: Rapid and complete reversal of residual neuromuscular blockade (rNMB) is essential for safe postoperative recovery in patients with myasthenia gravis (MG) undergoing video-assisted thoracoscopic (VATS) thymectomy. Although sugammadex provides a novel approach for reversing rocuronium-induced neuromuscular blockade, its efficacy in this high-risk population under routine-practice conditions—where reversal timing relies on clinical judgment—remains incompletely characterized. This multicenter randomized controlled trial (RCT) compared the efficacy of sugammadex versus neostigmine for reversing rNMB in patients with mild MG undergoing VATS thymectomy, specifically under this pragmatic, experience-guided scenario.
Patients and Methods: In this prospective, superiority-design RCT, MG patients scheduled for VATS thymectomy were randomized 1:1 to receive either sugammadex (2 mg/kg) or neostigmine (0.05 mg/kg with atropine 0.02 mg/kg) for reversal of rocuronium-induced neuromuscular blockade. All patients received a standard induction dose of rocuronium (0.6 mg/kg). The attending anesthesiologist, blinded to both the reversal agent and all quantitative neuromuscular monitoring data, managed blockade using a minimal-dose strategy (boluses only for clinical signs of inadequate block). This blinded anesthesiologist determined reversal timing based on clinical judgment, with administration contingent upon independent verification of a TOF count ≥ 2. The primary outcome was recovery time (interval from reversal agent administration to normalized TOF ratio of ≥ 0.9), analyzed with the Mann–Whitney U-test. Secondary outcomes included extubation time, operating room stay duration, and incidence of rNMB at extubation and post-anesthesia care unit (PACU) arrival.
Results: Among 62 randomized patients (31 per group), all patients received reversal at a train-of-four (TOF) count of ≥ 2 (median count at reversal: 3 in both groups). Sugammadex achieved significantly faster recovery (median 2.62 [IQR 1.83– 3.28] minutes; range 0.92– 5.80 minutes) versus neostigmine (14.63 [12.22– 16.30] minutes; range 10.97– 28.81 minutes), with an estimated median difference of 12.01 minutes (95% CI: 9.50– 14.52; P < 0.001). The sugammadex group also demonstrated: shorter extubation time (P < 0.001), reduced operating room (OR) stay (P < 0.001), and lower incidence of rNMB at extubation and PACU arrival (both P < 0.01). The incidence of postoperative complications was similar between groups.
Conclusion: In patients with MG undergoing VATS thymectomy, this pragmatic trial simulating routine practice demonstrates that sugammadex provides faster and more reliable reversal of moderate neuromuscular blockade (median TOF count 3) than neostigmine, leading to clinically meaningful reductions in recovery time (by 12.01 minutes), extubation time, and rNMB incidence.
Keywords: sugammadex, neostigmine, residual neuromuscular blockade, myasthenia gravis