Reply to “Is neostigmine safe and effective for neuromuscular blockade reversal in patients recovering from general anesthesia?”

We thank Wu et al. (1) for the interest in our study that aimed to investigate the efficacy and safety of neostigmine for neuromuscular blockade reversal in patients under general anesthesia via meta-analysis (2). They raised two valuable comments.

Firstly, we performed a sensitivity analysis by removing Xu et al.’s study (3) which had the most influence on the overall pooled estimates. As we noted that, the I² statistic was decreased from 92% to 86%. We also presented the overall pooled mean difference (MD) of length of stay in the post-anesthesia care unit (PACU), which was changed from −17.73 to −18.58, still indicating a significant difference.

Secondly, Yao et al.’s study (4) was mistakenly enrolled into the subgroup of dosage ≥40 µg/kg. We have reanalyzed the data and the new pooled results were shown in Figure 1. Based on the dosage of neostigmine, compared to that in the control group, the length of PACU stay was significantly shortened in both the neostigmine ≥40 µg/kg (MD =−19.91; 95% CI: −27.73 to −12.09; P<0.0001; I²=91%) and neostigmine <40 µg/kg (MD =−16.03; 95% CI: −26.51 to −5.55; P=0.003; I²=83%) groups. The results did not change the conclusion of our meta-analysis.

Figure 1 Forest plots of the length of stay in the PACU. PACU, post-anesthesia care unit.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Translational Medicine. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-2022-3/coif). The authors have no conflicts of interest to declare.

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References

1. Wu J, Yang J, Hu Z, et al. Is neostigmine safe and effective for neuromuscular blockade reversal in patients recovering from general anesthesia? Ann Transl Med 2022; [Crossref]
2. Ji W, Zhang X, Liu J, et al. Efficacy and safety of neostigmine for neuromuscular blockade reversal in patients under general anesthesia: a systematic review and meta-analysis. Ann Transl Med 2021;9:1691. [Crossref] [PubMed]
3. Xu K, Chen YJ, Lu ZJ, et al. Effects of neostigmine Muscle relaxation Antagonism on Postoperative Recovery of Patients Undergoing Laparoscopy under General Anesthesia. Medical Recapitulate 2020;26:3067-71.
4. Yao M, Shi H, Jiao B, et al. Effect of neostigmine antagonistic timing on residual muscle relaxation after general anesthesia -- a randomized, double-blind, parallel controlled study. Chinese Journal of Hospital Pharmacy 2021;41:191-4.