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New research · Anesthesiology
The Lancet. Respiratory medicine · 23h
Randomized trialThe Lancet. Respiratory medicine · 2026

Sugammadex versus neostigmine for reversal of neuromuscular blockade and postoperative pulmonary complications (SNaPP): an international, randomised, controlled, phase 4 trial.

Kate Leslie, Jai N Darvall, Matthew T V Chan … SNaPP Study Investigators and the Australian and New Zealand College of Anaesthetists Clinical Trials Network
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AnesthesiologyRandomized trial

Sugammadex reduced postoperative pulmonary complications or death compared with neostigmine.

Sugammadex versus neostigmine for reversal of neuromuscular blockade and postoperative pulmonary complications (SNaPP): an international, randomised, controlled, phase 4 trial.

Kate Leslie et al. · The Lancet. Respiratory medicine · 2026
Background

Sugammadex and neostigmine are used to reverse aminosteroid neuromuscular-blocking drugs at the end of surgery.

Purpose

We aimed to determine whether reversal of neuromuscular blockade with sugammadex reduces the incidence of postoperative pulmonary complications or death compared with neostigmine.

Methods

Were randomly assigned (1:1) to sugammadex or neostigmine, administered intravenously in doses chosen by the attending anaesthesiologist, for reversal of rocuronium-induced or vecuronium-induced neuromuscular blockade at the end of surgery.

n = 3498 patients
RR 0·88
Results
Sugammadex led to a lower risk of lung problems or death after surgery
n = 3498 patients
More results

Acute respiratory distress syndrome was not reported.

No adverse events were deemed to be treatment related.

“
Conclusion · 1 of 2

Sugammadex reduced the incidence of postoperative pulmonary complications or death compared with neostigmine. The risk reduction was small with atelectasis of uncertain clinical significance being the most common complication.

Conclusion · 2 of 2

Sugammadex can be considered as a first-line drug for reversal of aminosteroid-induced neuromuscular blockade at the end of surgery.

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