Neostigmine for reversing muscle paralysis in children following surgery

Review question

We reviewed the evidence about whether neostigmine should be routinely used to prevent residual muscle paralysis in children who received muscle relaxants during surgery.

Background

Neuromuscular blocks are drugs that cause paralysis of the skeletal muscles. They are used to facilitate certain surgical procedures. Residual muscle paralysis after surgery is associated with serious complications in children such as low oxygen content (hypoxia). Neostigimine is a drug that is used to reverse the effects of neuromuscular blocks. Neostigime reduces the risk of paralysis, but it can also cause children to feel sick and vomit and to produce excessive saliva and have a slow heart rate (bradycardia). As risk of residual paralysis is lower in children than in adults after neuromuscular blocks, the use of neostigmine in all surgeries performed on children should be carefully considered.

Study characteristics

This evidence is current to August 2013. We found no study that satisfied the inclusion criteria.

Key results

We found only one study that is awaiting classification. No RCTs supported, or argued against, the routine use of neostigmine to reverse neuromuscular block in paediatric patients.

Quality of the evidence

We found no relevant evidence.

Authors' conclusions: 

No RCTs were found that supported, or argued against, the routine use of neostigmine to reverse neuromuscular block in paediatric patients.

Read the full abstract...
Background: 

Residual neuromuscular block is associated with serious postoperative complications. Some anaesthesiologists use neostigmine to reverse neuromuscular blockade for all paediatric surgical patients. However, the incidence of residual neuromuscular block may be lower in paediatric patients than in adults. The use of neostigmine has also caused complications, such as postoperative nausea, vomiting, excessive salivation and bradycardia. Therefore, whether neostigmine should be used routinely to reverse neuromuscular blockade in each paediatric patient is an important question for paediatric anaesthesiologists.

Objectives: 

To assess the necessity of routine usage of neostigmine in preventing residual neuromuscular blockade in paediatric patients following the use of muscle relaxants.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 8, part of The Cochrane Library; MEDLINE via Ovid (1946 to August 2013); EMBASE via Ovid SP (1974 to August 2013); ClinicalTrials.gov (18 August 2013) and Chinese Clinical Trial Registry (18 August 2013) with no language restrictions.

Selection criteria: 

We planned to include randomized controlled trials (RCTs) comparing neostigmine versus placebo in American Society of Anaesthesiologists (ASA) I or II paediatric surgical participants (younger than 12 years of age, including newborns) who had received non-depolarizing muscle relaxants.

Data collection and analysis: 

Two review authors independently assessed the studies for inclusion.

Main results: 

We found no study that satisfied the inclusion criteria. We found one study awaiting classification.

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