***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Acetylcholinesterase inhibitors can not rapidly reverse profound neuromuscular block .  Sugammadex , a selective relaxant binding agent , reverses the effects of rocuronium and vecuronium by encapsulation . This study assessed the efficacy of sugammadex compared with neostigmine in reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia . Methods Patients aged ≥18 years , American Society of Anesthesiologists class 1 - 4 , scheduled to undergo surgery under general anesthesia were enrolled in this phase III , multicenter , r and omized , safety-assessor blinded study .  Sevoflurane anesthetized patients received vecuronium 0.1 mg/kg for intubation , with maintenance doses of 0.015 mg/kg as required . Patients were r and omized to receive sugammadex 4 mg/kg or neostigmine 70 μg/kg with glycopyrrolate 14 μg/kg at 1 - 2 post-tetanic counts . The primary efficacy variable was time from start of study drug administration to recovery of the train-of-four ratio to 0.9 . Safety assessment s included physical examination , laboratory data , vital signs , and adverse events . Results Eighty three patients were included in the intent-to-treat population  ( sugammadex , n = 47 ; neostigmine , n = 36 ) . Geometric mean time to recovery of the train-of-four ratio to 0.9 was 15-fold faster with sugammadex ( 4.5 minutes ) compared with neostigmine ( 66.2 minutes ; p < 0.0001 ) ( median , 3.3 minutes with sugammadex versus 49.9 minutes with neostigmine ) . No serious drug-related adverse events occurred in either group . Conclusions Recovery from profound vecuronium-induced block is significantly faster with sugammadex , compared with neostigmine . Neostigmine did not rapidly reverse profound neuromuscular block ( Trial registration number : NCT00473694 ) Backround Sugammadex is a reversal agent with well known advantages but it ’s effects on haemostasis and bleeding have been a topic of interest .  Septoplasty  is a common surgical procedure with postoperative respiratory complications and bleeding . The aim of this study is to investigate the effects of sugammadex on postoperative coagulation parameters and bleeding after septoplasty procedure . Material / Methods In this r and omized controlled study , fifty patients were grouped into two groups ; neostigmine ( Group N ) vs. sugammadex ( Group S ) . For the evaluation of PT , aPTT and INR , blood sample s were taken for at the postoperative 120th minutes and alteration of these values with respect to preoperative values were documented . Postoperative bleeding was measured by evaluating the amount of blood absorbed on the nasal tip dressing during 3 hours postoperatively . Results Postoperative bleeding amount was significantly higher in the Group S compared to Group N ( p=0.013 ) . No significant difference was observed between two groups according to coagulation parameters ( PT ; p=0.953 , aPTT ; p=0.734 , INR ; p=0.612 ) . Conclusions Sugammadex was associated with higher amount of postoperative bleeding than neostigmine in septoplasty patients . In surgical procedures having high risk of bleeding the safety of sugammadex need to be verified BACKGROUND : Sugammadex , a specifically design ed & ggr;-cyclodextrin , is a selective relaxant binding drug that rapidly reverses rocuronium-induced and , to a lesser extent , vecuronium-induced neuromuscular blockade . In this study , we compared the efficacy of sugammadex and neostigmine for the reversal of vecuronium-induced neuromuscular blockade in patients scheduled for elective surgery . METHODS : Patients aged ≥18 yr , ASA Class I – III , and scheduled for a surgical procedure under sevoflurane/opioid anesthesia  received an intubating dose of vecuronium ( 0.1 mg/kg ) and maintenance doses of 0.02–0.03 mg/kg at reappearance of the second twitch ( T2 ) of train-of-four ( TOF ) if required . Neuromuscular blockade was monitored using acceleromyography ( TOF-Watch ® SX , Schering-Plough Irel and , Dublin , Irel and ) . At end of surgery , at reappearance of T2 after the last dose of vecuronium , patients were r and omized to receive either sugammadex ( 2 mg/kg ) or neostigmine ( 50 & mgr;g/kg ) plus glycopyrrolate ( 10 & mgr;g/kg ) IV . The primary efficacy end-point was time from start of administration of sugammadex or neostigmine to recovery of TOF ratio to 0.9 . RESULTS : The geometric mean time to recovery of the TOF ratio to 0.9 was significantly faster with sugammadex compared with neostigmine ( 2.7 min [ 95 % confidence interval { CI } ] : 2.2–3.3 ) versus 17.9 min [ 95 % CI : 13.1–24.3 ] , respectively ; P < 0.0001 ) . The mean recovery times to a TOF ratio of 0.8 and 0.7 were also significantly shorter with sugammadex . No serious adverse events or unexpected side effects were reported with either drug . CONCLUSION : Sugammadex provided significantly faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine Background This study compared efficacy and safety of the selective relaxant binding agent sugammadex ( 2 mg/kg ) with neostigmine ( 50 μg/kg ) for neuromuscular blockade ( NMB ) reversal in Chinese and Caucasian subjects . Methods This was a r and omized , active-controlled , multicenter , safety-assessor-blinded study ( NCT00825812 ) in American Society of Anesthesiologists Class 1 - 3 subjects undergoing surgery with propofol anesthesia .  Rocuronium 0.6 mg/kg was administered for endotracheal intubation , with 0.1–0.2 mg/kg maintenance doses given as required . NMB was monitored using TOF-Watch ® SX . At second twitch reappearance , after last rocuronium dose , subjects received sugammadex 2 mg/kg or neostigmine 50 μg/kg plus atropine 10–20 μg/kg , according to r and omization . Primary efficacy variable was time from sugammadex/neostigmine to recovery of the train-of-four ( TOF ) ratio to 0.9 . Results Overall , 230 Chinese subjects ( sugammadex , n = 119 , neostigmine , n = 111 ) ; and 59 Caucasian subjects ( sugammadex , n = 29 , neostigmine , n = 30 ) had evaluable data . Geometric mean ( 95 % CI ) time to recovery to TOF ratio 0.9 was 1.6 ( 1.5–1.7 ) min with sugammadex vs 9.1 ( 8.0–10.3 ) min with neostigmine in Chinese subjects . Corresponding times for Caucasian subjects were 1.4 ( 1.3–1.5 ) min and 6.7 ( 5.5–8.0 ) min , respectively . Sugammadex 2 mg/kg was generally well tolerated , with no serious adverse events reported . There was no residual NMB or recurrence of NMB . Conclusion Both Chinese and Caucasian subjects recovered from NMB significantly faster after sugammadex 2 mg/kg vs neostigmine 50 μg/kg , with a ~5.7 times ( p < 0.0001 ) faster recovery with sugammadex vs neostigmine in Chinese subjects . Sugammadex was generally well tolerated . Trial registration Clinical Trials.gov Identifier : NCT00825812 Background Rapid and complete reversal of neuromuscular blockade ( NMB ) is desirable at the end of surgery . Sugammadex reverses rocuronium-induced NMB by encapsulation . It is well tolerated in Caucasian patients , providing rapid reversal of moderate ( reappearance of T2 ) rocuronium-induced NMB . We investigated the efficacy and safety of sugammadex versus neostigmine in Korean patients . Methods This r and omized , safety assessor-blinded trial ( NCT01050543 ) included Korean patients undergoing general anesthesia .  Rocuronium 0.6 mg/kg was given prior to intubation with maintenance doses of 0.1 - 0.2 mg/kg as required . Patients received sugammadex 2.0 mg/kg or neostigmine 50 µg/kg with glycopyrrolate 10 µg/kg to reverse the NMB at the reappearance of T2 , after the last rocuronium dose . The primary efficacy endpoint was the time from sugammadex or neostigmine administration to recovery of the train-of-four ( TOF ) ratio to 0.9 . The safety of these medications was also assessed . Results Of 128 r and omized patients , 118 had evaluable data ( n = 59 in each group ) . The geometric mean ( 95 % confidence interval ) time to recovery of the TOF ratio to 0.9 was 1.8 ( 1.6 , 2.0 ) minutes in the sugammadex group and 14.8 ( 12.4 , 17.6 ) minutes in the neostigmine group ( P < 0.0001 ) . Sugammadex was generally well tolerated , with no evidence of residual or recurrence of NMB ; four patients in the neostigmine group reported adverse events possibly indicative of inadequate NMB reversal . Conclusions Sugammadex was well tolerated and provided rapid reversal of moderate rocuronium-induced NMB in Korean patients , with a recovery time 8.1 times faster than neostigmine . These results are consistent with those reported for Caucasian patients The frequency and duration of postoperative residual neuromuscular block  on arrival of 150 patients in the recovery ward following the use of vecuronium ( n = 50 ) , atracurium ( n = 50 ) and rocuronium ( n = 50 ) were recorded . Residual block was defined as a train‐of‐four ratio of < 0.8 . An additional group of 10 patients received no neuromuscular blocking drugs during anaesthesia . The incidence of postoperative residual neuromuscular block was 64 % , 52 % and 39 % after the use of vecuronium , atracurium and rocuronium , respectively . Similar numbers of patients were not able to maintain a sustained head or leg lift for 5 s on arrival in the recovery ward . The mean [ range ] times to attaining a train‐of‐four ratio of ≥0.8 after arrival in the recovery ward were 9.2 [ 1–61 ] , 6.9 [ 1–24 ] and 14.7 [ 1.5–83 ] min for vecuronium , atracurium and rocuronium , respectively . None of the 10 patients who did not receive neuromuscular blocking drugs  had train‐of‐four ratios < 0.8 on arrival in the recovery ward . It is concluded that a large proportion of patients arrive in the recovery ward with a train‐of‐four ratio < 0.8 , even with the use of intermediate‐acting neuromuscular blocking drugs . Although the residual block is relatively short lasting , it may occasionally be prolonged , requiring close observation and monitoring of such patients in the recovery ward BACKGROUND Sugammadex is a selective relaxant binding agent design ed to encapsulate the neuromuscular blocking agent , rocuronium . The sugammadex-rocuronium complex is eliminated by the kidneys . This trial investigated the pharmacokinetics ( PKs ) of sugammadex and rocuronium in patients with renal failure and healthy controls . METHODS Fifteen ASA class II-III renal patients [ creatinine clearance ( CL(CR ) ) < 30 ml min(-1 ) ] and 15 ASA I-II controls ( CL(CR ) > or = 80 ml min(-1 ) ) were included . After induction of anaesthesia , a single i.v . dose of rocuronium 0.6 mg kg(-1 ) was given , followed by a single i.v . dose of sugammadex 2.0 mg kg(-1 ) at reappearance of the second twitch of the train-of-four response . Plasma concentrations of rocuronium and sugammadex  were estimated and PK variables determined using non-compartmental analyses . Percentages of sugammadex and rocuronium excreted in the urine were measured . RESULTS PK data were obtained from 26 patients .  Mean total plasma clearance ( CL ) of sugammadex  was 5.5 ml min(-1 ) in renal patients and 95.2 ml min(-1 ) in controls ( P<0.05 ) .  Rocuronium CL was 41.8 ml min(-1 ) in renal patients and 167 ml min(-1 ) in controls ( P<0.05 ) . The median amount of sugammadex and rocuronium excreted in the urine over 72 h in renal patients was 29 % and 4 % , respectively , and 73 % and 42 % over 24 h in controls . CONCLUSIONS Large differences in the PKs of  sugammadex  and rocuronium between patients with renal failure and healthy controls were observed . The effect of renal impairment on the PK variables of rocuronium was less than with sugammadex .  Urinary excretion of both drugs was reduced in renal patients Background Sugammadex is a 
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Finally , we found no significant differences between sugammadex and neostigmine regarding risk of serious adverse events ( RR 0.54 , 95 % CI 0.13 to 2.25 ; I2= 0 % ; 10 studies , n = 959 ; GRADE : low quality ) .Application of trial sequential analysis ( TSA ) indicates superiority of sugammadex for outcomes such as recovery time from T2 to TOFR > 0.9 , adverse events , and overall signs of postoperative residual paralysis .
AUTHORS ' CONCLUSIONS Review results suggest that in comparison with neostigmine , sugammadex can more rapidly reverse rocuronium-induced neuromuscular block regardless of the depth of the block .
With an NNTB of 8 to avoid an adverse event , sugammadex appears to have a better safety profile than neostigmine .