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 . 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.

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