Association of sugammadex, neostigmine, or pyridostigmine for reversal of neuromuscular block with postoperative bradycardia: a multicentre, retrospective observational study
An erratum to this article was published (Br J Anaesth, Jan 2026 ↗)
Authors' conclusion
The incidence of bradycardia after sugammadex administration was low, and its adjusted risk was not significantly different from that of neostigmine, the most commonly used acetylcholinesterase inhibitor for reversal of neuromuscular block.
Study context
- Population
- Adults undergoing surgery under GA, 2011–2021, three university hospitals in Koreaanalysed
- Participants
- 359,414 adults
- Exposure
- Sugammadex vs neostigmine or pyridostigmine for NMB reversal
- Sugammadexn = 107,018
- Neostigminen = 97,754reference
- Pyridostigminen = 154,642reference
- Outcome
- Bradycardia: relative (≥10%, ≥20%, ≥30%, or ≥40%) or absolute (≥5, ≥10, ≥15, or ≥20 beats min-1) decrease in HR from baseline
- Follow-up
- Within 30 min after administration
Methodological detailsmulticentre, stabilised inverse probability of treatment weighting
- Multicentre
- Stabilised inverse probability of treatment weighting
Main finding
As reported in the abstract
≥20% decrease in HR
Odds ratio (95% CI)
Sugammadex vs Neostigmine
1.00(0.97–1.03)
Sugammadex vs Pyridostigmine
1.93(1.87–1.98)
Observational data: associations, not effects.
Further findings
Dose–response of sugammadex (restricted cubic spline)
- Linear increase in risk of ≥20% decrease in HR as sugammadex dose increased
Original publication
Association of sugammadex, neostigmine, or pyridostigmine for reversal of neuromuscular block with postoperative bradycardia: a multicentre, retrospective observational study. Br J Anaesth. Published 6 June 2025. doi:10.
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