Ten databases, including DARE, MEDLINE and EMBASE, as well as several trial registers, the Internet and conference proceedings, were searched up to May 2008, with updates up to November 2008, for randomised controlled trials of sugammadex, compared with placebo or an active comparator.
For routine intubation, induction of blockade had to be by rocuronium or vecuronium for reversal by sugammadex; comparators were reversal by neostigmine plus glycopyrrolate, nothing or placebo. For rapid intubation, rocuronium then sugammadex was compared with rocuronium then placebo or succinylcholine then nothing (spontaneous recovery). The main outcome was speed of recovery from neuromuscular blockade, measured by objective monitoring of neuromuscular function. Tables of results and a narrative synthesis were presented. For the economic analysis, the threshold, at which the effectiveness of sugammadex could justify its cost, was investigated for a series of pairwise comparisons.
Two reviewers independently selected trials; one reviewer extracted the data and assessed quality, using a CRD checklist, another reviewer checked both. Disagreements were resolved by discussion or with a third reviewer.