Can Sugammadex Lower Postsurgical Pulmonary Complications?

A large international randomized trial found fewer postoperative pulmonary complications with sugammadex vs. neostigmine following major abdominal or thoracic surgery, although the difference was driven primarily by reduced atelectasis.

By
Andrea Surnit
July 17, 2026
3 min

Conexiant

Overview

Sugammadex may reduce postoperative pulmonary complications in older adults undergoing major surgery. The primary outcome showed a reduction in the composite outcome of complications or death, primarily due to a decrease in atelectasis cases compared to neostigmine.

Background

Postoperative pulmonary complications (PPC) are a significant cause of morbidity and mortality following major surgeries, leading to extended hospital stays and increased healthcare costs. Understanding the impact of neuromuscular blockade reversal agents like sugammadex versus neostigmine is crucial for improving patient outcomes in this high-risk population.

Data Highlights

Outcome	Sugammadex	Neostigmine
Postoperative pulmonary complications or mortality	19%	22%
Atelectasis	18%	21%
Pneumonia	Similar	Similar
Mortality	Similar	Similar

Key Findings

Sugammadex resulted in a 3% reduction in postoperative pulmonary complications or mortality compared to neostigmine.
Atelectasis was the most common pulmonary complication, occurring in 18% of patients receiving sugammadex and 21% receiving neostigmine.
No significant differences were observed in rates of pneumonia, pulmonary aspiration, or mortality between the two groups.
Sugammadex provided more complete reversal of neuromuscular blockade prior to tracheal extubation.
No statistically significant differences were found in postoperative nausea and vomiting or health-related quality of life at 3 months.

Clinical Implications

The findings indicate that sugammadex may offer an advantage over neostigmine in reducing certain postoperative pulmonary complications in older adults undergoing major surgery.

Conclusion

Sugammadex may provide a benefit in reducing postoperative pulmonary complications compared to neostigmine, primarily through a decrease in atelectasis.