# Response to the Letter regarding “Sugammadex vs neostigmine in post-anesthesia recovery: A systematic review and meta-analysis”

## TL;DR

This paper responds to feedback on a study comparing sugammadex and neostigmine for reversing muscle block after surgery, confirming sugammadex is more effective but noting limitations in data.

## Contribution

The paper clarifies methodological choices and addresses critiques, reinforcing sugammadex's pharmacologic advantages while acknowledging clinical variability.

## Key findings

- Sugammadex consistently showed faster and more complete reversal of neuromuscular block compared to neostigmine.
- High heterogeneity in time-based outcomes was acknowledged, likely due to differences in clinical settings.
- Sugammadex was associated with fewer complications, though broader recovery quality may not uniformly improve.

## Abstract

This response addresses feedback on our systematic review and meta-analysis comparing sugammadex with neostigmine for neuromuscular block reversal. We acknowledge high heterogeneity for time-based outcomes, likely due to differences in clinical settings and anesthetic/surgical protocols, but pooled effects consistently favored sugammadex for faster and more complete reversal. We agree hypnotic depth and other perioperative factors may modify emergence and airway safety, yet these variables were inconsistently reported and could not be analyzed quantitatively. We also clarify that time outcomes were synthesized using standardized mean differences to account for different reporting units, and any presentation inconsistencies will be corrected. Overall, our findings support pharmacologic superiority of sugammadex with reductions in selected complications, while emphasizing that broader recovery quality may not uniformly improve and should be interpreted in clinical context.