Table 3 Details of postoperative pulmonary complications

Sudre [32] 2015

Succinylcholine + Rocuronium or Atracurium

Induction: succinylcholine 1 mg.kg^− 1 TBW & interventional group (rocuronium 0.1 mg.kg^− 1.hr.^− 1 IBW)

Control group (atracurium 0.4 mg.kg^− 1)

Maintenance: IPG (rocuronium 0.1 mg.kg-1.hr.^− 1IBW) CG (atracurium 0.04 mg.kg^− 1)

Not specified

Not specified

Yes

OSA was associated with a higher risk of postoperative respiratory failure. (OR 6.88) No difference in atelectasis, bronchospasm, pleural effusion, pulmonary edema

Higher risk of postoperative respiratory failure in OSA vs. non-OSA patients receiving NMBA.

Ahmad [30] 2008

Succinycholine + rocuronium

Succinylcholine (0.5 mg/kg), rocuronium (0.5 mg/kg)

Neostigmine + glycopyrrolate

Neostigmine 0.05 mg.kg^− 1 (IBW) + Glycopyrolate 0.005 mg.kg^− 1 (IBW)

Yes

No difference in median SpO₂ in OSA vs. non-OSA patients given supplemental oxygen in first 24 h after surgery, P = 0.97

OSA did not increase the risk for postoperative hypoxemia

Pereira [31] 2013

NMB - drug not specified

Not specified

Neostigmine - where required

Not specified

Yes

Postoperative mild/moderate hypoxia was higher in HR-OSA vs. LR-OSA patients (n = 15 vs.4, P = 0.012).

Significantly higher residual NMB was found in HR-OSA vs. LR-OSA patients (n = 35 vs.25, P = 0.035).

Mild/moderate hypoxemia (P = 0.012) and residual neuromuscular blockade are more frequent in HR-OSA patients vs. LR-OSA patients (P = 0.035).

Unal [33] 2015

Rocuronium

Total rocuronium dose group S = 2.6 + − 16.7 mg, group N = 85.0 + − 14.7 mg.

Sugammadex / neostigmine

SG: 2 mg.kg^− 1 sugammadex, n = 37 and 0.04 mg.kg^− 1

N: neostigmine+ 0.02 mg.kg^− 1 atropine. n = 37.

Yes

PPCs (desaturation, hypoxemia, apnea, airway manipulation, airway usage, re-intubation, CPAP, invasive mechanical ventilation) were lower in OSA patients reversed with sugammadex vs neostigmine, P = 0.048.

Cardiovascular complications (bradycardia) lower with sugammadex vs. neostigmine, P = 0.04.

Postoperative pulmonary complications and bradycardia occurred less frequently in OSA patients who received sugammadex vs. neostigmine (P < 0.05).

Llaurado [34] 2014

Succinycholine/ Rocuronium/ Cis-atracurium

SG: succinylcholine 1 mg.kg^− 1 RBW or rocuronium 1 mg.kg^− 1 IBW + rocuronium 0.15 mg.kg^− 1 at T2.

HG: succinylcholine 1 mg.kg^− 1 RBW or rocuronium1 mg.kg^− 1 IBW or cis-atracurium 0.2 mg/ kg IBW + cis-atracurium 0.03 mg.kg^− 1

Sugammadex / neostigmine

SG: sugammadex 4 mg.kg^− 1 + 2 mg.kg^− 1 (TOFR< 0.9, 3 min apart);

HG: neostigmine 0.04 mg.kg^− 1 + 0.02 mg.kg^− 1

Yes

Significantly less postoperative abnormalities on chest radiograph (atelectasis, pleural effusions) were observed in the SG: 6.9% (n = 11) vs. HG 16.3% (n = 26).

P = 0.015

No difference in need for mechanical ventilation in SG vs. HG (2 vs.5), P = 0.38 or hospital stay (3 vs.4, P = 0.3).

Significantly less postoperative chest radiograph changes in the OSA patients receiving sugammadex vs. neostigmine. No difference in postoperative mechanical ventilation, and hospital stay.