Rocuronium-sugammadex as an alternative muscle relaxant to succinylcholine in electroconvulsive therapy: A meta-analysis

Table 3 Study findings

Ref.	Main findings	Conclusion/recommendation
Hoshi et al[11]	Recovery: Time to spontaneous respiration 10% and 90% recovery tended to be shorter in the RS group, but the difference was not statistically significant; seizure duration: RS longer (39 seconds vs 33 seconds)	It shows potential benefits as an alternative to succinylcholine for muscle relaxation; side effects: No adverse effects were reported with either muscle relaxants
Kadoi et al[12]	Efficacy as an alternative to SCC; sugammadex (8 mg/kg) produces equally rapid recovery as SCC for 0.6 mg/kg of rocuronium	Sugammadex (8 mg/kg) produces equally rapid recovery as SCC; side effects: No adverse effects were reported
Saricicek et al[13]	Recovery: Group RS is significantly shorter for spontaneous respiration and eye-opening across all sessions; side effects: Myalgia and headache VAS scores were significantly lower in the RS group; seizure duration: No statistically significant difference was observed	It also causes reduced myalgia and headache, and faster recovery compared to succinylcholine
Koksal et al[14]	Recovery: Rocuronium + succinylcholine was significantly shorter for Modified Alderete Score 9 (7.26 minutes vs 11.26 minutes), Spontaneous eye opening (6.64 minutes vs 9.67 minutes), obeying instructions (8.10 minutes vs 11.72 minutes), spontaneous breathing (5.93 minutes vs 8.14 minutes), and time to spontaneous respiration 90% (4.87 minutes vs 9.95 minutes); onset: Group RS longer (149.40 seconds vs 111.53 seconds); seizure duration: Group RS longer (23.28 seconds vs 15.62 seconds)	Sufficient muscle relaxation and early recovery. It can be used as an alternative to succinylcholine
Oflezer et al[15]	EEG/motor seizure duration: Rocuronium + succinylcholine longer than succinylcholine (36.61 seconds vs 33.15 seconds; P = 0.002, P < 0.001 respectively); adverse effects: No major complications or deaths were reported in either group; CGI-I score: No significant difference	Similar results in terms of seizure variables and clinical outcomes can be a suitable alternative.
Moutaoukil et al[16]	Recovery: Rocuronium + succinylcholine was significantly shorter for spontaneous respiration (219 seconds vs 296 seconds) and eye opening (402 seconds vs 467 seconds); motor seizure modification: RS had a significantly higher (better) score (3.6 vs 3.0); side effects: Agitation (0% vs 16%) and myalgia (4% vs 33%) were significantly lower in the RS group; seizure duration: Comparable (40 seconds vs 38 seconds)	Efficacious alternative to succinylcholine, leading to faster recovery with less myalgia and agitation
Karaca Bent et al[17]	Recovery: RS was notably shorter for spontaneous breathing time (88.82 seconds vs 111.78 seconds), spontaneous eye opening (173.12 seconds vs 211.42 seconds), and Modified Alderete Score 9 (410.54 seconds vs 542.60 seconds); seizure duration: No significant difference	Sugammadex is an ideal alternative agent when succinylcholine is contraindicated, or anticholinesterases are not suitable; it shortens recovery time and spontaneous respiration

RS: Rocuronium-sugammadex; SCC: Succinylcholine; VAS: Visual Analogue Scale; EEG: Electroencephalography; CGI-I: Global Impression Improvement.