Penehyclidine in the prevention of postoperative pulmonary complications in patients after general anesthesia: a systematic review and meta-analysis

Patients undergoing general anesthesia are susceptible to postoperative complications, among which postoperative pulmonary complications (PPCs) are highly prevalent. Penehyclidine (PHC) is a novel anticholinergic agent; however, its efficacy in preventing PPCs remains uncertain. Therefore, this systematic review and meta-analysis was conducted to evaluate the efficacy of PHC in preventing PPCs in patients undergoing general anesthesia. Randomized controlled trials (RCTs) were searched without language restrictions from database inception to December 31, 2023. Published literature was retrieved from Web of Science, The Cochrane Library, PubMed, EMbase, Sinomed, China National Knowledge Infrastructure (CNKI), and Wanfang Database. The references of the included studies were also manually screened. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A total of 10 randomized controlled trials involving 1,313 patients were included in this study. The forest plot demonstrated that, compared with the control group, PHC was associated with a lower incidence of PPCs (RR = 0.59, 95% CI [0.44, 0.78]; P = 0.0003, I2 = 50%). The subgroup analysis of intravenous administration yielded consistent results. In addition, inflammatory marker levels and airway resistance were significantly reduced in the PHC group. However, no significant differences were observed in length of hospital stay, extubation time, or mortality. The findings of this study suggest that PHC may be associated with a reduced incidence of PPCs. PHC was also associated with lower postoperative inflammatory marker levels and improved respiratory mechanics. However, large-scale randomized clinical trials are still required. The study was registered in PROSPERO under registration number CRD42022327301.