SNaPP study in The Lancet Respiratory Medicine

Professor Kate Leslie AO FAHMS has presented the results of the SNaPP study at the 8th Biennial Collaborative Clinical Trials in Anaesthesia Conference in Prato, Italy, coinciding with publication of the trial findings in The Lancet Respiratory Medicine on Wednesday 10 June 2026.

The SNaPP study, led by The University of Melbourne and the ANZCA Clinical Trials Network, was a large, multicentre, randomised, controlled phase 4 trial comparing sugammadex and neostigmine for reversal of rocuronium- or vecuronium-induced neuromuscular blockade in patients aged 40 years and over undergoing abdominal or thoracic surgery. The primary outcome was a composite of postoperative pulmonary complications or death up to hospital discharge, or postoperative day seven if still in hospital.

The trial recruited 3500 participants across 44 sites in Australia, Aotearoa New Zealand and Hong Kong in just under two years, almost a year ahead of schedule. The study received A$2.9 million from the Medical Research Future Fund, following an ANZCA Foundation-funded CTN pilot study.

Postoperative pulmonary complications or death occurred in 19.0 per cent of patients allocated to sugammadex and 21.5 per cent allocated to neostigmine, representing a small but statistically significant relative reduction in the primary composite outcome. This was mainly driven by a lower incidence of atelectasis. There were no meaningful differences in pneumonia, pulmonary aspiration, unplanned intensive care or high dependency unit admission, days alive and at home at 30 days, or health-related quality of life at three months.

The authors concluded that sugammadex reduced postoperative pulmonary complications or death compared with neostigmine, although the absolute risk reduction was small and atelectasis was of uncertain long-term clinical significance.

Professor Leslie also reflected on the features that supported successful delivery of the trial, including a simple and robust protocol, broad eligibility criteria, low-burden data collection, strong site engagement and a clinically important research question that motivated investigators and research teams.

Professor Leslie acknowledged the major contribution of the Trial Coordinating Centre, participating sites, investigators, research coordinators and patients, and the ANZCA Clinical Trials Network.

Congratulations to Kate and the SNaPP team on these important findings. A podcast interview with Professor Leslie is now available on TopMedTalk. A video presentation of the results and the media release are also available online.