Sugammadex

Abstract

Although neuromuscular block (NMB) allows immobility for airway management and surgical exposure, termination of its effect is limited by and associated with side effects of acetylcholinesterase inhibitors. Sugammadex is a selective relaxant binding agent that has been shown to reverse deep NMB, even when administered 3 minutes following a 1.2 mg/kg dose of rocuronium. This novel drug is a modified gamma cyclodextrin, that through encapsulation process terminates the effects of rocuronium and vecuronium (aminosteroid muscle relaxants), and enables the anesthesiologists rapidly to reverse profound NMB induced by rocuronium or vecuronium, in a "can't ventilate, can't intubate" crisis. In this review, data from published phase 1, 2, and 3 clinical trials are reviewed and presented. In addition, clinical trials on special patient populations (patients with pulmonary disease and renal insufficiency) are evaluated. Each article reviewed will conclude with a discussion of relevance, focus on adverse event profile, and clinical usefulness.

Effect of sugammadex administration on neural tube development in 48‐h chick embryos

“…It has many advantages such as providing rapid neutralization in difficult intubation situations, reducing the risk of postoperative reintubation, wide therapeutic index and limited drug interactions. However, although it has been well studied in surgical patients, including children, the elderly, those with kidney and liver disorders, those with lung disease, and pregnant women who had a recent cesarean delivery, it has been used in early and late pregnancy, lactating women, women of childbearing potential, and little is known about its use in newborns (Hemmerling et al, 2010; Jahr et al, 2015; Mitchell et al, 2016; Partownavid et al, 2015; Richardson & Raymond, 2020). However, the pregnancy category of sugammadex has been determined as B2 according to the Australian Therapeutic Goods Administration.…”