Sugammadex in patients with Myasthenia Gravis

Abstract

Myasthenia gravis (MG) is an autoimmune disorder caused by a decrease in functional acetylcholine receptors at the neuromuscular junction resulting from their destruction or inactivation by antibodies. Patients with MG can experience marked sensitivity to nondepolarizing neuromuscular blocking agents (NMBAs), and require specialized anesthetic care because of their increased risk of postoperative weakness and respiratory failure. Since pyridostigmine, a cholinesterase inhibitor, is a mainstay of MG treatment, the conventional neostigmine antagonism is unfavorable. Sugammadex is a direct, selective antagonist of aminosteroid NMBAs. It is a cyclodextrin derivative that irreversibly encapsulates rocuronium or vecuronium to terminate its action at the nicotinic receptor. Sugammadex is not reliant on acetylcholinesterase or any receptor system and appears to be capable of antagonizing profound neuromuscular blockade (NMB).