Sugammadex compared to neostigmine for neuromuscular blockade reversal

Abstract

Neuromuscular blocking agents are widely used during surgery to provide optimal conditions for endotracheal intubation and to provide surgical relaxation by inhibiting skeletal muscle movement. Although acetylcholinesterase inhibitors are the most common medications used to antagonize the effects of nondepolarizing neuromuscular blocking agents, residual blockade is a persistent problem. Incomplete recovery from neuromuscular blocking agents can result in critical postoperative adverse events (i.e., respiratory complications, airway obstruction, hypoxemia, etc.). Sugammadex, a modified gamma-cyclodextrin, could be the ideal reversal agent for steroidal nondepolarizing neuromuscular blocking agents such as rocuronium, vecuronium, and pancuronium, especially when a deep or profound block exists. Sugammadex works by selectively encapsulating aminosteroidal nondepolarizing neuromuscular blocking agents, thus reversing their neuromuscular blocking action. It is a safe, effective agent that can be used to reverse any level of neuromuscular blockade, and the fast onset allows for rapid airway control and can decrease the anesthesia recovery period. This selective binding agent is able to reliably reverse neuromuscular blockade without the unpredictable efficacy and adverse muscarinic side effects that are commonly associated with acetylcholinesterase inhibitors. Research shows reversal of neuromuscular blockade with sugammadex is overall superior to neostigmine as it induces rapid and predictable reversal of any level of neuromuscular block, decreases the occurrence of residual block in the postoperative period, and increases overall patient safety.