Sugammadex: a selective relaxant binding agent for reversal of neuromuscular block

Abstract

Neostigmine, the currently used agent for reversal of neuromuscular block, has several drawbacks, such as a slow onset of peak effect, inability to reverse deep block and the occurrence of widespread muscarinic effects. Sugammadex is a new class of reversal agent that acts by encapsulating the molecules of the relaxants rocuronium and vecuronium, for which it is a specific antagonist. Clinical trials in over 2000 subjects have shown it to be effective for reversal of block by these two relaxants even from deep levels, in doses of 2.0–4.0 mg/kg. Sugammadex can also reverse an intense (profound) high-dose rocuronium block, but the dose required in this situation is 16.0 mg/kg. The agent has been found to be safe so far, with few side effects.

Keywords::

• anticholinesterase
• cyclodextrin
• neostigmine
• neuromuscular block
• sugammadex

Financial & competing interests disclosure

Rajinder K Mirakhur is a Scientific Advisor to Schering Plough and has received unrestricted Research Grants and honoraria for lectures from Schering Plough (previously Organon). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.