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Current Pharmaceutical Design

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ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

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Review Article

Sugammadex for Reversal of Neuromuscular Blockade: Uses and Limitations

Author(s): Jesse Hawkins, Sandeep Khanna and Maged Argalious*

Volume 25, Issue 19, 2019

Page: [2140 - 2148] Pages: 9

DOI: 10.2174/1381612825666190704101145

Price: $65

Abstract

Sugammadex is a reversal agent that was engineered to reverse the effects of aminosteroid muscle relaxants. It is a modified gamma-cyclodextrin, i.e. a large glucose molecule bound in a ring-like structure. Sugammadex, when injected intravenously, creates a concentration gradient favoring the movement of aminosteroid muscle relaxants from the neuromuscular junction back into the plasma, and then encapsulates the aminosteroid muscle relaxants within its inner structure by forming tight water-soluble complexes. The dissociation of the aminosteroidal muscle relaxant from the post-synaptic acetylcholine receptors is responsible for the termination of neuromuscular blockade. This review article presents the current indication, mechanism of action, limitations, side effects and contraindications of sugammadex. An overview of monitoring of the adequacy of reversal of aminosteroid muscle relaxants with sugammadex is presented. Moreover, the use of sugammadex in special situations, including “cannot intubate cannot oxygenate” scenarios is also described.

Keywords: Sugammadex, neuromuscular blocker, aminosteroids, non-depolarizing muscle relaxants, neuromuscular reversal, neuromuscular monitoring.

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