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Sugammadex: A New Challenge in Neuromuscular Management

Hans D de Boer MD, PhD

Steroidal neuromuscular-blocking agents (NMBAs), such as rocuronium, are widely used in clinical anaesthesia and emergency medicine to facilitate endotracheal intubation and artificial ventilation and to allow surgical access to body cavities. The use of these drugs may be associated with complications attributable to the development of postoperative residual curarisation (PORC), resulting in hypoventilation, airway obstruction, hypoxia, and even death. The reversal of neuromuscular blockade is important for the acceleration of patient recovery and prevention of postoperative residual neuromuscular blockade, and to reduce the incidence of severe morbidity and mortality associated with anaesthesia management. Sugammadex is the first selective relaxant-binding agent designed to reverse the effect of the steroidal NMBA rocuronium; it is also effective against vecuronium. The mechanism by which sugammadex encapsulates rocuronium and vecuronium appears to be superior to current neuromuscular block reversal strategies in terms of speed, efficacy, and side effects. This may also help to reduce the occurrence of PORC and recurarisation. Adv Anaesthesiol Crit Care 2009;1(1):20–25.

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