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Editorial
. 2025 Jun;134(6):1591-1596.
doi: 10.1016/j.bja.2025.03.006. Epub 2025 Apr 16.

Developing novel drugs to reverse neuromuscular block: do we need them?

Jennifer M Hunter  1 , Manfred Blobner  2
Affiliations
Editorial

Developing novel drugs to reverse neuromuscular block: do we need them?

Jennifer M Hunter et al. Br J Anaesth. 2025 Jun.

Abstract

In the last 5 yr, rocuronium followed by reversal with sugammadex has become the most common combination of neuromuscular blocking drug and neuromuscular block antagonist in use during anaesthesia in the developed world. Despite a low incidence of side-effects from this drug combination, research continues on the development of new reversal agents. This includes development of new gamma cyclodextrins such as adamgammadex, and unrelated compounds such as calabadion 2 and Pillar[6]MaxQ, that not only sequestrate rocuronium, but also opioids such as fentanyl. The reasons for such work are questioned with the acknowledgement that, as in all areas of anaesthetic practice, the search for perfect drugs continues despite the limited clinical demand.

Keywords: Pillar[6]MaxQ; adamgammadex; calabadion 2; neostigmine; neuromuscular block; reversal; sugammadex.

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Conflict of interest statement

Declarations of interest JMH was editor-in-chief of the British Journal of Anaesthesia from 1997 to 2005 and Chair of the BJA Board from 2006 to 2012. JMH has no financial conflicts to report. MB received research support from Merck Sharp & Dohme (Haar, Germany) unrelated to this paper, honoraria for giving lectures from GE Healthcare (Helsinki, Finland) and Grünenthal (Aachen, Germany). MB is a consultant to HW Pharmaconsulting (Moosach, Germany), cosinuss (Munich, Germany), MIPM (Mammendorf, Germany), and SENZIME (Uppsala, Sweden).

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