Sugammadex for Neuromuscular Blockade Reversal: A Narrative Review

Abstract

Sugammadex represents a significant advancement in neuromuscular blockade management, enabling rapid, predictable, and highly effective reversal of steroidal neuromuscular blockers such as rocuronium and vecuronium. This review critically examines recent advances in sugammadex research, particularly over the last decade, detailing its pharmacological profile, clinical efficacy, and safety compared to traditional reversal agents, like neostigmine. Its expanding clinical applications across operating rooms, critical care units, and emergency medicine are discussed, emphasizing dosing recommendations and clinical utility in special patient populations, including individuals with renal impairment, pediatric, obstetric, and obese patients. Economic considerations are explored, highlighting sugammadex's cost-effectiveness through reduced postoperative complications and enhanced operational efficiency, despite higher initial costs. Finally, the review outlines ongoing research directions, including emerging reversal agents, advanced neuromuscular monitoring technologies, and potential future clinical applications, underscoring sugammadex's evolving role in improving patient safety and anesthetic practice.

Keywords: Vecuronuim; neostigmine; neuromuscular blockade reversal; neuromuscular monitoring; residual paralysis; rocuronium; sugammadex.

Figure 1

Clinical Decision Tree for Sugammadex Dosing and Use in Diverse Populations. NMBA = Neuromuscular Blocking Agent; TOF = Train-of-Four; PTC = Post-Tetanic Count; ESRD = End-Stage Renal Disease; CBW = Corrected Body Weight; TBW = Total Body Weight; BMI = Body Mass Index. Studies evaluating sugammadex use in patients with renal failure [19,20,21,22,23,24,25,26], obesity [27,28,29,30,31,32,33,34], pediatrics [35,36,37,38,39,40], and obstetrics [41,42,43,44,45].