Sugammadex in anesthesia practice.
BACKGROUND
Neuromuscular blocking agents are currently used during anesthesia but put patients at risk of postoperative paralysis. If the residual neuromuscular blockade is not reversed properly at the end of anesthesia, there is a risk of hypoxemia and pulmonary complication. Sugammadex is able to fully reverse different degrees of neuromuscular blockade induced by steroidal neuromuscular blocking agents.


METHODS
This review provides a background to the use of neuromuscular blocking agents during anesthesia. It also describes the mechanism of reversal and the clinical efficacy of sugammadex, and discusses the future changes in clinical anesthesia induced by this new selective binding agent.


RESULTS
An understanding of the rationale and use of sugammadex as a reversal agent of different degrees of neuromuscular blockade and the use of the high-dose rocuronium-sugammadex combination as an alternative to succinylcholine for rapid sequence induction.


CONCLUSIONS
Sugammadex provides an original mechanism of reversing the effect of neuromuscular steroidal agent by direct inactivation in plasma. Although its effect is spectacular, it is questionable whether this drug will change current practice.
Service d'Anesthésie, Réanimation Chirurgicale, SAMU 94-SMUR, Groupe Hospitalier et Universitaire Albert-Chenevier-Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil Cedex, France. philippe.duvaldestin@hmn.aphp.fr
Philippe
P
Duvaldestin
Benoit
B
Plaud
D000732:Androstanols / Q000009:adverse effects / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D019148:Neuromuscular Blockade / Q000009:adverse effects / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium