title: Sugammadex, a promising reversal drug. A review of clinical trials.
abstract: According to published data, sugammadex, rapidly reverses (2-5 min) shallow and profound NM block induced by rocuronium and vecuronium, without being connected with serious adverse events. It is accepted that in order to reverse shallow block, the suggested dose of sugammadex comes up to 2 mg/kg. Profound level of NM block demands 4 mg/kg in order to defy few responses at the post titanic count. Doses of sugammadex lower than 1 mg/kg may lead to rebound of rocuronium's effect. Higher doses of sugammadex (12  16 mg/g) are used in rescue reversal. In children and adolescents the 2 mg/kg dose is both effective and well tolerated, while, to date, data regarding infants are scarce. In patients with renal failure, 2 mg/kg of sugammadex resulted in a mean time to recovery of TOF ratio to 0.9 in 2 min, which was quicker than the time of reversal by acetylcholinesterase inhibitors. Investigations in cardiac patients undergoing noncardiac surgery suggest that 2 and 4 mg/kg of sugammadex are both safe and effective. Compared with neostigmine, sugammadex has no need to use muscarinic antagonists and therefore is not associated with variations in heart rate. Trials indicate that sugammadex acts faster than edrophonium and neostigmine. Sugammadex is a promising, well tolerated agent that enables fast reversal in different depths of NM block -shallow and profound- and in different patients  populations. After completion of trial probation and settlement of issues concerning estimated cost and cost impact, it is believed to play a leading part in future anesthesiology.
authors.affiliation: Department of Anesthesiology, Hippokrateion Hospital, Q. Sofias 114 avenue, 11527 Athens, Greece.
authors.forename: Ira
authors.initials: I
authors.lastname: Makri
authors.forename: Artemisia
authors.initials: A
authors.lastname: Papadima
authors.forename: Aimilia
authors.initials: A
authors.lastname: Lafioniati
authors.forename: Apostolos B
authors.initials: AB
authors.lastname: Pappas
authors.forename: Karanikas
authors.initials: K
authors.lastname: George
authors.forename: Koronakis E
authors.initials: KE
authors.lastname: Nikolaos
authors.forename: Chrysikos D
authors.initials: CD
authors.lastname: Ioannis
authors.forename: Seretis
authors.initials: S
authors.lastname: Charalambos
authors.forename: Lagoudianakis E
authors.initials: LE
authors.lastname: Emmanuel
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xanthos
authors.forename: Lila
authors.initials: L
authors.lastname: Papadimitriou
mesh_terms: D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D006801:Humans; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors*; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex