title: Clinical pharmacology and efficacy of sugammadex in the reversal of neuromuscular blockade.
abstract: BACKGROUND
  Sugammadex is the first clinical representative of a class of drugs called steroidal muscle relaxant encapsulators. Due to its 1:1 binding of rocuronium or vecuronium, sugammadex can reverse any depth of neuromuscular block and has therefore revolutionized the way anesthetists think about drug reversal.
  
  
  METHODS
  This review gives an overview of the clinical pharmacology and efficacy of sugammadex in healthy patients as well as in patients with pre-existing diseases.
  
  
  CONCLUSIONS
  After approval in Europe in 2008 and Asia in 2010, sugammadex has recently been approved in the USA and Canada. This will open the field for further research especially for the use in special patient populations and specific diseases. Due to its pharmacodynamic profile, sugammadex in combination with rocuronium might have the potential to displace succinylcholine as the gold standard muscle relaxant for rapid sequence inductions. The use of rocuronium or vecuronium with the potential to reverse its action with sugammadex seems to be safe in patients with impaired neuromuscular transmission, i.e. (neuro)muscular diseases including myasthenia gravis. Data from long-term use of sugammadex is not yet available. Evidence towards an economic advantage of using sugammadex, justifying the relatively high costs for an anesthesia-related drug, is missing.
authors.affiliation: a Klinik für Anaesthesiologie, Klinikum rechts der Isar , Technische Universität München , Munich , Germany.
authors.forename: Stefan Josef
authors.initials: SJ
authors.lastname: Schaller
authors.affiliation: a Klinik für Anaesthesiologie, Klinikum rechts der Isar , Technische Universität München , Munich , Germany.
authors.forename: Heidrun
authors.initials: H
authors.lastname: Lewald
mesh_terms: D000732:Androstanols / Q000037:antagonists & inhibitors; D000818:Animals; D006801:Humans; D019148:Neuromuscular Blockade / Q000379:methods*; D009468:Neuromuscular Diseases / Q000503:physiopathology; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors*; D000077123:Rocuronium; D000077122:Sugammadex; D014673:Vecuronium Bromide / Q000037:antagonists & inhibitors; D047408:gamma-Cyclodextrins / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D014673:Vecuronium Bromide; D000077123:Rocuronium
keywords: RNMB; Sugammadex; cyclodextrin; reoccurrence of neuromuscular block; residual neuromuscular blockade; reversal agent