PRO: Sugammadex Should be Routinely Used for Reversal of Neuromuscular Blockade in Patients Undergoing Thoracic Surgery

THE FIRST HUMAN STUDY describing the use of sugammadex for the reversal of nondepolarizing neuromuscular blocking agents was published in 2005. 1 Gijsenbergh F Ramael S Houwing N et al. First human exposure of Org 25969, a novel agent to reverse the action of rocuronium bromide. Anesthesiology. 2005; 103: 695-703 Crossref PubMed Scopus (237) Google Scholar Sugammadex is a synthetically modified gamma-cyclodextrin that directly binds to amino-steroidal nondepolarizing neuromuscular blocking agents, such as rocuronium and vecuronium, thereby antagonizing their neuromuscular junction blocking effect, with subsequent urinary excretion. Traditionally, neuromuscular blockade (NMB) has been reversed with cholinesterase inhibitors that increase the concentration of acetylcholine at the neuromuscular junction and competitively displace nondepolarizing neuromuscular blocking agents from acetylcholine receptors, thereby reversing muscle relaxation. The last decade has witnessed a significant increase in the utilization of sugammadex for reversal of NMB, especially in the United States after its approval by the United States Food and Drug Administration in 2015.