Clinical use of sugammadex

Kim, Kyo Sang

Abstract

An ideal reversal agent could be given at any time after the administration of a neuromuscular blocking agent, and should have no muscarinic side-effects. Sugammadex is a modified gamma-cyclodextrin designed to encapsulate rocuronium bromide, providing a rapid reversal of neuromuscular blockade. Sugammadex is a revolutionary investigational reversal drug currently undergoing Phase III testing whose introduction into clinical practice in Korea may change the face of clinical neuromuscular pharmacology. The dose of sugammadex for reversal of moderate block (when T2 is detectable) is approximately 2 mg/kg, the dose is 4-8 mg/kg for profound block (post-tetanic count 1-2) and a larger dose of 16 mg/kg for immediate reversal. The use of sugammadex has not been reported to be associated with recurrence of block provided a dose that is adequate for reversal has been used. Sugammadex appears to have an acceptable safety profile. Volatile agent such as sevoflurane seems not to influence the sugammadex ability to reverse the rocuronium neuromuscular blockade.