Related Experiment Video
Updated: Jun 25, 2026
08:50
Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy
Published on: June 25, 2013
Clinical implications of sugammadex
1Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, CA, USA. caldwell@anesthesia.ucsf.edu
Anaesthesia
|February 19, 2009
Summary
Sugammadex, a novel reversal agent, effectively and rapidly reverses neuromuscular block caused by rocuronium and vecuronium. This drug may alter anesthetic practices, potentially increasing rocuronium use and impacting pharmacy costs.
Area of Science:
- Anesthesiology
- Pharmacology
- Drug Discovery
Background:
- Sugammadex is a modified gamma-cyclodextrin designed for specific reversal of neuromuscular blocking agents.
- Rocuronium and vecuronium are commonly used non-depolarizing neuromuscular blocking drugs in anesthesia.
Purpose of the Study:
- To evaluate the efficacy and implications of sugammadex as a reversal agent for rocuronium and vecuronium.
- To explore the potential impact of sugammadex on anesthetic practice, drug utilization, and monitoring.
Main Methods:
- Sugammadex selectively encapsulates rocuronium and vecuronium molecules.
- Clinical studies assess the speed and completeness of neuromuscular block reversal.
Main Results:
- Sugammadex provides rapid and complete reversal of neuromuscular block without autonomic side effects.
- It allows for deep neuromuscular block maintenance until the end of surgery and flexible reversal timing.
- Dosing ranges from 2-16 mg/kg, dependent on the level of block.
Conclusions:
- Sugammadex offers a reliable method for reversing rocuronium-induced neuromuscular blockade.
- Its availability may lead to increased use of rocuronium, changes in monitoring practices, and potential pharmacy cost increases, offset by faster patient recovery.
Related Concept Videos
01:21Skeletal Muscle Relaxants: Adverse Effects
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Unlike...
01:19Depolarizing Blockers: Pharmocokinetics
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
01:27Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions
Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Although all competitive neuromuscular blockers are designed...
01:28Depolarizing Blockers: Mechanism of Action
Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because succinylcholine...
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because succinylcholine...
01:31Skeletal Muscle Relaxants: Therapeutic Uses
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.