Sugammadex, the first selective relaxant binding agent for neuromuscular block reversal

Neuromuscular blocking agents (NMBAs) are widely used to provide muscle relaxation for endotracheal intubation, certain modes of mechanical ventilation and surgical procedures. Full and rapid reversal of this muscle relaxation is needed to prevent residual muscle paralysis and respiratory compromise. The novel selective reversal binding agent, sugammadex, rapidly reverses muscle paralysis from steroidal NMBAs. Sugammadex encapsulates steroidal NMBAs in the plasma and renders them unavailable to the neuromuscular junction receptors. Unlike other reversal agents, sugammadex has the ability to provide fast and thorough reversal of neuromuscular paralysis regardless of the level of blockade. Sugammadex has shown limited adverse effects and avoids the cardiovascular and autonomic effects commonly seen with the conventional reversal of NMBAs (anticholinesterase plus anticholinergic). This review summarizes the current knowledge about sugammadex, its pharmacology and safety profile, dosing recommendations, potential clinical applications and economic impact.