Neuromuscular blockade: what was, is and will be

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Non-depolarizing neuromuscular blocking agents (NMBAs) are used to induce muscle relaxation during surgery.
• Potential complications include malignant hyperthermia, anaphylaxis, and residual neuromuscular blockade.
• Reversal agents like anticholinesterases and sugammadex (a selective relaxant binding agent, SRBA) are used to counteract NMBAs.

Purpose of the Study:

• To compare the efficacy and safety of sugammadex versus neostigmine for reversing neuromuscular blockade.
• To explore the potential advantages of sugammadex, including its impact on acetylcholine receptors and central respiratory control.

Main Methods:

• A pilot study in healthy volunteers was conducted.
• Electromyographic diaphragm activity was measured after administration of sugammadex and neostigmine.

Main Results:

• Recovery after sugammadex was faster than after neostigmine at all blockade levels.
• Sugammadex showed potential advantages over neostigmine related to acetylcholine levels and the need for anticholinergics.
• Hypersensitivity reactions, including anaphylaxis, have been reported with sugammadex.

Conclusions:

• Sugammadex provides faster reversal of neuromuscular blockade compared to neostigmine.
• Further investigation is required to understand sugammadex's effects on respiratory control and muscle activity.
• Emergence of new SRBAs and improved neuromuscular monitoring technologies are anticipated.