Potential Adverse Effects of Sugammadex Administration: A Scoping Review

Sugammadex, a novel agent for reversing neuromuscular blockade, has become the preferred method for reversal over the combination of neostigmine and glycopyrrolate due to its lower risk of adverse effects and high efficacy in reversing paralytic agents. Its primary theorized adverse effect is its ability to bind to steroids, which may compromise the effectiveness of hormonal birth control. Further investigation is needed to identify unanticipated or poorly understood side effects and better inform preoperative assessments and use across diverse patient populations. To gather existing research on sugammadex, with a particular focus on identifying gaps in knowledge regarding its adverse effects and optimizing preoperative evaluation strategies to enhance patient outcomes. A literature search was conducted by RV, GA, WL, LP, BO, and DN between January and March 2024 using PubMed and Google Scholar. The keywords used were "sugammadex," "adverse effects," and "side effects." Studies published between January 2019 and March 2024 were included, as prior reviews addressed adverse effects reported before 2019. The initial search yielded 1,236 studies, narrowed to 46 after applying eligibility criteria. From these, 20 studies were selected for in-depth analysis, including case reports and case series. Higher doses of sugammadex have been associated with an in vitro decrease in coagulation factors and a possible increased risk of bleeding. Cases of severe bradycardia, including instances leading to cardiac arrest, have been reported, particularly in pediatric patients and certain adult populations. In pediatric patients, sugammadex was also found to affect heart rate variability following neuromuscular blockade reversal. Anaphylactic reactions were observed at an incidence rate of two in 19,821 patients in a single-center cohort study. Sugammadex's early adoption in clinical settings, favored for cases with extensive neuromuscular blockade and significant comorbidities, reflects its clinical value. Adverse effects associated with its use include severe bradycardia, hypotension, a theoretical decrease in the effectiveness of oral contraceptives, and anaphylaxis. Efficacy in the special populations, such as patients who are pregnant is still relatively unexplored, and moving forward, usage of sugammadex should be considered with these adverse effects in mind as more extensive data becomes available.