Developing novel drugs to reverse neuromuscular block: do we need them?

In the last 5 yr, rocuronium followed by reversal with sugammadex has become the most common combination of neuromuscular blocking drug and neuromuscular block antagonist in use during anaesthesia in the developed world. Despite a low incidence of side-effects from this drug combination, research continues on the development of new reversal agents. This includes development of new gamma cyclodextrins such as adamgammadex, and unrelated compounds such as calabadion 2 and Pillar[6]MaxQ, that not only sequestrate rocuronium, but also opioids such as fentanyl. The reasons for such work are questioned with the acknowledgement that, as in all areas of anaesthetic practice, the search for perfect drugs continues despite the limited clinical demand.