Pro: The Use of Sugammadex Does Not Preclude the Need for Objective Neuromuscular Monitoring

Based on strong evidence, optimal management of neuromuscular block should incorporate objective (or quantitative) neuromuscular monitoring with appropriately dosed antagonists such as sugammadex. Sugammadex has the unique ability to antagonize aminosteroidal-induced neuromuscular block at any level; however, neostigmine is a reasonable alternative at minimal levels. Blind or excessive administration of sugammadex does not eliminate the risk of patients having postoperative residual neuromuscular block. Significant variability exists in how patients respond both to neuromuscular blocking agents and their antagonists.