Sugammadex in Perioperative Neuromuscular Management: Current Advances and Best Practices

Neuromuscular blocking agents (NMBAs) are crucial for anesthesia, enabling intubation and optimal surgical conditions. Timely reversal of blockade is critical for safe extubation and recovery. While neostigmine, a traditional reversal agent, is effective for moderate blockade, it has limitations in reversing deep blockade and requires anticholinergics to mitigate side effects. Sugammadex, a novel agent, addresses these limitations by selectively encapsulating aminosteroid NMBAs like rocuronium, providing rapid and reliable reversal. It demonstrates significant advantages, including faster recovery and reduced postoperative complications, especially in high-risk populations such as elderly patients or those with organ dysfunction. However, challenges such as high costs and potential adverse effects, including hypersensitivity and cardiovascular events, restrict its routine use. This review explores sugammadex's pharmacological features, clinical applications, and cost-effectiveness, offering strategies to optimize its use in complex surgical scenarios while addressing current limitations.