Sugammadex in anesthesia practice.

IMPORTANCE OF THE FIELD: Neuromuscular blocking agents are currently used during anesthesia but put patients at risk of postoperative paralysis. If the residual neuromuscular blockade is not reversed properly at the end of anesthesia, there is a risk of hypoxemia and pulmonary complication. Sugammadex is able to fully reverse different degrees of neuromuscular blockade induced by steroidal neuromuscular blocking agents. AREAS COVERED IN THIS REVIEW: This review provides a background to the use of neuromuscular blocking agents during anesthesia. It also describes the mechanism of reversal and the clinical efficacy of sugammadex, and discusses the future changes in clinical anesthesia induced by this new selective binding agent. WHAT THE READER WILL GAIN: An understanding of the rationale and use of sugammadex as a reversal agent of different degrees of neuromuscular blockade and the use of the high-dose rocuronium-sugammadex combination as an alternative to succinylcholine for rapid sequence induction. TAKE HOME MESSAGE: Sugammadex provides an original mechanism of reversing the effect of neuromuscular steroidal agent by direct inactivation in plasma. Although its effect is spectacular, it is questionable whether this drug will change current practice.