Selective reversal of muscle relaxation in general anesthesia: focus on sugammadex

Abstract

Despite the significant improvements in the pharmacology of muscle relaxants in the past six decades, the search for the ideal muscle relaxant continues, mainly because of the incomplete efficacy and persistent side effects associated with their antagonism. Clinical concerns remain about the residual paralysis and hemodynamic side effects associated with the classic pharmacologic reversal agents, the acetylcholinesterase inhibitors. Although the development of the "ideal muscle relaxant" remains illusory, pharmacologic advancements hold promise for improved clinical care and patient safety. Recent clinical advances include the development of short-acting nondepolarizing muscle relaxant agents that have fast onset and a very rapid metabolism that allows reliable and complete recovery; and the development of selective, "designer" reversal agents that are specific for a single drug or class of drugs. This article reviews recent developments in the pharmacology of these selective reversal agents: plasma cholinesterases, cysteine, and sugammadex. Although each of the selective reversal agents is specific in its substrate, the clinical use of the combination of muscle relaxant with its specific reversal agent will allow much greater intraoperative titrating ability, decreased side effect profile, and may result in a decreased incidence of postoperative residual paralysis and improved patient safety.

Investigation of the effect of sugammadex on glutamate‐induced neurotoxicity in C6 cell line and the roles played by nitric oxide and oxidative stress pathways

“…Sugammadex is a synthetic γ‐cyclodextrin and the first member of the SRBA (selective relaxant binding agents) class of neuromuscular reversal medicines. Cyclodextrins are cyclic dextrose units that are linked together by 1–4 glycosyl bonds and are made from starch or starch derivates utilizing cyclodextrin glycosyltransferase [17]. Cortical neurons are protected from glutamate excitotoxicity and oxygen–glucose deprivation by a variety of cyclodextrin groups [18].…”

Sudden Cardiac Collapse After Sugammadex Administration in a Patient with First Variant Angina Attack

“…The limited number of studies have reported that sugammadex does not have any clinically significant effect on blood pressure, heart rate, respiration, and thermoregulation. 14,15 There are only a few case presentations that show coronary vasospasm may be correlated with sugammadex. 16,17 The study, in which the hemodynamic effects of sugammadex and neostigmine on cardiac patients are compared, has found that sugammadex is more stable regarding cardiac function but causes a significant decrease in heart rate within the first minute after its administration.…”

Comparison of neostigmine and sugammadex for hemodynamic parameters in neurointerventional anesthesia

“…Because of its mechanism of action, sugammadex is thought to provide a faster and more predictable reversal of block. In addition, it can also avoid the unwanted side effects of neostigmine and antimuscarinic drugs (11)(12)(13). Sugammadex also does not affect heart rate, blood pressure, respiration, or thermoregulation in healthy patients (14).…”

“…In addition, it can also avoid the unwanted side effects of neostigmine and antimuscarinic drugs ( 11 – 13 ). Sugammadex also does not affect heart rate, blood pressure, respiration, or thermoregulation in healthy patients ( 14 ).…”