In-depth exploration of sugammadex and novel neuromuscular blockade antagonists: a narrative review

Sugammadex is a modified γ-cyclodextrin widely used in clinical practice to reverse neuromuscular blockade induced by non-depolarizing neuromuscular blockade agents, notably rocuronium and vecuronium. It has been proven to selectively reverse rocuronium-induced neuromuscular blockade within 3 min of administration, representing a revolutionary breakthrough in anesthesiology. Although severe adverse events have been observed in a very small subset of patients, these events have not compromised its overall clinical utility or widespread adoption. This review synthesizes key aspects of sugammadex, including its mechanism of action, pharmacokinetic profile in both healthy and special populations, dosing recommendations for various degrees of neuromuscular blockade in both healthy and special populations, the incidence of adverse effects, pharmacoeconomic considerations, and recent advances in novel reversal agents.