Safety of sugammadex for reversal of neuromuscular block

Abstract

Introduction: Sugammadex is a modified cyclodextrin that is able to reverse neuromuscular blockinduced by aminosteroidal neuromuscular blocking drugs. Compared to reversal with neostigmine, itreverses neuromuscular block quicker and more predictable and without cholinergic side effects.However, there have been concerns about sugammadex ability to bind other drugs and its effects onQT interval and clotting times. In addition, sugammadex might induce hypersensitivity reactions morefrequently than initially anticipated. This review summarizes current evidence with regard to these andother safety aspects of sugammadex.Areas covered: This review provides an overview of the efficacy of sugammadex in various patientpopulations, evaluates potential interactions with other drugs and discusses adverse effects andreactions that have been reported in the literature.Expert opinion: Sugammadex quickly reverses aminosteroid neuromuscular block with less side effectscompared to neostigmine. As such, it has the potential to significantly reduce the incidence of residualneuromuscular block and to improve postoperative pulmonary outcome. Current safety concernsmainly focus on hypersensitivity reactions and cardiac arrhythmias. Although the absolute risk forthese events is low, ongoing vigilance and research in this area are needed.