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Update on the management of neuromuscular block: focus on sugammadex

Authors Hans D de Boer, Jan van Egmond, Jacques J Driessen, Leo HD Booij

Published 15 November 2007 Volume 2007:3(5) Pages 539—544

Hans D de Boer1,2, Jan van Egmond2, Jacques J Driessen2, Leo HD Booij2

1Department of Anaesthesiology, Radboud University Medical Centre Nijmegen, the Netherlands; 2Martini Hospital Groningen, the Netherlands

Abstract: Steroidal neuromuscular blocking agents (NMBAs), such as rocuronium, are widely used in clinical anesthesia and emergency medicine to facilitate endotracheal intubation and artificial ventilation and to allow surgical access to body cavities. Reversal of neuromuscular blockade is important for the acceleration of patient recovery and prevention of postoperative residual neuromuscular blockade and reduces the incidence of severe morbidity and mortality associated with anesthesia management. Sugammadex is the first selective relaxant binding agent (SRBA) and has been designed to reverse the steroidal neuromuscular blocking drug rocuronium. Encapsulation of the rocuronium molecule by sugammadex results in a rapid decrease in free rocuronium in the plasma and subsequently at the nicotinic receptor at the motor endplate. After encapsulation, rocuronium is not available to bind to the nicotinic receptor in the neuromuscular junction. This promotes the liberation of acetylcholine receptors, and muscle activity reappears. This new concept of reversal of neuromuscular block induced by rocuronium (or vecuronium) led to impressive results in animal and phase 1 and 2 studies. Sugammadex is currently in phase 3 clinical studies and may be commercially available by 2008.

Keywords: neuromuscular block, rocuronium, neuromuscular blocking agent, sugammadex, reversal agent

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