Preparing for the Unexpected: Special Considerations and Complications After Sugammadex Administration

Hajime Iwasaki; J. Ross Renew; Takayuki Kunisawa; Sorin J. Brull


BMC Anesthesiol. 2017;17(140) 

In This Article


As the international use of sugammadex continues to expand, new scenarios will arise that challenge clinicians, and a thorough understanding of the properties, advantages and limitations of this drug are of paramount importance. Similarly important for good clinical care and patient safety, clinicians must remember that the reversal dose of sugammadex should always be calculated based on the degree of neuromuscular recovery obtained with neuromuscular monitoring (ideally, objective neuromuscular monitoring). By doing so, the use of sugammadex eliminates recurrence and/or residual paralysis after neuromuscular reversal. Appropriate dosing of sugammadex also broadens the range of clinical options when reliable and rapid re-induction of neuromuscular blockade is needed. Even in special situations (e.g. hypermagnesemia, hypothermia), sugammadex has an advantage as a neuromuscular reversal agent compared with acetylcholinesterase inhibitors. Although hypersensitivity to sugammadex is unpredictable, such rare events typically occur within minutes of administration and should be detected and treated successfully by the vigilant clinician.