Since its launch in 2008, sugammadex has been considered one of the most significant developments in anaesthesia-related pharmacology. With almost 500 sugammadex-related publications and over nine million patient exposures worldwide, user experience and scientific data have grown exponentially. However, several important questions are yet to be answered. This article reviews the sugammadex-related literature in 2013 and 2014 to determine which of these questions have been answered more fully over the last 18 months and which questions require more information and research.
LedowskiT., HillyardS., KozmanA., JohnstonF., GilliesE., GreenawayM.Unrestricted access to sugammadex: impact on neuromuscular blocking agent choice, reversal practice and associated healthcare costs.Anaesth Intensive Care2012; 40: 340–343.
2.
DuboisP.E., MulierJ.P.A review of the interest of sugammadex for deep neuromuscular blockade management in Belgium.Acta Anaesthesiol Belg2013; 64: 49–60.
3.
BenyK., PiriouV., DussartC., HenaineR., AulagnerG., ArmoiryX.[Impact of sugammadex on neuromuscular blocking agents use: a multicentric, pharmaco-epidemiologic study in French university hospitals and military hospitals].Ann Fr Anesth Reanim2013; 32: 838–843.
4.
DellaR.G., DiM.P., BerettaL., De GaudioA.R., OriC., MastronardiP.Do we need to use sugammadex at the end of a general anesthesia to reverse the action of neuromuscular bloking agents? Position Paper on Sugammadex use.Minerva Anestesiol2013; 79: 661–666.
5.
ChonJ.Y.In the hour of Sugammadex.Korean J Anesthesiol2013; 64: 3–5.
6.
DoiY., KagawaT.[Update on the practical use of new anesthetic agents].Masui2013; 62: 1088–1096.
KaralapillaiD., KaufmanM., WeinbergL.Sugammadex.Crit Care Resusc2013; 15: 57–62.
9.
KirienkoP.A., BabaiantsA.V., ShmakovI.A., GorobetsE.S., El'dzharkievA.A., Gel'fandB.R.[Assessment of sugammadex use efficiency and safety for neuromuscular block reversion].Anesteziol Reanimatol2013; n/a: 46–51.
10.
LeeS.Sugammadex: a turning point in our practice.Korean J Anesthesiol2013; 65: 493–494.
11.
SchallerS.J., FinkH.Sugammadex as a reversal agent for neuro-muscular block: an evidence-based review.Core Evid2013; 8: 57–67.
12.
Sokol-KobielskaE.Sugammadex - indications and clinical use.Anaesthesiol Intensive Ther2013; 45: 106–110.
13.
WelliverM.D.New and advanced options in neuromuscular blockade management.AANA J2013; Suppl: 12–17.
14.
Della RoccaG., PompeiL., PaganD.E., PaganisC., TesoroS., MendolaC.Reversal of rocuronium induced neuromuscular block with sugammadex or neostigmine: a large observational study.Acta Anaesthesiol Scand2013; 57: 1138–1145.
15.
WooT., KimK.S., ShimY.H., KimM.K., YoonS.M., LimY.J.Sugammadex versus neostigmine reversal of moderate rocu-ronium-induced neuromuscular blockade in Korean patients.Korean J Anesthesiol2013; 65: 501–507.
16.
LedowskiT., HillyardS., O'DeaB., ArcherR., Vilas-BoasF., KyleB.Introduction of sugammadex as standard reversal agent: Impact on the incidence of residual neuromuscular blockade and postoperative patient outcome.Indian J Anaesth2013; 57: 46–51.
17.
von QuillfeldtS., FohreB., AndreesN., SpiesC.D., GalvagniD., JoussenA.M.Rocuronium reversed by sugammadex versus mivacurium during high-risk eye surgery: an institutional anaesthetic practice evaluation.J Int Med Res2013; 41: 1740–1751.
18.
LedowskiT., FalkeL., JohnstonF., GilliesE., GreenawayM., De MelA.Retrospective investigation of postoperative outcome after reversal of residual neuromuscular blockade: sugam-madex, neostigmine or no reversal.Eur J Anaesthesiol2014; 31: 423–429.
19.
LlauradoS., SabateA., FerreresE., CamprubiI., CabreraA.Postoperative respiratory outcomes in laparoscopic bariatric surgery: Comparison of a prospective group of patients whose neuromuscular blockade was reverted with sugammadex and a historical one reverted with neostigmine.Rev Esp Anestesiol Reanim2014; n/a: n/a.
EstevesL.O.Case of anaphylaxis induced by rocuronium treated with sugammadex.Braz J Anesthesiol2013; 63: 511.
22.
IshikawaT., KawanoueN., MinamiE., IwasakiE., IshiiM., KobayashiH.[A case of rocuronium-induced anaphylactic shock successfully treated with sugammadex].Masui2013; 62: 1230–1232.
23.
ConteB., ZoricL., BonadaG., DebaeneB., RipartJ.Reversal of a rocuronium-induced grade IV anaphylaxis via early injection of a large dose of sugammadex.Can J Anaesth2014; 61: 558–562.
24.
RaftJ., Belhadj-TaharN., MeistelmanC.Slow recovery after sugammadex bolus after rocuronium-induced anaphylaxis.Br J Anaesth2014; 112: 1115–1116.
25.
KalkanY., TumkayaL., BostanH., TomakY., AltunerD., YilmazA.Effect of sugammadex on rocuronium induced changes in pancreatic mast cells.Toxicol Ind Health2013; n/a: n/a.
26.
BenhamS.W.Sugammadex in anticipated difficult airways(3.).Anaesthesia2013; 68: 1190–1191.
27.
CoppM.V.Sugammadex in anticipated difficult airways(5.).Anaesthesia2013; 68: 1192.
28.
DaltonA.J., McGuireB., RodneyG.Sugammadex in anticipated difficult airways(4.).Anaesthesia2013; 68: 1191–1192.
29.
ElliottS.K., BallD.R.Sugammadex in anticipated difficult air-ways(2.).Anaesthesia2013; 68: 1190.
30.
GutierrezG.R., AbadG.A., CubekQ.D., JimenezS.C.[Can sugam-madex save the situation of a “no intubation, no ventilation” patient?].Rev Esp Anestesiol Reanim2013; 60: 411–412.
31.
KuroiwaK., MochizukiT., SatoS.[A case of an unexpected difficult nasal intubation, caused by hypertrophied lingual tonsil].Masui2013; 62: 172–174.
32.
MendoncaC.Sugammadex to rescue a ‘can't ventilate’ scenario in an anticipated difficult intubation: is it the answer?Anaesthesia2013; 68: 795–759.
33.
Montealegre-AngaritaM.C., Llaurado-PacoS., SabateA., FerreresE., CabreraA., CamprubiI.[Analysis of difficult intubation factors in bariatric surgery. Influence of the choice of neuromuscular blocker on the availability of sugammadex].Rev Esp Anestesiol Reanim2013; 60: 434–439.
34.
PatonL., GuptaS., BlacoeD.Successful use of sugammadex in a ‘can't ventilate’ scenario.Anaesthesia2013; 68: 861–864.
35.
TurnbullJ., SuarisP.Sugammadex in anticipated difficult air-ways(1.).Anaesthesia2013; 68: 1189–1190.
36.
LuxenJ., TrentzschH., UrbanB.[Rocuronium and sugammadex in emergency medicine: requirements of a muscle relaxant for rapid sequence induction].Anaesthesist2014; 63: 331–337.
37.
Woloszczuk-GebickaB., Zawadzka-GlosL., LenarczykJ., SitkowskaB.D., RzewnickaI.Two cases of the “cannot ventilate, cannot intu-bate” scenario in children in view of recent recommendations.Anaesthesiol Intensive Ther2014; 46: 88–91.
38.
OzbilginS., OzbilginM., KucukoztasB., KamaciG., UnekT., YurtluB.S.Evaluation of the effectiveness of sugammadex for verapamil intoxication.Basic Clin Pharmacol Toxicol2013; 113: 280–285.
CondeR., PereiraM.Anesthetic management of a patient with Brugada syndrome - the use of sugammadex in major abdominal surgery.Rev Bras Anestesiol2013; 63: 159–160.
43.
Franco-HernandezJ.A., RodriguezL.M., Ortiz de LandazuriP.J., HernandezA.G.Use of sugammadex in Strumpell-Lorrain disease: a report of two cases.Rev Bras Anestesiol2013; 63: 113–115.
44.
GonzalezA., BenavidesJ., LemaG.Anesthesia and electrocon-vulsive therapy: when succinylcholine is contraindicated.J ECT2013; 29: 75–76.
45.
GrandjeanB., GuerciP., VialF., RaftJ., Fuchs-BuderT., BouazizH.[Sugammadex and profound rocuronium neuromuscular blockade induced by magnesium sulphate].Ann Fr Anesth Reanim2013; 32: 378–379.
46.
HamadaK., KayashimaK.[Management of cesarean section under general anesthesia using sugammadex].Masui2013; 62: 75–77.
47.
InamoriM., ImashukuY., SonobeS., SukenagaC., YabutaK., HashimuraT.[General anesthetic management of a patient with spinal muscular atrophy type III].Masui2013; 62: 702–704.
48.
KadoiY., NishidaA., SaitoS.Recovery time after sugammadex reversal of rocuronium-induced muscle relaxation for electro-convulsive therapy is independent of cardiac output in both young and elderly patients.J ECT2013; 29: 33–36.
49.
KelsakaE., KarakayaD., ZenginE.C.Use of sugammadex in a patient with amyotrophic lateral sclerosis.Med Princ Pract2013; 22: 304–306.
50.
KissG., LacourA., d'HollanderA.Fade of train-of-four ratio despite administration of more than 12 mg kg(-1) sugamma-dex in a myasthenia gravis patient receiving rocuronium.Br J Anaesth2013; 110: 854–855.
51.
LangleyA., DavieM.Sugammadex and general anaesthesia in a patient with Brugada syndrome.Anaesth Intensive Care2013; 41: 434.
52.
LobazS., SammutM., DamodaranA.Sugammadex rescue following prolonged rocuronium neuromuscular blockade with ‘recurarisation’ in a patient with severe renal failure.BMJ Case Rep2013; 2013: doi: 10.11.36|ber-2012–007603.
53.
MatinyanN.V., SaltanovA.I., MareevaA.A.[Sugammadex use experience in pediatric oncology].Anesteziol Reanimatol2013; n/a: 34–37.
54.
NakamoriE., NitaharaK., SugiY., KatoriK., MatsuzakiA., HigaK.[Reversal of rocuronium induced neuromuscular block with sugammadex in a patient with myasthenia gravis].Masui2013; 62: 972–974.
55.
NeimarkM.I., BulganinA.A.[Controlled myorelaxation in patients with aldosteroma].Anesteziol Reanimatol2013; n/a: 14–18.
56.
NonakaT., FujimotoM., NishiM., YamamotoT.[The effect of rocuronium and sugammadex in hepatic tumor patients without preoperative hepatic impairment].Masui2013; 62: 304–308.
57.
OtaC., UetaK., ImadaT., HayashiY., MashimoT.[Sugammadex reversal after extubation under muscle relaxation to prevent cough reflex in a patient with intractable spontaneous pneumo-thorax].Masui2013; 62: 968–971.
58.
PickardA., LoboC., StoddartP.A.The effect of rocuronium and su-gammadex on neuromuscular blockade in a child with congenital myotonic dystrophy type 1.Pediatr Anesth2013; 23: 871–873.
59.
SanfilippoM., Wefki Abdelgawwad ShoushaA.A., PaparazzoA.Emergence in elderly patient undergoing general anesthesia with xenon.Case Rep Anesthesiol2013; 2013: 736790.
60.
StewartP.A., PhillipsS., De BoerH.D.Sugammadex reversal of rocuronium-induced neuromuscular blockade in two types of neuromuscular disorders: Myotonic dystrophy and spinal muscular atrophy.Rev Esp Anestesiol Reanim2013; 60: 226–229.
61.
StouracP., KrikavaI., SeidlovaJ., StrazevskaE., HuserM., HrubanL.Sugammadex in a parturient with myotonic dystrophy.Br J Anaesth2013; 110: 657–658.
62.
Sungur UlkeZ., YavruA., CamciE., OzkanB., TokerA., SenturkM.Rocuronium and sugammadex in patients with myasthenia gravis undergoing thymectomy.Acta Anaesthesiol Scand2013; 57: 745–748.
63.
YukselE., SerginD., TanattiB., AlperI.Rocuronium-sugammadex use in electroconvulsive therapy of patients with pseudocho-linesterase enzyme deficiency.J Clin Anesth2013; 25: 680–681.
64.
BuijsE.J., ScholtenJ.G.F., RosJ.J.W.Successful administration of su-gammadex in a patient with acute porphyria: A case report.Eur J Anaesthesiol2014; 31: 439–441.
65.
CarronM., GasparettoM., VindigniV., FolettoM.Laparoscopic surgery in a morbidly obese, high-risk cardiac patient: the benefits of deep neuromuscular block and sugammadex.Br J Anaesth2014; 113: 186–187.
66.
ChangY.J., JungW.S., SonW.R., JoY.Y.Discordance between train-of-four response and clinical symptoms in a patient with amyo-trophic lateral sclerosis.Acta Med Okayama2014; 68: 125–127.
67.
CzarnetzkiC., TassonyiE., LysakowskiC., EliaN., TramerM.R.Efficacy of sugammadex for the reversal of moderate and deep rocuronium-induced neuromuscular block in patients pretreated with intravenous magnesium: a randomized controlled trial.Anesthesiology2014; 121: 59–67.
68.
KayashimaK., NodaY., HayashiT., YoshinoH.[Case of delayed extubation in a woman with low pulmonary function].Masui2014; 63: 153–156.
69.
MatsudaK., YakushijiT., RyoJ., HigashimotoS., SasakiK.[Anesthetic management of a patient with 8 trisomy mosaic combined with cerebral palsy].Masui2014; 63: 459–461.
70.
SakuraiY., UchidaM., AibaJ., MimuraF., YamaguchiM., KakumotoM.[Reversal of rocuronium-induced neuromuscular blockade with sugammadex in patients for cesarean delivery treated with magnesium sulfate].Masui2014; 63: 315–319.
71.
SalasB.A., de CarlosV.J.C., ClaveroR.C., MirallesM.F.[Extubation failure due to prolonged residual block after vecuronium. Treatment with sugammadex].An Pediatr (Barc)2014; 80: e92–e93.
72.
SaricicekV., SahinL., BulbulF., UcarS., SahinM.Does rocuronium-sugammadex reduce myalgia and headache after electrocon-vulsive therapy in patients with major depression?J ECT2014; 30: 30–34.
73.
Wefki Abdelgawwad ShoushaA.A., SanfilippoM., SabbaA., PincheraP.Sugammadex and reversal of neuromuscular block in adult patient with duchenne muscular dystrophy.Case Rep Anesthesiol2014; 2014: 680568.
74.
StaalsL.M., SnoeckM.M.J., DriessenJ.J., van HamersveltH.W., FlocktonE.A., van den HeuvelM.W.Reduced clearance of rocuronium and sugammadex in patients with severe to end-stage renal failure: a pharmacokinetic study.Br J Anaesth2010; 104: 31–39.
75.
ShimizuT., TodaY., ShimizuK., IwasakiT., KanazawaT., IshiiN.[Increase in serum vecuronium concentration following sugam-madex administration in a pediatric patient after prolonged sedation].Masui2013; 62: 1225–1229.
76.
CammuG., Van VlemB., van den HeuvelM., StetL., el GaltaR., ElootS.Dialysability of sugammadex and its complex with rocuronium in intensive care patients with severe renal impairment.Br J Anaesth2012; 109: 382–390.
77.
Fabregat LopezJ., Porta VilaG., Martin-FloresM.Reversal of moderate and intense neuromuscular block induced by rocu-ronium with low doses of sugammadex for intraoperative facial nerve monitoring.Rev Esp Anestesiol Reanim2013; 60: 465–468.
78.
KopmanA.F., BrullS.J.Low-dose sugammadex reversal: there is no such thing as a free lunch.Anesthesiology2013; 119: 10–12.
79.
PongraczA., SzatmariS., NemesR., FulesdiB., TassonyiE.Reversal of neuromuscular blockade with sugammadex at the reappearance of four twitches to train-of-four stimulation.Anesthesiology2013; 119: 36–42.
80.
SanfilippoM., AlessandriF., Wefki Abdelgawwad ShoushaA.A., SabbaA., CutoloA.Sugammadex and ideal body weight in bariat-ric surgery.Anesthesiol Res Pract2013; 2013: 389782.
81.
SchmartzD., GuerciP., Fuchs-BuderT.Sugammadex dosing in bariatric patients.Anesthesiology2013; 118: 754.
82.
Van GestelL., CammuG.Is the effect of sugammadex always rapid in onset?Acta Anaesthesiol Belg2013; 64: 41–47.
83.
KayashimaK., SozenR., OkuraD.[Insufficient sugammadex effect in an obese pregnant woman undergoing cesarean section under general anesthesia].Masui2014; 63: 188–190.
84.
KopmanA.F.Recovery times after sugammadex: is the data flawed?Acta Anaesthesiol Scand2014; 58: 496–497.
85.
Van LanckerP., DillemansB., BogaertT., MulierJ.P., De KockM., HaspeslaghM.Ideal versus corrected body weight for dosage of sugammadex in morbidly obese patients.Anaesthesia2011; 66: 721–715.
86.
CarronM.Sugammadex and ideal body weight in bariatric surgery: the debate continues.Anesthesiol Res Pract2014; 2014: 762432.
87.
KotakeY., OchiaiR., SuzukiT., OgawaS., TakagiS., OzakiM.Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block.Anesth Analg2013; 117: 345–351.
88.
JeyadossJ., KuruppuP., NanjappaN., Van WijkR.Sugammadex hypersensitivity-a case of anaphylaxis.Anaesth Intensive Care2014; 42: 89–92.
89.
SadleirP.H.M., RussellT., ClarkeR.C., MaycockE., PlattP.R.Intraoperative anaphylaxis to sugammadex and a protocol for intradermal skin testing.Anaesth Intensive Care2014; 42: 93–96.
90.
SavicL., SavicS., HopkinsP.M.Anaphylaxis to sugammadex.Anaesth Intensive Care2014; 42: 7–9.
91.
TokuwakaJ., TakahashiS., TanakaM.Anaphylaxis after sugamma-dex administration.Can J Anesth2013; 60: 733–734.
92.
TsurA., KalanskyA.Hypersensitivity associated with sugam-madex administration: a systematic review.Anaesthesia2014; 69: 1251–1257.
93.
CarronM.Effects of sugammadex on coagulation: it does not represent a bleeding risk in surgical patients.Int J Clin Pharmacol Ther2014; 52: 824.
94.
de KamP.J., El GaltaR., KruithofA.C., FennemaH., van LieropM.J., MiharaK.No clinically relevant interaction between su-gammadex and aspirin on platelet aggregation and coagulation parameters.Int J Clin Pharmacol Ther2013; 51: 976–985.
95.
De KamP.J., GrobaraP., ProhnM., HoppenerF., KluftC., BurggraafJ.Effects of sugammadex on activated partial thrombo-plastin time and prothrombin time in healthy subjects.Int J Clin Pharmacol Ther2014; 52: 227–236.
96.
De KamP.J., KruithofA.C., van LieropM.J., MoerlandM., DennieJ., TroyerM.D.Lack of a clinically relevant effect of sugamma-dex on anti-Xa activity or activated partial thromboplastin time following pretreatment with either unfractionated or low-molecular-weight heparin in healthy subjects.Int J Clin Pharmacol Ther2014; 52: 631–641.
97.
RezonjaK., LorenzonP., MarsT.Opposing effects of dexametha-sone, agrin and sugammadex on functional innervation and constitutive secretion of IL-6 in in vitro innervated primary human muscle cells.Neurosci Lett2013; 549: 186–190.
98.
RezonjaK., SostaricM., VidmarG., MarsT.Dexamethasone produces dose-dependent inhibition of sugammadex reversal in in vitro innervated primary human muscle cells.Anesth Analg2014; 118: 755–763.
99.
StaikouC., StamelosM., StavroulakisE.Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity.Br J Anaesth2014; 112: 217–230.
100.
SuzukiM., InagiT., KikutaniT., MishimaT., BitoH.Negative pressure pulmonary edema after reversing rocuronium-induced neuromuscular blockade by sugammadex.Case Rep Anesthesiol2014; 2014: 135032.
101.
PalancaJ.M., Aguirre-RuedaD., GranellM.V., AldasoroM., GarciaA., IradiA.Sugammadex, a neuromuscular blockade reversal agent, causes neuronal apoptosis in primary cultures.Int J Med Sci2013; 10: 1278–1285.
102.
HanciV., VuralA., HanciS.Y., AliK.H., OmurD., UnverA.In vitro evaluation of antimicrobial features of sugammadex.Braz J Anesthesiol2014; 64: 105–108.
