Sugammadex has been approved for use in the European Union since 2008 and in the U.S. since 2015. One of the most notable variabilities in the current practices of anesthesiologists is whether to use acetylcholinesterase inhibitors (such as neostigmine or pyridostigmine) versus sugammadex for routine reversal of neuromuscular blockade. The purpose of this brief article is to discuss the current literature in regard to common arguments for or against the routine use of sugammadex in neuromuscular blockade reversal.

It has been demonstrated that sugammadex is more effective and rapid than acetylcholinesterase inhibitors in reversing neuromuscular blockade, especially as acetylcholinesterase inhibitors may carry a risk of residual or even increased weakness. A Cochrane systematic review compared the efficacy of sugammadex versus neostigmine in reversing neuromuscular blockade in adults, resulting in a meta-analysis of 949 total patients showing that sugammadex more rapidly reverses rocuronium-induced neuromuscular block compared to neostigmine, regardless of the...

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