Sugammadex: Role in current anaesthetic practice and its safety benefits for patients

Table 1 Suggested guideline for use of sugammadex

Sugammadex is not to be prescribed for routine reversal from moderate NMB (TOF count > 2)
Clinical situations where avoiding the use of neostigmine and glycopyrrolate potentially gives significant safety benefits to patients, e.g., avoidance of tachycardia/tachyarrthymias in patients with ischaemic heart disease and/or atrial fibrillation. Avoidance of potential bronchospasm in patients with brittle asthma
Concern about residual neuromuscular block (after rocuronium or vecuronium) post-operatively in patients with airway difficulty or respiratory insufficiency that have already been reversed with a max 5 mg dose of neostigmine
Reversal from deep neuromuscular block that would otherwise waste 30 min of theatre time if waiting for a TOF count of 2 to use neostigmine reversal, e.g., when a large dose of rocuronium has been used to provide deep neuromuscular block for a short surgical procedure or the surgery has finished earlier than predicted
In morbidly obese patients where there is a concern about the potential for residual neuromuscular blockade following reversal of NMB drugs
Emergency reversal of rocuronium (1.2 mg/kg) using the sugammadex rescue pack (16 mg/kg) after failed intubation at RSI

NMB: Neuromuscular block; TOF: Train of four; RSI: Rapid sequence induction.