Profound Neuromuscular Blockade: Advantages and Challenges for Patients, Anesthesiologists, and Surgeons

Abstract

Rarely has the introduction of an anesthetic agent or adjunct been as anticipated or needed as that of sugammadex. Residual paralysis after neuromuscular blockade (NMB) occurs frequently and is associated with a range of adverse effects ranging from patient discomfort to respiratory complications and death. Residual neuromuscular block is due to a number of factors that include overdosing of neuromuscular blocking agents (NMBAs), inadequate monitoring of the effect of NMBAs, and the limitations of anticholinesterses to antagonize neuromuscular block (relatively slow onset of effect and inability to antagonize deep levels of NMB. Sugammadex, a selective relaxant binding agent, will, when dosed appropriately, rapidly and completely reverse the effects of vecuronium and rocuronium, steroidal NMBAs, from any depth of NMB. While this approach has the potential to increase safety in the perioperative use of NMBAs, it also allows clinicians to revise dosing paradigms to improve surgical conditions and, importantly, patient outcome.