Bridion (sugammadex) / Merck (MSD) - LARVOL DELTA

Reversal of rocuronium-induced neuromuscular blockade by sugammadex in patients undergoing kidney transplantation: Pharmacokinetics, efficacy, and safety analyses. (PubMed, J Clin Anesth) - "The significant differences in the pharmacokinetics of sugammadex between the patients undergoing kidney transplantation and healthy controls were observed. In patients with end-stage renal disease, sugammadex 2 mg·kg-1 provided a safety profile similar to healthy controls. Sugammadex is safe and effective for patients undergoing kidney transplantation, although the clearance of sugammadex is slower in this patient population."

Journal • PK/PD data • Chronic Kidney Disease • Nephrology • Renal Disease • Transplantation

Reversing rocuronium-induced neuromuscular block by sugammadex: New safety horizon for Indian population. (PubMed, Natl J Maxillofac Surg) - "In post operative period patient population with facio maxilla surgery will get increased safety. These findings have implications not only for India but also for the global medical community."

Journal • Anesthesia

Incidence of immediate hypersensitivity to sugammadex in Aotearoa New Zealand: a retrospective cohort study. (PubMed, Br J Anaesth) - No abstract available

Journal • Retrospective data • Allergy • Immunology

Association of sugammadex, neostigmine, or pyridostigmine for reversal of neuromuscular block with postoperative bradycardia: a multicentre, retrospective observational study. (PubMed, Br J Anaesth) - "The incidence of bradycardia after sugammadex administration was low, and its adjusted risk was not significantly different from that of neostigmine, the most commonly used acetylcholinesterase inhibitor for reversal of neuromuscular block."

Journal • Observational data • Retrospective data • Anesthesia • Cardiovascular

Comparison of the efficacy of Sugammadex and Neostigmine in antagonizing muscle relaxation after general anesthesia in frail elderly patients (ChiCTR) - P4 | N=100 | Not yet recruiting | Sponsor: Kunshan Traditional Chinese Medicine Hospital; Yichang Humanwell Pharmaceutical Co.,Ltd.

New P4 trial • Anesthesia • Geriatric Disorders

The Effect of Various Administration Protocols of Sugammadex Sodium in the Post-anesthesia Care Unit (PACU) on the Reversal of Postoperative Neuromuscular Blockade in Patients Following Laparoscopic Surgery (ChiCTR) - P=N/A | N=80 | Not yet recruiting | Sponsor: The Second Affiliated Hospital of Air Force Medical University; The Second Affiliated Hospital of Air Force Medical University

New trial • Anesthesia

Reversal of rocuronium-induced fixed pupillary dilation by sugammadex, in an ICU patient after surgery (Euroanaesthesia 2025) - "During transfer to the OR the patient was intubated, with remifentanil, midazolam and low noradrenaline infusion (1 μg/kg/h). During induction fentanyl (150 μg), propofol (40mg) and rocuronium (70 mg) were administered (10 mg of rocuronium were given 60 min later). Anaesthesia was preserved with sevoflurane and low dose of noradrenaline continued intraoperatively. The patient received 8mg morphine for postoperative analgesia...Full eye-recovery was gradual, within 24hours. Intraoperative use of rocuronium in an ICU non-COVID patient caused pupils' mydriasis and depression of light reflex. Reverse of this rare side effect was imminently achieved with sugammadex administration and consequently, other serious CNS causes were excluded"

Clinical • Surgery • Anesthesia • CNS Disorders • Depression • Oncology • Ophthalmology • Ovarian Cancer • Psychiatry • Solid Tumor

The management conundrum of a Myasthenia Gravis patient with high aspiration risk for ultra-short surgery (Euroanaesthesia 2025) - "Intubation was achieved using video laryngoscopy, with effect site target-controlled infusions (TCI) of propofol (Schneider Cet 6mcg/ml) and remifentanil (Minto Cet: 7ng/ml), facilitated by topical 10% lignocaine sprays to the glottis...Remifentanil offers several advantages - avoiding prolonged paralysis from succinylcholine and the unpredictable dosing or reversal requirements with a rocuronium and sugammadex combination. Although the use of remifentanil may lead to hemodynamic instability, its predictable pharmacokinetics and ultra-short duration of action make it an ideal agent - allowing for both optimal conditions for intubation and rapid adjustment of doses to manage hemodynamic changes after intubation. Further studies are recommended to optimise remifentanil dosing and compare clinical outcomes between MG patients receiving remifentanil and NMBAs for RSI.Learning Points: RSI with remifentanil can be used in short surgeries with high aspiration risk."

Clinical • Surgery • Anesthesia • CNS Disorders • Hypotension • Myasthenia Gravis • Solid Tumor • Thymoma • Thymus Cancer

Rocuronium-Induced anaphylactic shock with reversal after the use of sugammadex: a case report (Euroanaesthesia 2025) - "His medical history included hypertension (treated with enalapril) and smoking. He reported an allergy to ibuprofen (hives) and a previous uncomplicated orthopedic surgery under GA. GA was induced with 50ug of fentanyl, 80mg of lidocaine, 160mg of propofol, 20mg of ketamine and 100mg of rocuronium followed by orotracheal intubation...Anaphylactic shock was suspected, and treatment with adrenaline ev (3 bolus of 0,1mg), 200mg of hydrocortisone ev, 2mg of clemastine ev, IV fluids, and bronchodilators was initiated... Anaphylactic shock was attributed to rocuronium, a rare but life-threatening complication of GA that requires prompt recognition and intervention, even in patients with no previous issues. If suspected, the administration of sugammadex may be crucial for stabilizing the patient."

Case report • Clinical • Anesthesia • Cardiovascular • Dermatology • Gastroenterology • Hypertension • Hypotension • Immunology • Orthopedics • Urticaria

Effect of intravenous magnesium sulphate on neostigmine or sugammadex reversal of rocuronium-induced neuromuscular block - a randomized electrophysiological study (Euroanaesthesia 2025) - "There was a significant association between treatment group (A or B) and TOF ratio decrease; odds ratio of 27.3 (p-value of 0.0002).Conclusion(s): These findings indicate that magnesium distinctly affects the potentiation of rocuronium residual neuromuscular block reversed with neostigmine versus sugammadex. Further studies are needed to validate these outcomes and improve clinical protocols, particularly for obstetric patients receiving general anesthesia for delivery, where magnesium use is common."

Clinical • Anesthesia • Obstetrics

Effect of respiratory acid-base balance on the rocuronium induced neuromuscular blockade and sugammadex induced reversal in the rat phrenic nerve hemidiaphragm (Euroanaesthesia 2025) - "Total dose of rocuronium and sugammadex is different between control vs respiratory acidosis (p=0.0318 in ROC, p=0.0315 in SGX), and between respiratory acidosis vs alkalosis (p=0.0007 in ROC, p=0.0007 in SGX)Conclusion(s): We suspect that respiratory acid-base changes will be affected the rocuronium induced relaxation and reversal of sugammadex. But it will be needed further suty."

Preclinical • CNS Disorders • Depression • Metabolic Disorders • Psychiatry

Apneic oxygenation with high-flow nasal oxygen: a safer approach to microlaryngeal surgery (Euroanaesthesia 2025) - "After pre-oxygenation with a face mask to an EtO2 >90%, anesthesia was induced with TCI of remifentanil 1 ng/ml, TCI of propofol 3-4 mcg/ml, and rocuronium 1.3 mg/kg...At the end of the surgery, neuromuscular blockade was reversed with 4 mg/kg of sugammadex, intravenous infusions were stopped, and ABG was performed, revealing respiratory acidosis (PaCO2 66.2 mmHg, PaO2 233 mmHG, and pH 7.25). The patient was sent to the post-anesthesia care unit, where she remained and developed a mild, bilateral headache. After 30 minutes, ABG was repeated, showing correction of respiratory acidosis (PaCO2 41.3 mmHg, pH 7.38) and complete reversal of the headache. The administration of oxygen under HFNO during microlaryngeal surgery under apneic oxygenation is a safe way to ensure oxygenation, optimizing the surgical field and avoiding complications arising from multiple ETIs or JV."

Surgery • Anesthesia • Cardiovascular • CNS Disorders • Dysphonia • Metabolic Disorders • Migraine • Otorhinolaryngology • Pain

When reversal fails: investigating recurarization after sugammadex administration (Euroanaesthesia 2025) - "Background: Sugammadex, a modified γ-cyclodextrin, has transformed clinical practice by providing rapid and reliable reversal of neuromuscular blockade (NMB) induced by rocuronium and vecuronium, even at profound levels...Induction was achieved with fentanyl (2 mcg/kg), lidocaine (1 mg/kg), propofol (2 mg/kg), and rocuronium (0.6 mg/kg). Intraoperative medications included dexamethasone, ondansetron, ketorolac, paracetamol, and metamizole...Other causes were systematically ruled out. To minimize recurarization risks, clinicians should ensure rigorous monitoring, individualized dosing, drug quality assessment, and extended observation."

Anesthesia • Breast Cancer • Fibromyalgia • Gynecology • Musculoskeletal Pain • Oncology • Ovarian Cancer • Pain • Rheumatology • Solid Tumor

Anaesthesia management in Kennedy´s disease. A case report (Euroanaesthesia 2025) - "The patient fasted for >8 hours and received metoclopramide and atropine for premedication...A rapid sequence induction was performed using fentanyl 1mcg/kg, propofol 2mg/kg, rocuronium 0.8 mg/kg, Sellick's manoeuvre and videolaryngoscopy. Maintenance was achieved with propofol and remifentanil. The patient was extubated without complications when fully alert, after performing TOF-guided neuromuscular block reversal using sugammadex 4mg/kg and a period of CPAP. KD, an X-linked disorder that leads to neuromuscular toxicity, bulbar weakness (dysarthria, dysphagia), and impaired airway (AW) reflexes...Short-acting agents minimise respiratory depression, with depolarising (succinylcholine) and non-depolarising muscle relaxants being used, though succinylcholine may pose a hyperkalaemia risk (2). Reversing neuromuscular block is crucial to prevent later respiratory depression, and extubation is preferred when the patient is awake."

Case report • Clinical • Anesthesia • CNS Disorders • Depression • Dysphonia • Gastrointestinal Disorder • Genetic Disorders • Movement Disorders • Muscular Atrophy • Psychiatry • Rare Diseases

Unraveling negative pressure pulmonary edema post-tonsillectomy (Euroanaesthesia 2025) - "Rocuronium was used for neuromuscular blockade and reversed with sugammadex 200mg before extubation with train-of-four monitoring. NPPE is often self-limiting and managed with supportive care, including oxygen and monitoring. Awareness is vital, particularly after surgeries like tonsillectomy, to avoid unnecessary interventions."

Anesthesia • Cardiovascular • Otorhinolaryngology • Pulmonary Disease • Respiratory Diseases

Perioperative management of myotonic dystrophy: tailored approaches to general anaesthesia – a case report (Euroanaesthesia 2025) - "Anesthesia induction was performed with 2mg midazolam, 100mcg fentanyl, 200mg propofol, and 50mg rocuronium, followed by orotracheal intubation...Analgesia included 1g paracetamol, 100mg tramadol, and 30mg ketorolac...At the procedure's end, 400mg sugammadex were administered, achieving a TOF ratio >0.9...Hypersensitivity to sedatives and paralytics increases risks of ventilatory dysfunction, delayed muscle recovery, pharyngeal dysfunction, and aspiration. To mitigate these, short-acting drugs are recommended to allow rapid recovery of consciousness and muscle strength.2"

Case report • Clinical • Anesthesia • Cardiovascular • Cataract • Dysphonia • Gastrointestinal Disorder • Genetic Disorders • Immunology • Muscular Dystrophy • Myositis • Myotonic Dystrophy • Ophthalmology • Otorhinolaryngology • Pain • Pulmonary Disease

Medication errors, a preventable patient harm cause? (Euroanaesthesia 2025) - "Reporting incidents and implementing prevention strategies are critical to minimizing their occurrence.Case Report: We describe the case of a 55-year-old heart transplant recipient who was approaching extubation, managed without hypnotics or neuromuscular blockers, while receiving norepinephrine, dobutamine, and morphine for pain control.Just post-extubation, he became unresponsive, desaturated to 60%, and required reintubation, not needing any induction drugs. Suspecting a medication error, naloxone was administered without effect, but sugammadex restored movement and responsiveness.Further investigation revealed an unlabelled syringe and an empty rocuronium vial, supporting the idea of a medication error...Strategies such as surgical checklists, medication reconciliation, and verifying verbal orders are effective when supported by a culture of safety and error reporting. Tools like root cause and failure mode effect analysis are pivotal in identifying and addressing..."

Clinical • Pain

Perioperative considerations for adult patients with pyruvate dehydrogenase complex deficiency (Euroanaesthesia 2025) - "The patient remained hemodynamically stable throughout the procedure and emergence, with successful reversal with sugammadex. There is a paucity of information on perioperative management of PDCD, especially in adults with only one additional case report.2 Feared complications with PDCD are MH, propofol infusion syndrome (PIS) and lactic acidosis. Our case shows that the use of propofol for TIVA with rocuronium can be a safe option for adult PDCD patients undergoing a short procedure under general anesthesia."

Clinical • Anesthesia • CNS Disorders • Developmental Disorders • Epilepsy • Metabolic Disorders • Movement Disorders • Pediatrics

The use of neuromuscular blocking agents and its reversal in adult, pediatric and pregnant patients in Italy: a survey of current management (Euroanaesthesia 2025) - "Rocuronium is the most widely used neuromuscular blocking agent in adult, pediatric and pregnant patients...Sugammadex is the most widely used reversal in both adults, pregnant women and children... This survey highlight what is the current Italian experience regarding the myoresolution in pediatric and adult patients. The data obtained show that clinical practice in the management of correct myoresolution is still not standardized. The immediate consequence is the real risk of incomplete neuromuscular recovery."

Clinical • Anesthesia • Pediatrics

Attitudes of anaesthetists towards neuromuscular blockade monitoring: An audit in a teaching hospital (Euroanaesthesia 2025) - "Despite multiple interventions in education, practitioners won't necessarily change their practice. The anaesthetists' clinical experience together with the efficiency and affordability of sugammadex, has led to a heightened sense of safety, despite nine of the anaesthetists admitting that they had a complication due to inadequate reversal of muscle relaxants during their practice.Conclusion(s): Educational interventions might not be sufficient to change clinical practices and further administrative interventions might be necessary."

Clinical • Anesthesia

A case report of Kounis syndrome type I triggered by sugammadex administration (Euroanaesthesia 2025) - "1)Case Report: We report a case of Type I KS following the administration of sugammadex, a reversal agent for rocuronium-induced neuromuscular blockade...His medical history included a valacyclovir allergy and a smoking history of 20 cigarettes/day for 15 years but no evidence of coronary artery disease, electrocardiogram (ECG) abnormalities, or exercise intolerance...In this case, rapid diagnosis and therapeutic intervention ensured a favorable outcome. ​"

Case report • Clinical • Acute Coronary Syndrome • Anesthesia • Bladder Cancer • Cardiovascular • Coronary Artery Disease • Dyslipidemia • Hypertension • Hypotension • Immunology • Oncology • Solid Tumor

Role of rare anatomical variation in adapting anaesthesia management in Kartagener's syndrome (Euroanaesthesia 2025) - "After the administration of 60 mg of rocuronium, an attempt at endotracheal intubation was performed using direct laryngoscopy, which revealed a Grade II laryngoscopy (Cormack-Lehane classification) and difficulty in guiding the RAE tube...Neuromuscular blockade was reversed with sugammadex (2 mg/kg)...TIVA with propofol and remifentanil may help preserve mucociliary function, reducing pulmonary complications3, while reverse ECG electrode positioning addresses anatomical variations.Learning points: Anatomical variations in KGS should be considered when monitoring for anaesthesia. Volatile anesthetics may exacerbate ciliary dyskinesia in KGS and predispose patients to respiratory complications; thus TIVA is a safe option in this population."

Anesthesia • Asthma • Bronchiectasis • Diabetes • Endocrine Disorders • Genetic Disorders • Immunology • Metabolic Disorders • Obesity • Otorhinolaryngology • Pulmonary Disease • Respiratory Diseases • Sinusitis • Type 2 Diabetes Mellitus

Airway management challenges in a patient with Moebius syndrome: a case report (Euroanaesthesia 2025) - "Neuromuscular blockade was reversed with sugammadex, and residual block excluded with quantitative peripheral nerve stimulation...Videolaryngoscopy proved invaluable in overcoming anatomical challenges. Extubation required a high index of suspicion for inadequate ventilation, emphasizing the need for close monitoring."

Case report • Clinical • Anesthesia • CNS Disorders • Genetic Disorders

General anesthesia in a patient with corticobasal syndrome: a rare clinical case (Euroanaesthesia 2025) - "Balanced general anesthesia was induced with propofol and rocuronium with adequate muscle relaxation. Neuromuscular blockade was reversed with sugammadex, allowing smooth extubation without complications...A tailored approach to CBS, including careful perioperative monitoring and judicious selection of anesthetic agents, is critical to mitigate these risks. This case adds to the limited body of knowledge demonstrating the feasibility of general anesthesia in such patients."

Clinical • Anesthesia • Chronic Kidney Disease • Chronic Obstructive Pulmonary Disease • CNS Disorders • Depression • Dysphonia • Dystonia • Immunology • Movement Disorders • Nephrology • Pain • Psychiatry • Pulmonary Disease • Renal Disease • Respiratory Diseases

Anesthetic approach with neuromonitoring tube and endobronchial blocker in uniportal VATS surgery (Euroanaesthesia 2025) - "Before surgical incision, the neuromuscular blockade was reversed with sugammadex...Previous studies suggest that endobronchial blockers are a safe and efficient solution in situations where DLTs are less suitable(2). This case underscores the importance of tailored, evidence-based approaches to challenging clinical scenarios."

Surgery • Anesthesia