Benefits & Risks of Sugammadex - Korean Journal of Anaesthesiology

ARTICLE HERE

• Hormonal contraceptive drug interaction
• Hypersensitivity
• Bronchospasm
• Reoccurrence of NMB
• ?Bleeding influence
• Movement, coughing etc
• Parosmia and 'funny taste'

"Although sugammadex has some benefits, it also has several side effects. Hypersensitivity to sugammadex is the major concern. However, hypersensitivity reactions rarely occur. In patients with known sugammadex hypersensitivity, it is contraindicated. Other reported side effects include coughing, movement of a limb or the body, parosmia (abnormal sense of smell), and elevated urine levels of N-acetyl-glucosaminidase [13]. Theoretically, sugammadex can bind to endogenous and pharmaceutical molecules other than steroidal neuromuscular-blocking drugs, therefore reducing the efficacy of these molecules. When sugammadex has a very high affinity for another molecule, this molecule may displace rocuronium or vecuronium from the complex with sugammadex, resulting in the reoccurrence of neuromuscular blockade [14]. Sugammadex may interact with hormonal contraceptive drugs via unwanted binding, therefore, possibly reducing their clinical efficacy [15]. It should be explained to female patients using hormonal contraceptives that the effectiveness of such drugs could be reduced by the administration of sugammadex. The efficacy and safety of sugammadex in obstetric anesthesia have not been determined. To date, no serious adverse event in the mother or neonate after sugammadex has been reported. Because sugammadex is expensive, this is an important factor that may limit its use as a routine antagonist of neuromuscular-blocking drugs.
In this issue of the Korean Journal of Anesthesiology, there are three interesting papers on muscle relaxants [16,17], and sugammadex [18]. The study of sugammadex and its influence on bleeding is quite novel [18].
If you wish to use an antagonist of neuromuscular-blocking drugs, which would you choose between sugammadex and acetylcholinesterase inhibitors? This depends on the decision and experience of the anesthesiologists regarding the benefits and risks of sugammadex, with which they should therefore be well acquainted."