Sugammadex, the Guardian of Deep Muscle Relaxation During Conventional and Robot-Assisted Laparoscopic Surgery: A Narrative Review.

High intra-abdominal pressure induced by artificial pneumoperitoneum can obviously impair respiratory and circulatory functions and has a negative effect on the prognosis of patients undergoing conventional and robot-assisted laparoscopic surgery. The application of deep neuromuscular blockade (NMB) during the operation is reported to lower the intra-abdominal pressure and improve patients’ outcome. However, concern lies in the risks of postoperative residual muscular paralysis with the use of deep neuromuscular blockade. Sugammadex, a specific antagonist for aminosteroids muscle relaxants, can effectively and rapidly reverse rocuronium and vecuronium induced neuromuscular blockade of different depths. Thus, sugammadex allows the ability to safeguard the application of deep neuromuscular blockade in laparoscopic operations and helps to alleviate the adverse complications associated with pneumoperitoneum. Here, the application of deep neuromuscular blockade in different laparoscopic surgeries is reviewed and the benefits and possible risks of sugammadex administration in the reversal of deep neuromuscular blockade in these operations are discussed.
Sugammadex is currently marketed for use in more than seventy countries around the world, but only an estimated 10% of the surgical population have received sugammadex from 2010 to 2018. Except for hypersensitivity, bleeding, bradycardia, effect on coagulation parameters and risk of recurarization, there are a number of potential adverse events that remain of concern. In Japan, sugammadex is now the leading cause of perioperative anaphylaxis since it has been approved for clinical use. A case was also reported that deep residual NMB reoccurred in a 74-year-old woman who received a single dose of sugammadex (4 mg/kg).
Sugammadex is a major breakthrough and innovation in the field of anesthesia. When administered with an appropriate dose, sugammadex offers anesthesiologists greater flexibility and better control over different depths of NMB, especially deep NMB and intense NMB. However, a clear and comprehensive understanding of the adverse effects of sugammadex has yet to be obtained and more large-scale multi-center studies on sugammadex are urgently needed.

Sun Y, Wu Z, Wang Q, Chen R, Sun S, Lin Y. Sugammadex, the Guardian of Deep Muscle Relaxation During Conventional and Robot-Assisted Laparoscopic Surgery: A Narrative Review. Drug Des Devel Ther. 2021;15:3893-3901
https://doi.org/10.2147/DDDT.S328682