Sugammadex Is Not a Silver Bullet: Caveats Regarding Unmonitored Reversal

Editorial| July 2023 Sugammadex Is Not a Silver Bullet: Caveats Regarding Unmonitored Reversal This article has an Audio Podcast Michael M. Todd, M.D.; Michael M. Todd, M.D. 1Department of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota. https://orcid.org/0000-0003-1531-5825 Search for other works by this author on: This Site PubMed Google Scholar Aaron F. Kopman, M.D. Aaron F. Kopman, M.D. 2Retired from the Department of Anesthesiology, Weill Cornell Medical College, New York, New York. Search for other works by this author on: This Site PubMed Google Scholar Author and Article Information Accepted for publication April 11, 2023. This editorial accompanies the article on p. 6. Address correspondence to Dr. Todd: Anesthesiology July 2023, Vol. 139, 1–3. https://doi.org/10.1097/ALN.0000000000004587 Connected Content Article: A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Michael M. Todd, Aaron F. Kopman; Sugammadex Is Not a Silver Bullet: Caveats Regarding Unmonitored Reversal. Anesthesiology 2023; 139:1–3 doi: https://doi.org/10.1097/ALN.0000000000004587 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsAnesthesiology Search Advanced Search Topics: bullets (device), silver, sugammadex In the current issue of Anesthesiology, Bowdle et al.1 report the results of an observational study examining the dose of sugammadex required to achieve adequate reversal of a rocuronium neuromuscular block in a group of elective cardiac surgical patients. At the end of surgery, the authors gave 97 patients small (50 mg), repeated (every 5 min) incremental doses of sugammadex until a train-of-four ratio of 0.90 or greater was achieved and then continued to monitor the train-of-four ratio for up to 7 h postoperatively. This work contains a number of findings that deserve attention from our entire profession. Most importantly, it contradicts the widespread belief that simply giving the recommended 2- or 4-mg/kg dose of sugammadex, based solely on an observed twitch count (or post-tetanic count) ensures adequate reversal. While we have no objections to these recommended (and Food and Drug Administration–approved) doses, the Bowdle et al.1... You do not currently have access to this content.