To describe the systemic benefits of sugammadex as a reversal agent for neuromuscular blockade. Sugammadex is the preferred reversal agent for neuromuscular blockade as recommended in guidelines from the American Society of Anesthesiology. This recommendation is primarily based on a faster time to recovery from neuromuscular blockade as compared to that seen with neostigmine. Systemic adverse effects of neostigmine are often mitigated by the administration of glycopyrrolate. However, glycopyrrolate is an antimuscarinic agent that may be associated with its own adverse effects when used as part of a reversal strategy for neuromuscular blockade. This review describes the potential systemic benefits of sugammadex, compared to an acetylcholinesterase/anticholinergic strategy, related to postoperative nausea and vomiting, urinary retention, bowel recovery, and cognitive dysfunction while also discussing its role in enhanced recovery after surgery protocols. Sugammadex is associated with a reduction in systemic effects when compared to combinations of neostigmine and glycopyrrolate. Further research is needed on important clinical and economic outcomes associated with a reduction in these adverse effects.
Linn et al. (Mon,) studied this question.