Clinical Case Database / Category: Patient Management

Mechanism of action, monitoring & reversal of neuromuscular blocking agents: the use of Sugammadex

Publication details

Dr T Jacobs, MV Copp
Foundation Years Journal, volume 9, issue 8, p.45 (123Doc Education, London, September 2015)


The classical triad of anaesthesia consists of hypnosis, analgesia and muscle relaxation. The introduction of neuromuscular blocking drugs (NMB) in the 1940's transformed the way in which anaesthesia could be safely delivered to patients. The NMB drugs provided the ability to paralyze patients to facilitate intubation of the trachea and provide muscle relaxation during major surgery. The NMB drugs work by occupying nicotinic Acetylcholine receptors (nAchR) in a competitive antagonism with endogenous acetylcholine (Ach) at the neuromuscular junction. At the end of surgery muscle paralysis usually needs to be reversed by the administration of anticholinesterase drugs such as Neostigmine. These drugs have known side effects which can give rise to problems in some patients. A new novel drug called Sugammadex has been introduced into anaesthetic clinical practice which has a completely different mechanism of action to reverse NMB drugs. It brings significant safety benefits for some patients. Its drawback is that it is expensive. In this article we will overview the role and mechanism of action of NMB drugs, including reversal, and will highlight some specific indications for Sugammadex.

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Dr T Jacobs (Corresponding author)

ST5 in Anaesthesia Severn Deanery
Department of Anaesthesia
Cheltenham General Hospital
Cheltenham, GL52 3BS

MV Copp

Consultant Anaesthetist
Gloucestershire Hospitals NHSFT
Department of Anaesthesia
Cheltenham General Hospital
Cheltenham, GL52 3BS


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