Sugammadex, sold under the brand name Bridion, is a medication for the reversal of neuromuscular blockade induced by rocuronium and vecuronium in general anaesthesia. 

It is a selective relaxant binding agent (SRBA). I

Pregnancy category AU: B2

Routes of administration Intravenous 

The most common side effects include cough, airway problems due to the anaesthesia wearing off, reduced blood pressure and other complications such as changes in heart rate.

It is a modified γ-cyclodextrin, with a lipophilic core and a hydrophilic periphery. 

Sugammadex’s binding encapsulation of rocuronium is one of the strongest among cyclodextrins and their guest molecules. 

The rocuronium molecule bound within sugammadex’s lipophilic core, is rendered unavailable to bind to the acetylcholine receptor at the neuromuscular junction.

Sugammadex, unlike neostigmine, does not inhibit acetylcholinesterase.

Therefore cholinergic effects are not produced and co-administration of an antimuscarinic agent, glycopyrronium bromide or atropine, is not needed. 

Sugammadex expected to have fewer adverse effects than the traditional reversal agents.

Succinylcholine a muscle relaxant with rapid onset and short duration of action but this drug has important contraindications; it can trigger malignant hyperthermia in susceptible individuals, it has a prolonged duration of action in patients with pseudocholinesterase deficiency and it causes an increase in plasma potassium concentration which is dangerous in some circumstances. 

Rocuronium has a comparably quick onset in high dose (0.6 mg kg−1 to 1 mg kg−1) and can be rapidly reversed with sugammadex.

Sugammadex has been shown to have affinity for two other aminosteroid neuromuscular blocking agents, vecuronium and pancuronium. 

Sugammadex was shown to be more effective neostigmine in reversing muscle relaxation caused by neuromuscular blockade during surgery and is relatively safe. 

Serious complications occurred in less than 1% of the patients who received sugammadex. 

It has a better safety profile than neostigmine with 40% fewer adverse events.

The risks of postoperative residual paralysis, bradycardia, nausea and vomiting are reduced if sugammadex is used as a reversal agent. 

Sugammadex was generally well tolerated.

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