{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T09:34:41Z","timestamp":1768296881148,"version":"3.49.0"},"reference-count":61,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Sugammadex reverses neuromuscular blockade by the steroidal nondepolarizing neuromuscular blocking agents rocuronium and vecuronium. In 2015, it was approved in the United States by the Food and Drug Administration for adult use. However, there are ongoing clinical trials investigating its use in the pediatric population. Before approval in adult use in the United States, several adverse effects were noted to occur in patients receiving sugammadex in clinical trials including prolonged QT interval, bradycardia, hypersensitivity reactions, and prolongation of coagulation parameters. Additional investigations further elucidated the risks of these adverse events. Sugammadex is approved for use in children older than 2 years in other countries in Europe and Asia. Investigations suggest that the efficacy, safety, and pharmacokinetic profile is similar in children when compared with adults. Published pediatric data favor the use of sugammadex in children older than 2 years, but there are some data in young children younger than 2 years. Case reports discuss the use of sugammadex in pediatric patients with neuromuscular diseases. Although sugammadex is typically used in the operating room for reversing neuromuscular blockade for surgical procedures, there is a small but important role for sugammadex use in the emergency department. In cases where rapid neurological examination is required after neuromuscular blockage with rocuronium or vecuronium, sugammadex can assist in facilitating a timely comprehensive neurological examination where pharmacologic or surgical management may depend on examination findings such as in the case of cerebral vascular accident, status epilepticus, or traumatic brain injury. Some clinicians have advocated for the use of sugammadex in the cannot intubate, cannot ventilate scenario. However, caution should be exercised in this situation as reversal of paralysis can take up to 22 minutes to occur.<\/jats:p>","DOI":"10.1097\/pec.0000000000002126","type":"journal-article","created":{"date-parts":[[2020,5,29]],"date-time":"2020-05-29T19:16:29Z","timestamp":1590779789000},"page":"296-301","source":"Crossref","is-referenced-by-count":8,"title":["Sugammadex"],"prefix":"10.1097","volume":"36","author":[{"given":"Betty","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"bib1-20231002","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jcrc.2008.10.010","article-title":"Preclinical pharmacology of sugammadex","volume":"24","year":"2009","journal-title":"J Crit Care"},{"key":"bib2-20231002","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/MJT.0000000000000092","article-title":"Sugammadex: a scientific review including safety and efficacy, update on regulatory issues, and clinical use in Europe","volume":"22","year":"2015","journal-title":"Am J Ther"},{"key":"bib3-20231002","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/00000542-200510000-00007","article-title":"First human exposure of Org 25969, a novel agent to reverse the action of rocuronium bromide","volume":"103","year":"2005","journal-title":"Anesthesiology"},{"key":"bib5-20231002","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.anclin.2010.08.014","article-title":"Sugammadex: cyclodextrins, development of selective binding agents, pharmacology, clinical development, and future directions","volume":"28","year":"2010","journal-title":"Anesthesiol Clin"},{"key":"bib6-20231002","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1017\/S0025727300041132","article-title":"Suxamethonium-the development of a modern drug from 1906 to the present day","volume":"26","year":"1982","journal-title":"Med Hist"},{"key":"bib8-20231002","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/MJT.0000000000000103","article-title":"Sugammadex: a comprehensive review of the published human science, including renal studies","volume":"22","year":"2015","journal-title":"Am J Ther"},{"key":"bib9-20231002","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1002\/bdd.747","article-title":"Sugammadex is cleared rapidly and primarily unchanged via renal excretion","volume":"32","year":"2011","journal-title":"Biopharm Drug Dispos"},{"key":"bib10-20231002","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/bja\/aep340","article-title":"Reduced clearance of rocuronium and sugammadex in patients with severe to end-stage renal failure: a pharmacokinetic study","volume":"104","year":"2010","journal-title":"Br J Anaesth"},{"key":"bib11-20231002","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1093\/bja\/aen216","article-title":"Multicentre, parallel-group, comparative trial evaluating the efficacy and safety of sugammadex in patients with end-stage renal failure or normal renal function","volume":"101","year":"2008","journal-title":"Br J Anaesth"},{"key":"bib12-20231002","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/bja\/aet586","article-title":"Efficacy, safety and pharmacokinetics of sugammadex 4 mg kg-1 for reversal of deep neuromuscular blockade in patients with severe renal impairment","volume":"114","year":"2015","journal-title":"Br J Anaesth"},{"key":"bib13-20231002","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1093\/bja\/aei314","article-title":"Org 25969 (sugammadex), a selective relaxant binding agent for antagonism of prolonged rocuronium-induced neuromuscular block","volume":"96","year":"2006","journal-title":"Br J Anaesth"},{"key":"bib14-20231002","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1213\/01.ane.0000260135.46070.c3","article-title":"A randomized, dose-finding, phase II study of the selective relaxant binding drug, sugammadex, capable of safely reversing profound rocuronium-induced neuromuscular block","volume":"104","year":"2007","journal-title":"Anesth Analg"},{"key":"bib15-20231002","first-page":"41","article-title":"Is the effect of sugammadex always rapid in onset?","volume":"64","year":"2013","journal-title":"Acta Anaesthesiol Belg"},{"key":"bib16-20231002","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1093\/bja\/aeq167","article-title":"Repeat dosing of rocuronium 1.2 mg kg-1 after reversal of neuromuscular block by sugammadex 4.0 mg kg-1 in anaesthetized healthy volunteers: a modelling-based pilot study","volume":"105","year":"2010","journal-title":"Br J Anaesth"},{"key":"bib17-20231002","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1097\/ALN.0000000000001744","article-title":"Reversal of vecuronium-induced neuromuscular blockade with low-dose sugammadex at train-of-four count of four: a randomized controlled trial","volume":"127","year":"2017","journal-title":"Anesthesiology"},{"key":"bib18-20231002","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12871-017-0348-9","article-title":"Half dose sugammadex combined with neostigmine is non-inferior to full dose sugammadex for reversal of rocuronium-induced deep neuromuscular blockade: a cost-saving strategy","volume":"17","year":"2017","journal-title":"BMC Anesthesiol"},{"key":"bib19-20231002","first-page":"1,10,1","article-title":"Current status of sugammadex usage and the occurrence of sugammadex-induced anaphylaxis in Japan","volume":"33","year":"2018","journal-title":"APSF Newsletter"},{"key":"bib20-20231002","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1007\/s00540-015-2105-x","article-title":"Sugammadex and rocuronium-induced anaphylaxis","volume":"30","year":"2016","journal-title":"J Anesth"},{"key":"bib21-20231002","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1213\/ANE.0000000000002562","article-title":"Incidence of anaphylaxis associated with sugammadex","volume":"126","year":"2018","journal-title":"Anesth Analg"},{"key":"bib22-20231002","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.bja.2018.05.056","article-title":"Hypersensitivity incidence after sugammadex administration in healthy subjects: a randomised controlled trial","volume":"121","year":"2018","journal-title":"Br J Anaesth"},{"key":"bib23-20231002","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1213\/01.ane.0000231829.29177.8e","article-title":"Reversal of rocuronium-induced neuromuscular block with the novel drug sugammadex is equally effective under maintenance anesthesia with propofol or sevoflurane","volume":"104","year":"2007","journal-title":"Anesth Analg"},{"key":"bib24-20231002","doi-asserted-by":"crossref","first-page":"595","DOI":"10.5414\/CP201693","article-title":"Sugammadex is not associated with QT\/QTc prolongation: methodology aspects of an intravenous moxifloxacin-controlled thorough QT study","volume":"50","year":"2012","journal-title":"Int J Clin Pharmacol Ther"},{"key":"bib25-20231002","doi-asserted-by":"crossref","first-page":"599","DOI":"10.2165\/11537210-000000000-00000","article-title":"Effects of sugammadex doses up to 32 mg\/kg alone or in combination with rocuronium or vecuronium on QTc prolongation: a thorough QTc study","volume":"30","year":"2010","journal-title":"Clin Drug Investig"},{"key":"bib26-20231002","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s40261-013-0095-8","article-title":"Effect of sugammadex on QT\/QTc interval prolongation when combined with QTc-prolonging sevoflurane or propofol anaesthesia","volume":"33","year":"2013","journal-title":"Clin Drug Investig"},{"key":"bib27-20231002","doi-asserted-by":"crossref","first-page":"227","DOI":"10.5414\/CP201976","article-title":"Effects of sugammadex on activated partial thromboplastin time and prothrombin time in healthy subjects","volume":"52","year":"2014","journal-title":"Int J Clin Pharmacol Ther"},{"key":"bib28-20231002","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1097\/ALN.0000000000000424","article-title":"Effect of reversal of neuromuscular blockade with sugammadex versus usual care on bleeding risk in a randomized study of surgical patients","volume":"121","year":"2014","journal-title":"Anesthesiology"},{"key":"bib29-20231002","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4097\/kjae.2015.68.1.17","article-title":"Biological evaluation of the effect of sugammadex on hemostasis and bleeding","volume":"68","year":"2015","journal-title":"Korean J Anesthesiol"},{"key":"bib30-20231002","doi-asserted-by":"crossref","first-page":"2382","DOI":"10.12659\/MSM.894971","article-title":"Effect of sugammadex on postoperative bleeding and coagulation parameters after septoplasty: a randomized prospective study","volume":"21","year":"2015","journal-title":"Med Sci Monit"},{"key":"bib31-20231002","doi-asserted-by":"crossref","first-page":"976","DOI":"10.5414\/CP201970","article-title":"No clinically relevant interaction between sugammadex and aspirin on platelet aggregation and coagulation parameters","volume":"51","year":"2013","journal-title":"Int J Clin Pharmacol Ther"},{"key":"bib32-20231002","doi-asserted-by":"crossref","first-page":"631","DOI":"10.5414\/CP202091","article-title":"Lack of a clinically relevant effect of sugammadex on anti-Xa activity or activated partial thromboplastin time following pretreatment with either unfractionated or low-molecular-weight heparin in healthy subjects","volume":"52","year":"2014","journal-title":"Int J Clin Pharmacol Ther"},{"key":"bib34-20231002","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1111\/anae.12736","article-title":"Hypersensitivity associated with sugammadex administration: a systematic review","volume":"69","year":"2014","journal-title":"Anaesthesia"},{"key":"bib35-20231002","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jclinane.2018.03.018","article-title":"Incidence of hypersensitivity and anaphylaxis with sugammadex","volume":"47","year":"2018","journal-title":"J Clin Anesth"},{"key":"bib36-20231002","first-page":"66","article-title":"Sugammadex-induced hypersensitivity reaction in a pediatric patient","volume":"46","year":"2018","journal-title":"Turk J Anaesthesiol Reanim"},{"key":"bib37-20231002","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.aat.2012.08.010","article-title":"Hypersensitivity reaction probably induced by sugammadex","volume":"50","year":"2012","journal-title":"Acta Anaesthesiol Taiwan"},{"key":"bib38-20231002","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/1471-2253-14-92","article-title":"Three suspected cases of sugammadex-induced anaphylactic shock","volume":"14","year":"2014","journal-title":"BMC Anesthesiol"},{"key":"bib39-20231002","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1111\/pan.13401","article-title":"Association between sugammadex and anaphylaxis in pediatric patients: a nested case-control study using a national inpatient database","volume":"28","year":"2018","journal-title":"Paediatr Anaesth"},{"key":"bib40-20231002","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/bja\/aem402","article-title":"Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers","volume":"100","year":"2008","journal-title":"Br J Anaesth"},{"key":"bib41-20231002","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/pan.13343","article-title":"Train-of-four recovery precedes twitch recovery during reversal with sugammadex in pediatric patients: a retrospective analysis","volume":"28","year":"2018","journal-title":"Paediatr Anaesth"},{"key":"bib42-20231002","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1097\/ALN.0b013e318194caaa","article-title":"Reversal of rocuronium-induced neuromuscular blockade with sugammadex in pediatric and adult surgical patients","volume":"110","year":"2009","journal-title":"Anesthesiology"},{"key":"bib43-20231002","first-page":"762","article-title":"Comparison of reversal and adverse effects of sugammadex and combination of - anticholinergic-anticholinesterase agents in pediatric patients","volume":"19","year":"2014","journal-title":"J Res Med Sci"},{"key":"bib44-20231002","doi-asserted-by":"crossref","first-page":"247","DOI":"10.4103\/1658-354X.154696","article-title":"Comparative study between sugammadex and neostigmine in neurosurgical anesthesia in pediatric patients","volume":"9","year":"2015","journal-title":"Saudi J Anaesth"},{"key":"bib45-20231002","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.jclinane.2016.08.040","article-title":"Sugammadex given for rocuronium-induced neuromuscular blockade in infants: a retrospective study","volume":"35","year":"2016","journal-title":"J Clin Anesth"},{"key":"bib46-20231002","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1111\/aas.12868","article-title":"A comparison of sugammadex and neostigmine for reversal of rocuronium-induced neuromuscular blockade in children","volume":"61","year":"2017","journal-title":"Acta Anaesthesiol Scand"},{"key":"bib47-20231002","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1111\/pan.13643","article-title":"Case series of 331 cases of sugammadex compared to neostigmine in patients under 2 years of age","volume":"29","year":"2019","journal-title":"Paediatr Anaesth"},{"key":"bib48-20231002","first-page":"48","article-title":"Preliminary indications for the use of sugammadex after its addition to a formulary at a tertiary care children's hospital","volume":"23","year":"2018","journal-title":"J Pediatr Pharmacol Ther"},{"key":"bib49-20231002","doi-asserted-by":"crossref","first-page":"5724","DOI":"10.1038\/s41598-017-06159-2","article-title":"The efficacy and safety of sugammadex for reversing postoperative residual neuromuscular blockade in pediatric patients: a systematic review","volume":"7","year":"2017","journal-title":"Sci Rep"},{"key":"bib50-20231002","doi-asserted-by":"crossref","first-page":"e6456","DOI":"10.1097\/MD.0000000000006456","article-title":"Rocuronium-induced neuromuscular block and sugammadex in pediatric patient with duchenne muscular dystrophy: a case report","volume":"96","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"bib51-20231002","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1111\/j.1460-9592.2009.03178.x","article-title":"Reversal of rocuronium-induced profound neuromuscular block by sugammadex in Duchenne muscular dystrophy","volume":"19","year":"2009","journal-title":"Paediatr Anaesth"},{"key":"bib52-20231002","first-page":"855","article-title":"Case of anesthesia for thoracoscopic thymectomy in a pediatric patient with myasthenia gravis: reversal of rocuronium-induced neuromuscular blockade with sugammadex [in Japanese]","volume":"61","year":"2012","journal-title":"Masui"},{"key":"bib53-20231002","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1111\/pan.12205","article-title":"The effect of rocuronium and sugammadex on neuromuscular blockade in a child with congenital myotonic dystrophy type 1","volume":"23","year":"2013","journal-title":"Paediatr Anaesth"},{"key":"bib54-20231002","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/00000542-199802000-00013","article-title":"The response of patients with Duchenne's muscular dystrophy to neuromuscular blockade with vecuronium","volume":"88","year":"1998","journal-title":"Anesthesiology"},{"key":"bib55-20231002","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1097\/00000542-200505000-00009","article-title":"Onset and duration of rocuronium-induced neuromuscular blockade in patients with Duchenne muscular dystrophy","volume":"102","year":"2005","journal-title":"Anesthesiology"},{"key":"bib56-20231002","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1007\/s00101-011-1873-4","article-title":"Anesthesia and Angelman syndrome","volume":"60","year":"2011","journal-title":"Anaesthesist"},{"key":"bib57-20231002","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1097\/EJA.0000000000000338","article-title":"The use of rocuronium and sugammadex in paediatric renal transplantation: two case reports","volume":"33","year":"2016","journal-title":"Eur J Anaesthesiol"},{"key":"bib58-20231002","first-page":"88","article-title":"Two cases of the \u201ccannot ventilate, cannot intubate\u201d scenario in children in view of recent recommendations","volume":"46","year":"2014","journal-title":"Anaesthesiol Intensive Ther"},{"key":"bib59-20231002","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1111\/j.1365-2044.2010.06455.x","article-title":"Can sugammadex save a patient in a simulated 'cannot intubate, cannot ventilate' situation?","volume":"65","year":"2010","journal-title":"Anaesthesia"},{"key":"bib60-20231002","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1111\/j.1365-2044.2010.06600.x","article-title":"Can sugammadex save a patient in a simulated 'cannot intubate, cannot ventilate' scenario?","volume":"66","year":"2011","journal-title":"Anaesthesia"},{"key":"bib61-20231002","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1213\/ane.0b013e31818a9932","article-title":"The effect of residual neuromuscular blockade on the speed of reversal with sugammadex","volume":"108","year":"2009","journal-title":"Anesth Analg"},{"key":"bib62-20231002","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1213\/ANE.0000000000001347","article-title":"The myth of rescue reversal in \u201ccan't intubate, can't ventilate\u201d scenarios","volume":"123","year":"2016","journal-title":"Anesth Analg"},{"key":"bib63-20231002","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1111\/pan.12615","article-title":"Development of a guideline for the management of the unanticipated difficult airway in pediatric practice","volume":"25","year":"2015","journal-title":"Paediatr Anaesth"},{"key":"bib64-20231002","doi-asserted-by":"crossref","first-page":"e3383","DOI":"10.1097\/MD.0000000000003383","article-title":"Difficult airway due to an undiagnosed subglottic tumor: a case report","volume":"95","year":"2016","journal-title":"Medicine (Baltimore)"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002126","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T21:07:50Z","timestamp":1696280870000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002126"}},"subtitle":["A Limited But Important Role in Emergency Medicine"],"short-title":[],"issued":{"date-parts":[[2020,6]]},"references-count":61,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000002126","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2020,6]]}}}