{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:42:05Z","timestamp":1783942925615,"version":"3.55.0"},"reference-count":51,"publisher":"The Korean Society of Anesthesiologists","issue":"2","license":[{"start":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T00:00:00Z","timestamp":1682294400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["anesth-pain-med.org"],"crossmark-restriction":true},"short-container-title":["Anesth Pain Med"],"published-print":{"date-parts":[[2023,4,30]]},"abstract":"<jats:p>Sugammadex is a chemically modified \u03b3-cyclodextrin that is used as a selective reversal agent for steroidal neuromuscular blockade. The use of sugammadex has greatly increased globally; however, little is known about its potential adverse effects in pregnant and lactating women or those using hormonal contraceptives. There are three important theoretical assumptions. Firstly, pregnancy-related physiological changes involve most organs and affect the pharmacokinetic profiles of medications. Considering the physiological changes in pregnant women and the pharmacokinetic properties of sugammadex, alterations in the dosage and safety profiles of sugammadex may occur during pregnancy. Secondly, very large and polarized sugammadex molecules are expected to have limited placental transfer to the fetus and excretion into breast milk. Finally, sugammadex can bind to steroidal neuromuscular blocking agents as well as other substances with similar structures, such as progesterone. As a result of using sugammadex, progesterone levels can be reduced, causing adverse effects such as early pregnancy cessation and failure of hormonal contraceptives. This narrative review aims to demonstrate the correlations between sugammadex and pregnancy, lactation, and reproductive potential based on previously published preclinical and clinical studies. This will bridge the gap between theoretical assumptions and currently unknown clinical facts. Moreover, this review highlights what anesthesia providers should be aware of and what actions to take while administering sugammadex to such patients.<\/jats:p>","DOI":"10.17085\/apm.23041","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T01:23:11Z","timestamp":1682644991000},"page":"114-122","update-policy":"https:\/\/doi.org\/10.17085\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives"],"prefix":"10.17085","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2338-9648","authenticated-orcid":true,"given":"Wangseok","family":"Do","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7108-1384","authenticated-orcid":true,"given":"Ah-Reum","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2573","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd012763"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13277"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex171"},{"key":"ref4","volume-title":""},{"key":"ref5","volume-title":""},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.4103\/0259-1162.123211"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1097\/01.aoa.0000719488.32191.77"},{"key":"ref8","volume-title":""},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.4103\/ija.ija_458_18"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2014.00065"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002160"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2014.00009"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200510000-00007"},{"key":"ref14","first-page":"667","volume-title":"Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex: a dose-finding and safety study","author":"Sorgenfrei","year":"2006"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.anclin.2010.08.014"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2015.08.003"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2009.05.002"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1213\/xaa.0000000000001407"},{"key":"ref19","volume-title":""},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.6254"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.17545"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1097\/aln.0000000000000037"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1056\/nejmp1414786"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/9682703"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.5152\/balkanmedj.2015.15502"},{"key":"ref26","first-page":"179","volume-title":"The effect of Rocuronium and Sugammadex on progesterone levels in pregnant rabbits under general anesthesia","author":"T\u00fcrk","year":"2019"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1016\/s0169-409x(03)00034-6"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2022.04.007"},{"key":"ref29","first-page":"1536","volume-title":"Low-dose or high-dose Rocuronium reversed with Neostigmine or Sugammadex for cesarean delivery anesthesia: a randomized controlled noninferiority trial of time to tracheal intubation and extubation","author":"Stourac","year":"2016"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2011.02431.x"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq227"},{"key":"ref32","first-page":"697","volume-title":"Multicenter Perioperative Outcomes Group Collaborators. Frequency and risk factors for difficult intubation in women undergoing general anesthesia for cesarean delivery: a multicenter retrospective cohort analysis","author":"Reale","year":"2022"},{"key":"ref33","first-page":"460","volume-title":"General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study","author":"Odor","year":"2021"},{"key":"ref34","first-page":"1360","volume-title":"Multicenter Perioperative Outcomes Group (MPOG) Perioperative Clinical Research Committee. Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group","author":"Kheterpal","year":"2013"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1097\/aln.0000000000001974"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13260"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijoa.2019.01.002"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjane.2021.07.034"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijoa.2022.103620"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.4820"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15902"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2016.03.039"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-019-02725-2"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000005465"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.11.017"},{"key":"ref46","volume-title":""},{"key":"ref47","volume-title":""},{"key":"ref48","volume-title":""},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15179"},{"key":"ref50","volume-title":""},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1097\/grf.0000000000000142"}],"container-title":["Anesthesia and Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/anesth-pain-med.org\/upload\/pdf\/apm-23041.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/anesth-pain-med.org\/journal\/view.php?doi=10.17085\/apm.23041","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/anesth-pain-med.org\/upload\/pdf\/apm-23041.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T01:23:28Z","timestamp":1682645008000},"score":1,"resource":{"primary":{"URL":"http:\/\/anesth-pain-med.org\/journal\/view.php?doi=10.17085\/apm.23041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,30]]},"references-count":51,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,4]]}},"URL":"https:\/\/doi.org\/10.17085\/apm.23041","relation":{},"ISSN":["1975-5171","2383-7977"],"issn-type":[{"value":"1975-5171","type":"print"},{"value":"2383-7977","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,30]]},"assertion":[{"value":"2023-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-24","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-30","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}