{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:13:50Z","timestamp":1777972430917,"version":"3.51.4"},"reference-count":92,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Medical errors are inevitable and will happen to almost every specialist. In anesthesiology, one of the main concerns is the inappropriate application of muscle relaxants (MRs). As this group of drugs plays a significant role in facilitating endotracheal intubation and optimizing surgical conditions, it is widely and commonly used in the medical field. To prevent residual neuromuscular block, anesthesiologists may pharmacologically reverse the neuromuscular block (NMB) by administering reversal agents. Lately, sugammadex is becoming more popular due to its ability to reverse various levels of NMB more rapidly than traditionally used acetylcholinesterase inhibitors such as neostigmine. The common challenges and errors associated with the administration of neuromuscular blocking agents (NMBAs) and muscle reversal agents include the absence of neuromuscular monitoring, underestimation of the residual block (RB), misinterpretation of DUR25, inappropriate size descriptors for muscle relaxants and reversal agents requiring weight-based dosing, the wrong dosing of rocuronium, poor usage of cisatracurium among patients with renal or hepatic failure, and the wrong usage of succinylcholine. Another source of mistakes may be inaccurate knowledge about the pharmacokinetics and pharmacodynamics of the administered drugs. Medication errors may occur not only when it comes to the usage of muscle relaxants but also with the use of reversal agents, including lack of neuromuscular monitoring, choosing the wrong antagonist strategy, \u201ctoo early\u201d administration of neostigmine, inappropriate dosing, and insufficient knowledge about drug interactions. Improving the knowledge of administered drugs and adhering to the latest recommendations could prevent many complications. This article aims to review the current challenges in the use of muscle relaxants and reversal agents in anesthesia.<\/jats:p>","DOI":"10.3390\/jcm15093513","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T07:57:29Z","timestamp":1777967849000},"page":"3513","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neuromuscular Blocking Agents in Anesthesia: A Narrative Review of Contemporary Challenges and Reversal Approaches"],"prefix":"10.3390","volume":"15","author":[{"given":"Pawe\u0142","family":"Radkowski","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland"},{"name":"Department of Anesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, 10-561 Olsztyn, Poland"},{"name":"Department of Anesthesiology and Intensive Care, Hospital Zum Heiligen Geist in Fritzlar, 34560 Fritzlar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7266-1586","authenticated-orcid":false,"given":"Marta","family":"Jutrzenka","sequence":"additional","affiliation":[{"name":"Department of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0818-4848","authenticated-orcid":false,"given":"Maciej","family":"Szewczyk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Independent Public Multispecialty Health Care Center, 73-110 Stargard, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicja","family":"Witkowska","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical University of \u0141\u00f3d\u017a, 90-419 \u0141\u00f3d\u017a, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4903-8774","authenticated-orcid":false,"given":"Marcin","family":"Mu\u017ca","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Powi\u015bla\u0144ska Academy of Apllied Sciences, 82-500 Kwidzyn, Poland"},{"name":"Department of Anesthesiology and Intensive Care, Ceynowa Specialist Hospital, 84-200 Wejherowo, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dariusz","family":"Onichimowski","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland"},{"name":"Department of Anesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, 10-561 Olsztyn, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0022-2741","authenticated-orcid":false,"given":"\u0141ukasz","family":"Grabarczyk","sequence":"additional","affiliation":[{"name":"Alarm Clock Clinic, Coma Recovery and Neurorehabilitation Center, Kondratowicza 8, 03-242 Warszawa, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"ref_1","unstructured":"Cook, D., and Simons, D.J. (2023). Neuromuscular Blockade. StatPearls, StatPearls Publishing."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e944510","DOI":"10.12659\/MSM.944510","article-title":"The influence of acid-base balance on anesthetic muscle relaxants: A comprehensive review on clinical applications and mechanisms","volume":"30","author":"Radkowski","year":"2024","journal-title":"Med. Sci. Monit."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.jemermed.2017.12.001","article-title":"Suffering in silence: Medical error and its impact on health care providers","volume":"54","author":"Robertson","year":"2018","journal-title":"J. Emerg. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1177\/0310057X1704500514","article-title":"A survey of the sequelae of memorable anaesthetic drug errors from the anaesthetist\u2019s perspective","volume":"45","author":"McCawley","year":"2017","journal-title":"Anaesth. Intensive Care"},{"key":"ref_5","first-page":"2045382","article-title":"Drug errors and protocol for prevention among anaesthetists in Nigeria","volume":"2017","author":"Johnson","year":"2017","journal-title":"Anesthesiol. Res. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s40560-020-00455-2","article-title":"Neuromuscular blockade management in the critically ill patient","volume":"8","author":"Renew","year":"2020","journal-title":"J. Intensive Care"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bickler, P.E., Abouyannis, M., Bhalla, A., and Lewin, M.R. (2023). Neuromuscular weakness and paralysis produced by snakebite envenoming: Mechanisms and proposed standards for clinical assessment. Toxins, 15.","DOI":"10.3390\/toxins15010049"},{"key":"ref_8","first-page":"1257","article-title":"The Myth of the Phase I Block After Succinylcholine in Clinical Practice","volume":"141","author":"Todd","year":"2025","journal-title":"Anesth. Analg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1213\/01.ane.0000246431.57502.56","article-title":"The Ideal Dose of Succinylcholine for Tracheal Intubation","volume":"103","author":"Lu","year":"2006","journal-title":"Anesth. Analg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1213\/01.ane.0000246443.50817.7f","article-title":"The Ideal Dose of Succinylcholine for Tracheal Intubation","volume":"103","author":"Naguib","year":"2006","journal-title":"Anesth. Analg."},{"key":"ref_11","unstructured":"Hager, H.H., Patel, P., and Burns, B. (2025). Succinylcholine chloride. StatPearls, StatPearls Publishing."},{"key":"ref_12","first-page":"192","article-title":"Does succinylcholine have a future in anaesthesiology?","volume":"17","author":"Radkowski","year":"2024","journal-title":"Farm. Wsp\u00f3\u0142czesna"},{"key":"ref_13","first-page":"195","article-title":"Rapid sequence intubation: The current state of knowledge","volume":"102","author":"Radkowski","year":"2024","journal-title":"Milit. Physician."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3651","DOI":"10.2147\/IJGM.S524089","article-title":"Neuromuscular Blocking Agents and Reversal Agents Usage, and Neuromuscular Blockade Monitoring in the Intensive Care Unit\u2014Review Article","volume":"18","author":"Szewczyk","year":"2025","journal-title":"Int. J. Gen. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e951845","DOI":"10.12659\/MSM.951845","article-title":"Narrative Review of the Role of Nondepolarizing Neuromuscular Blocking Agents in Anesthesia: Perspective 2026","volume":"32","author":"Radkowski","year":"2026","journal-title":"Med. Sci. Monit."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"500","DOI":"10.4097\/kjae.2017.70.5.500","article-title":"Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents","volume":"70","author":"Kim","year":"2017","journal-title":"Korean J. Anesthesiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e945141","DOI":"10.12659\/MSM.945141","article-title":"Navigating anesthesia: Muscle relaxants and reversal agents in patients with renal impairment","volume":"30","author":"Radkowski","year":"2024","journal-title":"Med. Sci. Monit."},{"key":"ref_18","first-page":"e945822","article-title":"Impact of liver disease on use of muscle relaxants in anesthesia: A comprehensive review","volume":"31","author":"Radkowski","year":"2025","journal-title":"Med. Sci. Monit."},{"key":"ref_19","first-page":"283","article-title":"Use of skeletal muscle relaxants in neurosurgery \u2013 the current state of knowledge","volume":"19","author":"Radkowski","year":"2025","journal-title":"Anestezjol. I Ratow."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.bja.2022.08.009","article-title":"Molecular mechanisms of muscular and non-muscular actions of neuromuscular blocking agents in critical illness: A narrative review","volume":"130","author":"Martyn","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_21","unstructured":"Adeyinka, A., and Layer, D.A. (2025). Neuromuscular Blocking Agents. StatPearls, StatPearls Publishing."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Vacanti, C., Segal, S., Sikka, P., and Urman, R. (2011). Muscle Relaxants. Essential Clinical Anesthesia, Cambridge University Press.","DOI":"10.1017\/CBO9780511842306"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s40140-018-0262-9","article-title":"New drug developments for neuromuscular blockade and reversal: Gantacurium, CW002, CW011, and calabadion","volume":"8","author":"Carlos","year":"2018","journal-title":"Curr. Anesthesiol. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.bjae.2020.03.008","article-title":"Reversal of neuromuscular block","volume":"20","author":"Hunter","year":"2020","journal-title":"BJA Educ."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1097\/ALN.0b013e3181dc1b5b","article-title":"Rapid chemical antagonism of neuromuscular blockade by L-cysteine adduction to and inactivation of the olefinic isoquinolinium diester compounds gantacurium (AV430A), CW002, and CW011","volume":"113","author":"Savarese","year":"2010","journal-title":"Anesthesiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1592\/phco.27.8.1181","article-title":"Sugammadex: A novel agent for the reversal of neuromuscular blockade","volume":"27","author":"Nicholson","year":"2007","journal-title":"Pharmacotherapy"},{"key":"ref_27","first-page":"490","article-title":"Occurrence of butyrylcholinesterase polymorphisms in patients undergoing surgery in Slovakia","volume":"14","author":"Firment","year":"2023","journal-title":"Casp. J. Intern. Med."},{"key":"ref_28","first-page":"113","article-title":"Pesticides and susceptible populations: People with butyrylcholinesterase genetic variants may be at risk","volume":"21","author":"Lockridge","year":"2000","journal-title":"Neurotoxicology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"89","DOI":"10.4097\/kja.22654","article-title":"Mechanisms and implications in gene polymorphism mediated diverse responses to sedatives, analgesics and muscle relaxants","volume":"76","author":"Sun","year":"2023","journal-title":"Korean J. Anesthesiol."},{"key":"ref_30","unstructured":"Trujillo, R., and West, W.P. (2023). Pseudocholinesterase Deficiency. StatPearls, StatPearls Publishing."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Motamed, C. (2023). Intraoperative monitoring of neuromuscular blockade. Life, 13.","DOI":"10.3390\/life13051184"},{"key":"ref_32","first-page":"125","article-title":"Guidelines on muscle relaxants and reversal in anaesthesia","volume":"39","author":"Plaud","year":"2020","journal-title":"Anaesth. Crit. Care. Pain. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1213\/ANE.0000000000002670","article-title":"Consensus statement on perioperative use of neuromuscular monitoring","volume":"127","author":"Naguib","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1213\/ANE.0000000000002387","article-title":"Neuromuscular monitoring in the perioperative period","volume":"126","author":"Murphy","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1177\/0310057X1304100316","article-title":"A survey of the management of neuromuscular blockade monitoring in Australia and New Zealand","volume":"41","author":"Phillips","year":"2013","journal-title":"Anaesth. Intensive Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/ALN.0000000000001409","article-title":"Current status of neuromuscular reversal and monitoring: Challenges and opportunities","volume":"126","author":"Brull","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/ALN.0000000000004044","article-title":"Quantitative neuromuscular monitoring and postoperative outcomes: A narrative review","volume":"136","author":"Murphy","year":"2022","journal-title":"Anesthesiology"},{"key":"ref_38","first-page":"274","article-title":"Postoperative residual curarization as a complication after general anesthesia","volume":"29","author":"Radkowski","year":"2022","journal-title":"Pol. Ann. Med."},{"key":"ref_39","first-page":"55","article-title":"Neuromuscular monitoring: An update","volume":"25","author":"Tudorache","year":"2018","journal-title":"Rom. J. Anaesth. Intensive Care"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Blum, F.E., Locke, A.R., Nathan, N., Katz, J., Bissing, D., Minhaj, M., and Greenberg, S.B. (2024). Residual neuromuscular block remains a safety concern for perioperative healthcare professionals: A comprehensive review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13030861"},{"key":"ref_41","first-page":"410248","article-title":"Postoperative residual neuromuscular paralysis at an Australian tertiary children\u2019s hospital","volume":"2015","author":"Ledowski","year":"2015","journal-title":"Anesthesiol. Res. Pract."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"77","DOI":"10.5603\/AIT.2013.0017","article-title":"Residual neuromuscular block in elderly patients after surgical procedures under general anaesthesia with rocuronium","volume":"45","author":"Pietraszewski","year":"2013","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.17085\/apm.2017.12.1.1","article-title":"What anesthesiologists ask to know and should know about neuromuscular monitoring: An updated review","volume":"12","author":"Lee","year":"2017","journal-title":"Anesth. Pain Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1111\/anae.13738","article-title":"Conceptual and technical insights into the basis of neuromuscular monitoring","volume":"72","author":"Naguib","year":"2017","journal-title":"Anaesthesia"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/00000542-199607000-00011","article-title":"Mivacurium neuromuscular block at the adductor muscles of the larynx and adductor pollicis in humans","volume":"85","author":"Plaud","year":"1996","journal-title":"Anesthesiology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/BF03019373","article-title":"Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: A review","volume":"50","author":"Hemmerling","year":"2003","journal-title":"Can. J. Anaesth."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s00134-019-05594-1","article-title":"Obesity in the critically ill: A narrative review","volume":"45","author":"Schetz","year":"2019","journal-title":"Intensive Care Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1177\/0310057X20968573","article-title":"Dosing of neuromuscular blocking agents in patients with obesity: A narrative review","volume":"49","author":"Erstad","year":"2021","journal-title":"Anaesth. Intensive Care"},{"key":"ref_49","first-page":"229","article-title":"How can I manage anaesthesia in obese patients?","volume":"39","author":"Souche","year":"2020","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/ACO.0000000000000286","article-title":"Best anaesthetic drug strategy for morbidly obese patients","volume":"29","author":"Margarson","year":"2016","journal-title":"Curr. Opin. Anesthesiol."},{"key":"ref_51","first-page":"549","article-title":"Weight-based dosing in medication use: What should we know?","volume":"10","author":"Pan","year":"2016","journal-title":"Patient Prefer. Adherence"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e304","DOI":"10.1097\/CCM.0000000000004824","article-title":"Awareness with paralysis in mechanically ventilated patients in the emergency department and ICU: A systematic review and meta-analysis","volume":"49","author":"Pappal","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1034\/j.1399-6576.2003.00036.x","article-title":"Gender differences in drug effects: Implications for anesthesiologists","volume":"47","author":"Pleym","year":"2003","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1213\/00000539-199709000-00033","article-title":"Dose-response and time course of effect of rocuronium in male and female anesthetized patients","volume":"85","author":"Xue","year":"1997","journal-title":"Anesth. Analg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"146","DOI":"10.2344\/anpr-66-04-04","article-title":"Potentiation of rocuronium bromide by lithium carbonate: A case report","volume":"67","author":"Kishimoto","year":"2020","journal-title":"Anesth. Prog."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"15","DOI":"10.4103\/joacp.joacp_139_22","article-title":"Coadministration of intravenous calcium along with neostigmine for rapid neuromuscular blockade recovery: A systematic review and meta-analysis","volume":"40","author":"Khanna","year":"2024","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e949876","DOI":"10.12659\/MSM.949876","article-title":"Use of Muscle Relaxants in Emergency Medicine: A Review","volume":"31","author":"Radkowski","year":"2025","journal-title":"Med. Sci. Monit."},{"key":"ref_58","first-page":"55","article-title":"Muscle relaxants in anaesthesiology, intensive care and emergency medicine, including recent reports about patients with COVID-19 infection","volume":"15","author":"Radkowski","year":"2021","journal-title":"Anestezjol. Ratow."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1007\/s43678-021-00119-6","article-title":"NEAR Investigators. The association of rocuronium dosing and first-attempt intubation success in adult emergency department patients","volume":"23","author":"Levin","year":"2021","journal-title":"Can. J. Emerg. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1111\/bcpt.12628","article-title":"Neuromuscular effects of rocuronium bromide in patients in statin therapy for at least three months","volume":"119","author":"Ren","year":"2016","journal-title":"Basic Clin. Pharmacol. Toxicol."},{"key":"ref_61","first-page":"450","article-title":"Use of cisatracurium in critical care: A review of the literature","volume":"81","author":"Szakmany","year":"2015","journal-title":"Minerva Anestesiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.bja.2020.06.025","article-title":"Another nail in the coffin of succinylcholine?","volume":"125","author":"Blobner","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1093\/ajhp\/zxz098","article-title":"Cisatracurium dosing in a patient with hyperthermia","volume":"76","author":"Lim","year":"2019","journal-title":"Am. J. Health Syst. Pharm."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1213\/ANE.0000000000005925","article-title":"Pro-con debate: Do we need quantitative neuromuscular monitoring in the era of sugammadex?","volume":"135","author":"Blobner","year":"2022","journal-title":"Anesth. Analg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/ACO.0000000000000891","article-title":"The future of neuromuscular blocking agents","volume":"33","author":"Blobner","year":"2020","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"153","DOI":"10.4103\/joacp.JOACP_383_19","article-title":"Sugammadex and anaphylaxis: An analysis of 33 published cases","volume":"37","author":"Arslan","year":"2021","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1111\/anae.14160","article-title":"The comparative efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults: A Cochrane systematic review with meta-analysis and trial sequential analysis","volume":"73","author":"Hristovska","year":"2018","journal-title":"Anaesthesia"},{"key":"ref_68","first-page":"311","article-title":"Neostigmine versus sugammadex on post-operative recovery following bariatric surgery","volume":"9","author":"Ekinci","year":"2022","journal-title":"N. Clin. Istanb."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1007\/s00540-019-02725-2","article-title":"Pre- and post-operative counseling for women on hormonal contraceptives receiving sugammadex at an academic hospital","volume":"34","author":"Lazorwitz","year":"2020","journal-title":"J. Anesth."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"360","DOI":"10.4103\/joacp.JOACP_573_20","article-title":"Sugammadex-induced anaphylactic reaction: A systematic review","volume":"38","author":"Zecic","year":"2022","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.bja.2024.07.042","article-title":"Sugammadex hypersensitivity: A multicentre retrospective analysis of a large Australian cohort","volume":"134","author":"Crimmins","year":"2025","journal-title":"Br. J. Anaesth."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1093\/bja\/52.3.291","article-title":"Comparative study of atropine and glycopyrrolate on suxamethonium-induced changes in cardiac rate and rhythm","volume":"52","author":"Cozanitis","year":"1980","journal-title":"Br. J. Anaesth."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.bja.2018.02.036","article-title":"Severe bradycardia and asystole after sugammadex","volume":"121","author":"Bhavani","year":"2018","journal-title":"Br. J. Anaesth."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.bja.2018.03.003","article-title":"Sugammadex-induced bradycardia and asystole: How great is the risk?","volume":"121","author":"Hunter","year":"2018","journal-title":"Br. J. Anaesth."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/ACO.0000000000001397","article-title":"Sugammadex and oral contraceptives","volume":"37","author":"Devoy","year":"2024","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e412","DOI":"10.1016\/j.bja.2022.11.017","article-title":"Contraceptive failure and sugammadex administration: A single-centre survey and audit of professional knowledge and practice","volume":"130","author":"Passi","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"114","DOI":"10.17085\/apm.23041","article-title":"What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives","volume":"18","author":"Do","year":"2023","journal-title":"Anesth. Pain Med."},{"key":"ref_78","first-page":"33","article-title":"Postoperative recurarization after sugammadex administration due to the lack of appropriate neuromuscular monitoring: The Japanese experience","volume":"35","author":"Sasakawa","year":"2020","journal-title":"Anesth. Patient Saf. Found. Newsl."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Ravindranath, S., Backfish-White, K., Wolfe, J., and Ranganath, Y.S. (2025). Sugammadex for Neuromuscular Blockade Reversal: A Narrative Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14124128"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/ALN.0000000000004379","article-title":"2023 American Society of Anesthesiologists practice guidelines for monitoring and antagonism of neuromuscular blockade: A report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade","volume":"138","author":"Thilen","year":"2023","journal-title":"Anesthesiology"},{"key":"ref_81","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","author":"Asztalos","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"F\u00e1bi\u00e1n, \u00c1.I., Tassonyi, E., Csernoch, V., Fedor, M., Sohajda, T., Szente, L., and F\u00fclesdi, B. (2021). Carboxymethyl-\u03b3-cyclodextrin, a novel selective relaxant binding agent for the reversal of neuromuscular block induced by aminosteroid neuromuscular blockers: An ex vivo laboratory study. BMC Anesthesiol., 21.","DOI":"10.1186\/s12871-021-01424-4"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1213\/ANE.0000000000000766","article-title":"Reversal of Pipecuronium-Induced Moderate Neuromuscular Block with Sugammadex in the Presence of a Sevoflurane Anesthetic: A Randomized Trial","volume":"121","author":"Tassonyi","year":"2015","journal-title":"Anesth. Analg."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Greco, M., Caruso, P.F., Angelotti, G., Aceto, R., Coppalini, G., Martinetti, N., Albini, M., Bash, L.D., Carvello, M., and Piccioni, F. (2023). REVersal of nEuromusculAr bLocking agents in patients undergoing general anaesthesia (REVEAL study). J. Clin. Med., 12.","DOI":"10.3390\/jcm12020563"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1097\/00000542-200404000-00004","article-title":"Clinical pharmacology of GW280430A in humans","volume":"100","author":"Belmont","year":"2004","journal-title":"Anesthesiology"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Davis, P.J., Bosenberg, A., Davidson, A., Jimenez, N., Kharasch, E., Lynn, A.M., Tofovic, S.P., and Woelfel, S. (2011). Pharmacology of pediatric anesthesia. Smith\u2019s Anesthesia for Infants and Children, Elsevier. [8th ed].","DOI":"10.1016\/B978-0-323-06612-9.00007-9"},{"key":"ref_87","unstructured":"Avera Pharmaceuticals (2025, October 28). The Efficacy and Safety of Gantacurium Chloride for Injection in Tracheal Intubation in Healthy Adult Patients Undergoing Surgery Under General Anesthesia, Available online: https:\/\/clinicaltrials.gov\/."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1097\/ALN.0000000000002408","article-title":"Preclinical pharmacology in the rhesus monkey of CW 1759-50, a new ultra-short acting nondepolarizing neuromuscular blocking agent, degraded and antagonized by L-cysteine","volume":"129","author":"Savarese","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1097\/ALN.0b013e3181d31f8c","article-title":"Cysteine reversal of the novel neuromuscular blocking drug CW002 in dogs: Pharmacodynamics, acute cardiovascular effects, and preliminary toxicology","volume":"112","author":"Sunaga","year":"2010","journal-title":"Anesthesiology"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1097\/ALN.0b013e3182910213","article-title":"Calabadion: A new agent to reverse the effects of benzylisoquinoline and steroidal neuromuscular-blocking agents","volume":"119","author":"Hoffmann","year":"2013","journal-title":"Anesthesiology"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/EJA.0000000000001769","article-title":"Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care","volume":"40","author":"Romero","year":"2023","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1097\/CCM.0000000000007002","article-title":"Society of Critical Care Medicine guidelines for the administration of neuromuscular blockade in adults with acute respiratory distress syndrome","volume":"54","author":"Erstad","year":"2026","journal-title":"Crit. Care Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3513\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T08:38:35Z","timestamp":1777970315000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3513"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":92,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093513"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093513","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]}}}