Efficacy of Sugammadex as a Reversal with an Optimized Train of Four Stimulation Parameters

Residual neuromuscular blockades are a potentially dangerous complication after surgery due to administering neuromuscular blocking agents. Sugammadex is a novel neuromuscular blocking agent reversal drug that combats faster reversal times. However, it still needs to be determined how efficient it is compared to neostigmine, particularly with optimal Train of Four monitoring. Sugammadex and neostigmine were analyzed through 11 studies to determine the speed of recovery and postoperative complications. Sugammadex was found to have a quicker recovery time and fewer complications after surgery compared to neostigmine. A train of four stimulation analyses determined that higher voltages do not create as adequate 4/4 responses as at a lower, more reliable voltage. Therefore, our results determine that Sugammadex is a faster, safer drug choice, and the train of four stimulations is most reliable at 30mA. Still, it may be adequate up to 50mA without supramaximal stimulation. Further research should investigate how Sugammadex may differentiate depending on the patient’s sex and how muscle relaxant dosages may change recovery time even with adequate train of four responses.