Anaes SAQs · Neuromuscular blockade & reversal
Reversal of a non-depolarising block — neostigmine versus sugammadex
The reversal-comparison SAQ — neostigmine (AChE inhibitor, outcompetes the blocker, only at shallow depth) versus sugammadex (encapsulation, removes rocuronium/vecuronium, any depth). Anchored to the Cochrane review and the SNaPP outcomes trial.
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Prompt
Compare and contrast neostigmine and sugammadex for the reversal of a rocuronium-induced neuromuscular block. Include the mechanism of each, the depth of block at which each is effective, and the evidence on their relative efficacy and safety.
Question
Compare and contrast neostigmine and sugammadex for the reversal of a rocuronium-induced neuromuscular block. Include the mechanism of each, the depth of block at which each is effective, and the evidence on their relative efficacy and safety.
References4ShowHide
- [1]Gijsenbergh F, Ramael S, Houwing N, van Iersel T. First human exposure of Org 25969, a novel agent to reverse the action of rocuronium bromide. Anesthesiology, 2005.PMID 16192761
- [2]Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database of Systematic Reviews, 2017.PMID 28806470
- [6]Leslie K, Darvall JN, Chan MTV, Peyton PJ, et al. Sugammadex versus neostigmine for reversal of neuromuscular blockade and postoperative pulmonary complications (SNaPP). The Lancet Respiratory Medicine, 2026.PMID 42263720
- [7]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.