J Pediatr Intensive Care 2020; 09(03): 162-171
DOI: 10.1055/s-0040-1705133
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Sugammadex: Applications in Pediatric Critical Care

Joseph D. Tobias
1  Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
2  Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States
3  Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States
› Author Affiliations
Further Information

Publication History

11 December 2019

27 January 2020

Publication Date:
06 March 2020 (online)


Sugammadex is a novel pharmacologic agent, which reverses neuromuscular blockade with a mechanism that differs from acetylcholinesterase inhibitors such as neostigmine. There is a growing body of literature demonstrating its efficacy in pediatric patients of all ages. Prospective trials have demonstrated a more rapid and more complete reversal of rocuronium-induced neuromuscular blockade than the acetylcholinesterase inhibitor, neostigmine. Unlike the acetylcholinesterase inhibitors, sugammadex effectively reverses intense or complete neuromuscular blockade. It may also be effective in situations where reversal of neuromuscular blockade is problematic including patients with neuromyopathic conditions or when acetylcholinesterase inhibitors are contraindicated. This article reviews the physiology of neuromuscular transmission as well as the published literature, regarding the use of sugammadex in pediatric population including the pediatric intensive care unit population. Clinical applications are reviewed, adverse effects are discussed, and dosing algorithms are presented.