Sugammadex and neuromuscular reversal: special focus on neonatal and infant populations;

  • Review of sugammadex pharmacology but only a small section specific to infants and neonates.
  • FDA approval in 2015 but not approved for use in children. In Europe, sugammadex is approved for use in children aged 2-17 years old, for routine reversal only.
  • Higher dosing for the reversal of vecuronium may be warranted as lower affinity results in delayed recovery of TOF 0.9 (by <2 mins) and recurrence of neuromuscular blockade.
  • Incidence of hypersensitivity is 0.1% in children.
  • Multiple studies demonstrating similar times to TOF 0.9 in infants/children as in adults. Sugammadex consistently avoids bradycardia when compared with neostigmine. However, overall literature in children <2 years old remains scant.


Reviewed by Dr. Philip Cheung