Core evidence clinical impact summary for sugammadex

Outcome measure	Evidence	Implications
Patient-oriented evidence
Reversal of neuromuscular block by rocuronium or vecuronium	Multiple randomized clinical trials and comparison to antagonists	Efficient reversor of neuromuscular block and superior to antagonists regarding efficacy
Recommended doses for profound, deep and moderate neuromuscular block (immediate reversal following 1.2 mg/kg rocuronium, PTC 1–2, TOF-C 2)	Multiple randomized clinical trials	Recommended doses are currently under postmarketing surveillance (Phase IV)
Doses for shallow neuromuscular block (TOF-C 4, TOF ratio 0.5)	Single center randomized trials	Further studies (including safety) pending
Disease-oriented evidence
Renal disease	Multicenter parallel-group trial	2 mg/kg sugammadex is efficient in patients with renal failure (creatinine clearance <30 mL/min), however current recommendations are to use sugammadex only if creatinine clearance >30 mL/min
Obese patients	Single center randomized trials (heterogeneous comparison groups)	Doses according to ideal body weight +40% instead of actual body weight seems to be efficient for reversal
RSI	Several randomized clinical trials	Combination of rocuronium and sugammadex are an alternative to succinylcholine for RSI
Cesarian section	Several case series	Rocuronium and sugammadex might be a possible alternative to succinylcholine for RSI for patients undergoing a Cesarian section
Electroconvulsive therapy	Single center trials (one randomized)	Rocuronium followed by 8 mg/kg sugammadex after electroconvulsive therapy is completed seems to be an alternative to succinylcholine
Myasthenia gravis and muscular diseases	Case reports	Sugammadex seems to be efficient in such patients
Allergic/anaphylactic reaction to rocuronium	Case reports and preclinical data	Might be useful however standard treatment of anaphylaxis has priority
Economic evidence	Limited data.	Cost-effectiveness not proven.
	No prospective randomized economic trials	Economic benefits highly dependent on country, state or hospital reimbursement system as well as operation room logistics

Abbreviations: PTC, post tetanic count; TOF-C, train of four count; RSI, rapid sequence induction.