الفهرس 
Physiology of the neuromuscular junctionOnly 14 pages are availabe for public view
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Abstract
Neuromuscular blocking agents (NMBAs) are commonly used during surgery to facilitate endotracheal intubation, allow assisted or controlled ventilation, and let surgery proceed easily. Although neuromuscular function will recover spontaneously, rapid and complete reversal of neuromuscular blockade (NMB) is desirable in the surgical setting to avoid residual paralysis and related adverse outcomes. Traditionally, reversal of NMB has been accomplished with a cholinesterase inhibitor (eg, neostigmine, pyridostigmine, eDROPhonium) that acts by inhibiting the breakdown of acetylcholine (ACh) in the neuromuscular junction. Although effective once some recovery has already taken place, cholinesterase inhibitors are associated with a number of limitations, including the induction of cholinergic adverse events (eg, bradycardia, bronchospasm, bronchial secretions, abdominal cramping) and incomplete reversal of NMB under certain circumstances (Murphy et al, 2006).
Residual NMB is a common but under-recognized problem associated with a number of adverse physiologic effects, such as postoperative pulmonary complications, hypoxemia, impaired hypoxic ventilatory response, pharyngeal dysfunction, an increased risk of aspiration and prolonged recovery (Murphy et al, 2006).
In surgical patients, Sugammadex produces dose-dependent reversal of NMB induced by Rocuronium or Vecuronium. In comparative studies, Sugammadex has demonstrated effectiveness superior to cholinesterase inhibitors for NMB reversal at several time points after the administration of Rocuronium or Vecuronium. This includes routine reversal of deep, moderate NMB and immediate reversal of NMB (Nagiub, 2007).
Sugammadex provides clinicians with the option of rapidly reversing NMB, potentially avoiding the risks of residual blockade without concerns about the hemodynamic, cardiovascular, and gastrointestinal complications found typically in current reversal agents. Sugammadex is appropriate for use in a wide range of surgical situations, including short, medium, or long procedures that require endotracheal intubation (Mirkahur, 2009).