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1 the risk of neuromuscular blockade recurrence may also be increased with the use of lower than recommended doses of sugammadex or with the concomitant use of drugs that potentiate neuromuscular blockade The majority (>90%) of a dose of sugammadex is excreted within 24 hours of administration. Adverse effects are described in the anesthesia literature and the most serious side effect is in patients with a known hypersensitivity to sugammadex [2] sugammadex is only fda approved for reversal for patients undergoing surgery

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The drug has been used in europe since 2008 [4] In healthy adult volunteers, renal excretion of unchanged drug has been observed as the primary route of elimination for sugammadex (table 2) More than 90% of the dose is excreted within 24 hours with at least 95% as unchanged drug

Over 90% of the dose is excreted within 24 hours with 96% excreted unchanged in the urine.

Sugammadex works by two mechanisms, firstly on entering the plasma it encapsulates the circulating aminosteroid rendering it inactive. In adult anesthetized patients with normal renal function, the elimination half‐life (t1/2) of sugammadex is about 2 hours and the estimated plasma clearance is about 88 ml/min (based on. Residual neuromuscular blockade is common after surgery, with an estimated 30 to 60% incidence in the recovery room Sugammadex itself is not metabolized, and most of it will be excreted in urine unchanged

This complex inactivates the neuromuscular blocking agent and therefore effectively reverses profound neuromuscular blockade in humans