Table 3 Classification, dose, and side effects of reversal agents
From: Neuromuscular blockers and their reversal: have we finally found the on-off switches?
Class of reversal agent | Name of drug Duration of action | Dose | Side effects | Remarks |
|---|---|---|---|---|
Carbamate group AntiAch esterase (Ganapati et al. 2016) | Neostigmine 0.5–2 h | TOF count < 1: do NOT give neostigmine | Residual block, muscarinic S/E, (bradycardia, arrhythmias, salivation, bronchospasm, increased airway secretions, nausea, vomiting, diarrhea, micturition) | Does not cross blood-brain barrier MG treatment Paralytic ileus Urinary retention |
TOF count 2–4 (tactile/visual fade; TOFR < 0.4): 0.05–0.07 mg/kg | ||||
TOF count = 4 (no tactile/visual fade; TOFR = 0.4–0.9): 0.02–0.03 mg/kg | ||||
TOFR is ≥0.9: do NOT give neostigmine | ||||
Pyridostigmine 3–6 h |  |  | MG treatment | |
Alcohol group AntiAch esterase | Edrophonium 5-15 min | Â | Â | MG diagnosis |
Gamma Cyclodextrin | Sugammadex Renal excretion after 24 h | TOF count = T2: 2mg/kg | Marked bradycardia and cardiac arrest, coagulopathy, anaphylaxis, contraceptive failure | Approved in Europe (2008), Japan (2010), Australia, Middle East, US (2015) |
Post-tetanic count = 1–2: 4 mg/kg | ||||
3 min post-IV rocuronium (1.2 mg/kg): 16 mg/kg | ||||
Non-essential amino acid | l-Cysteine Adduct-hydrolysis 300 min: gantacurium 60 min: CW002 60 min: CW011 | 10–50 mg/kg 1 min after 8× ED95 gantacurium |  |  |
Cucurbit[n]urils | Calabadion-1 90% renal; 1 h | 60 mg/kg (rocuronium rat) 120 mg/kg (cisatra; rat) | Not significant |  |
Calabadion-2 69% and 42% renal excretion after 1 h | 5–10 mg/kg (rat) 40–80 mg/kg (rat) | Not significant | Not yet available for clinical use |