Reversing neuromuscular blockade: Inhibitors of the acetylcholinesterase versus the encapsulating agents sugammadex and calabadion

Friederike Haerter, Matthias Eikermann

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations


Introduction: Acetylcholinesterase inhibitors (neostigmine, edrophonium) and encapsulating agents (sugammadex and calabadion) can be used to reverse residual neuromuscular blockade (NMB).Areas covered: This review provides information about efficacy, effectiveness, and side effects of drugs (acetylcholinesterase inhibitors and encapsulating agents) used to reverse neuromuscular blocking agents (NMBAs).Expert opinion: The therapeutic range of acetylcholinesterase-inhibitors is narrow and effectiveness studies demonstrate clinicians dont use these unspecific reversal agents effectively to increase postoperative respiratory safety. The encapsulating drugs sugammadex and calabadion reverse all levels of NMB, and complete recovery of muscle strength can be achieved almost immediately after administration. For this reason encapsulating agents can be used as a solution for "cannot intubate cannot ventilate"- situations. Poor binding selectivity of encapsulating agents carries the risk of displacement of the NMBA by a competitively binding drug, which may lead to recurarization. In order to avoid side-effects, related to unspecific binding of endogenous proteins and drugs administered perioperatively it is prudent to titrate the dose of reversal agents to the minimal effective dose, depending on the depth of neuromuscular transmission block identified by neuromuscular transmission monitoring. Calabadions provide a diversified (increased binding selectivity) and expanded (reversal of benzylisoquinolines) spectrum of possible indications.

Original languageEnglish (US)
Pages (from-to)819-833
Number of pages15
JournalExpert Opinion on Pharmacotherapy
Issue number6
StatePublished - Apr 12 2016
Externally publishedYes


  • encapsulation
  • neuromuscular transmission block
  • Respiratory complications
  • reversal

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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