Skip Navigation LinksHome > August 2009 - Volume 22 - Issue 4 > Update on neuromuscular pharmacology
Current Opinion in Anaesthesiology:
doi: 10.1097/ACO.0b013e32832b8cff
Drugs in anesthesia: Edited by Klaus T. Olkkola

Update on neuromuscular pharmacology

Naguib, Mohameda; Brull, Sorin Jb

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Purpose of review: We review the efficacy and safety of gantacurium and AV002, two novel, investigational fumarate-based nondepolarizing neuromuscular blockers, as well as sugammadex and cysteine, two novel reversal drugs that have no acetylcholinesterase inhibition properties.

Recent findings: Gantacurium (with a pharmacodynamic profile similar to that of succinylcholine) and AV002 (with an intermediate duration of action) have shown efficacy in animals and, for gantacurium, in humans. Animal data have shown that exogenous administration of the amino acid cysteine accelerates the natural chemical degradation of both gantacurium and AV002 via the cysteine adduction pathway. Another reversal drug, sugammadex (a modified γ-cyclodextrin and the first selective relaxant binding agent), forms very tight complexes in a 1: 1 ratio with steroidal neuromuscular blocking agents.

Summary: In a multicenter phase-2 randomized controlled study in the European Union, the efficacy and safety of gantacurium were evaluated, but results have not yet been published. Sugammadex is currently available in the European Union, but the United States Food and Drug Administration has had concerns about its safety (hypersensitivity and allergic reactions) and has asked for additional safety data. It is hoped that the widespread use of sugammadex in the European Union will provide additional information.

© 2009 Lippincott Williams & Wilkins, Inc.


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