CME Review ArticleSugammadex A Limited But Important Role in Emergency MedicineChen, Betty MDAuthor Information From the Assistant Professor, Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA. Disclosure: The author declares no conflict of interest. The author, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations relevant to this educational activity. Reprints: Betty Chen, MD, Harborview Medical Center, Department of Emergency Medicine, Box 359702, 1CT89, 325 9th Ave, Seattle, WA 98104 (e-mail: firstname.lastname@example.org). Pediatric Emergency Care: June 2020 - Volume 36 - Issue 6 - p 296-301 doi: 10.1097/PEC.0000000000002126 Buy Take the CME Test Metrics Abstract Sugammadex reverses neuromuscular blockade by the steroidal nondepolarizing neuromuscular blocking agents rocuronium and vecuronium. In 2015, it was approved in the United States by the Food and Drug Administration for adult use. However, there are ongoing clinical trials investigating its use in the pediatric population. Before approval in adult use in the United States, several adverse effects were noted to occur in patients receiving sugammadex in clinical trials including prolonged QT interval, bradycardia, hypersensitivity reactions, and prolongation of coagulation parameters. Additional investigations further elucidated the risks of these adverse events. Sugammadex is approved for use in children older than 2 years in other countries in Europe and Asia. Investigations suggest that the efficacy, safety, and pharmacokinetic profile is similar in children when compared with adults. Published pediatric data favor the use of sugammadex in children older than 2 years, but there are some data in young children younger than 2 years. Case reports discuss the use of sugammadex in pediatric patients with neuromuscular diseases. Although sugammadex is typically used in the operating room for reversing neuromuscular blockade for surgical procedures, there is a small but important role for sugammadex use in the emergency department. In cases where rapid neurological examination is required after neuromuscular blockage with rocuronium or vecuronium, sugammadex can assist in facilitating a timely comprehensive neurological examination where pharmacologic or surgical management may depend on examination findings such as in the case of cerebral vascular accident, status epilepticus, or traumatic brain injury. Some clinicians have advocated for the use of sugammadex in the cannot intubate, cannot ventilate scenario. However, caution should be exercised in this situation as reversal of paralysis can take up to 22 minutes to occur. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.