Clinical implications of new neuromuscular concepts and agents: so long, neostigmine! So long, sux!

Although antiquated and long targeted for obsolescence, neostigmine and succinylcholine still serve the anesthesia community, decades after their inferior pharmacological profiles have been recognized. The need to quickly establish a good intubation condition with a relaxant that will recover rapidly is fundamental to safe anesthesia practice. So is the need to restore muscle power safely and quickly at the end of surgery, by reversing a residual neuromuscular block. Recent data have shown that sugammadex can safely and rapidly reverse profound neuromuscular block established by rocuronium and vecuronium. This allows for use of rocuronium to establish a good intubation condition, and use of sugammadex to terminate the neuromuscular block at will. The present article assesses the clinical implications of such therapeutic regimen, and provides an educated guess on how the clinical neuromuscular practice might change, if and when sugammadex becomes clinically available.