{"title":"Next generation of neuromuscular blockade reversal agents.","authors":"Hans D de Boer, Ricardo Vieira Carlos","doi":"10.1097/ACO.0000000000001485","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of the review: </strong>The purpose of this review is to explore emerging pharmacological strategies for neuromuscular blockade (NMB) reversal, focusing on their mechanisms of action, efficacy, and potential advantages over existing agents like sugammadex and neostigmine.</p><p><strong>Recent findings: </strong>Several novel reversal agents are under investigation: calabadions, synthetic molecular containers that effectively reverse aminosteroidal and benzylisoquinolinium neuromuscular blocking agents (NMBAs) with rapid clearance; l-cysteine adduction, a promising method for reversing ultrashort-acting NMBAs by accelerating metabolism; adamgammadex, a modified γ-cyclodextrin with improved binding to rocuronium and reduced hypersensitivity risks, showing noninferiority to sugammadex; acyclic cucurbit[n]urils, broad-spectrum reversal agents with superior water solubility and biocompatibility; and ClC-1 channel blockers, a novel approach that enhances muscle excitability rather than directly binding to NMBAs.</p><p><strong>Summary: </strong>Emerging NMBA reversal agents offer potential improvements in safety, efficacy, and broader NMBA compatibility. These alternatives to sugammadex and neostigmine show promise in preclinical and early clinical trials. Further studies are necessary to confirm their clinical applicability and regulatory approval.</p>","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Opinion in Anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/ACO.0000000000001485","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose of the review: The purpose of this review is to explore emerging pharmacological strategies for neuromuscular blockade (NMB) reversal, focusing on their mechanisms of action, efficacy, and potential advantages over existing agents like sugammadex and neostigmine.
Recent findings: Several novel reversal agents are under investigation: calabadions, synthetic molecular containers that effectively reverse aminosteroidal and benzylisoquinolinium neuromuscular blocking agents (NMBAs) with rapid clearance; l-cysteine adduction, a promising method for reversing ultrashort-acting NMBAs by accelerating metabolism; adamgammadex, a modified γ-cyclodextrin with improved binding to rocuronium and reduced hypersensitivity risks, showing noninferiority to sugammadex; acyclic cucurbit[n]urils, broad-spectrum reversal agents with superior water solubility and biocompatibility; and ClC-1 channel blockers, a novel approach that enhances muscle excitability rather than directly binding to NMBAs.
Summary: Emerging NMBA reversal agents offer potential improvements in safety, efficacy, and broader NMBA compatibility. These alternatives to sugammadex and neostigmine show promise in preclinical and early clinical trials. Further studies are necessary to confirm their clinical applicability and regulatory approval.
期刊介绍:
Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in Anesthesiology features hand-picked review articles from our team of expert editors. With fifteen disciplines published across the year – including cardiovascular anesthesiology, neuroanesthesia and pain medicine – every issue also contains annotated references detailing the merits of the most important papers.