Neuromuscular Blockade

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NMBA NMBD

Standards/Guidelines

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

Neuromuscular blockade in children

Incidence, risk factors, and consequences of residual neuromuscular block in the United States: The prospective, observational, multicenter RECITE-US study

Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care

Physiology

Development of the neuromuscular junction and neuromuscular blocking agents in neonates, infants and children: A narrative review

Pharmacokinetics and pharmacodynamics of d-tubocurarine in infants, children, and adults.

Pseudocholinesterase Deficiency

Antiepileptic-Induced Resistance to Neuromuscular Blockers: Mechanisms and Clinical Significance

Vanlinthout LE, Driessen JJ, Stolker RJ, Lesaffre EM, Berghmans JM, Staals LM. Effect of neuromuscular blocking agents on tracheal intubation quality in paediatric patients: a systematic review using network meta-analysis and meta-regression. Br J Anaesth. 2025 Dec;135(6):1787-1802. doi: 10.1016/j.bja.2025.08.036. Epub 2025 Oct 10. PMID: 41076411.

Monitoring

Neuromuscular block management: evidence-based principles and practice

Quantitative Neuromuscular Monitoring and Postoperative Outcomes: A Narrative Review

Neuromuscular Monitoring in the Perioperative Period

Leg lift and maximum inspiratory force, clinical signs of neuromuscular blockade reversal in neonates and infants

Use of a train-of-four ratio of 0.95 versus 0.9 for tracheal extubation: an exploratory analysis of POPULAR data

Intraoperative neuromuscular monitoring site and residual paralysis

Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative

Pediatric Intraoperative Electromyographic Responses at the Adductor Pollicis and Flexor Hallucis Brevis Muscles: A Prospective, Comparative Analysis

Accuracy and Precision of Three Acceleromyographs, Three Electromyographs, and a Mechanomyograph Measuring the Train-of-four Ratio in the Absence of Neuromuscular Blocking Drugs

Skin Injury after Removal of Electrode Used for Quantitative Monitoring of Neuromuscular Transmission

Agents

Depolarizing

Succinylcholine

The place of suxamethonium in pediatric anesthesia

Failure of succinylcholine to alter plasma potassium in children with myelomeningocoele

Non-Depolarizing

Rocuronium

Intramuscular rocuronium

Bioavailability of intramuscular rocuronium in infants and children

Goldilocks and the Three Rocuronium Reversals: A Sugammadex Dose-finding Study

Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children

Intramuscular rocuronium in infants and children: a multicenter study to evaluate tracheal intubating conditions, onset, and duration of action

Test Your Knowledge: unique advantage of rocuronium

Elkhateb R, Campbell DL, Zhao X, et al. Neuromuscular blockade and antagonism in patients with renal impairment: a multicenter retrospective cross-sectional study. Anesthesiology. 2025 Jun; 142(6): 1009-1024. PMID: 39928534

Vecuronium

Cis-atracurium

Antagonism/Reversal

Assessment of neuromuscular blockade in children at the time of block reversal and the removal of the endotracheal tube

A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade

Measuring Success of Patient Safety Initiatives: The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade

A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis

Sugammadex

StatPearls: Sugammadex

Retrospective Analysis of the Safety and Efficacy of Sugammadex Versus Neostigmine for the Reversal of Neuromuscular Blockade in Children

Encapsulation dynamics of neuromuscular blocking drugs by sugammadex

Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults

The comparative efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. A Cochrane systematic review with meta-analysis and trial sequential analysis

Sugammadex for reversal of neuromuscular blockade in pediatric patients: Results from a phase IV randomized study

Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study

Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study

Advantages and pitfalls of clinical application of sugammadex

Cardiac arrest following sugammadex administration

Encapsulation Dynamics of Neuromuscular Blocking Drugs by Sugammadex

A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis

A retrospective observational cross-sectional study of intraoperative neuromuscular blocking agent choice and dosing in a US paediatric referral hospital before and after introduction of sugammadex

Sugammadex Vial Wastage: Implications for the Cost of Anesthesia Care in Children: Research Letter

Recurarisation after sugammadex in children: review of case reports and recommendations

Factors Associated With Decision to Use and Dosing of Sugammadex in Children: A Retrospective Cross-Sectional Observational Study

Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study

X tweet about sugammadex

Unintended Consequences: Is Sugammadex Changing the Way We Deliver Anesthesia?

Heart rate changes following the administration of sugammadex in children: a prospective, observational study

Sugammadex for reversal of neuromuscular blockade in neonates and infants <2 years old: results from a phase IV randomized clinical trial

Sugammadex and neuromuscular reversal: Special focus on neonatal and infant populations

Retrospective analysis of the safety and efficacy of sugammadex versus neostigmine for the reversal of neuromuscular blockade in children

Current evidence for the use of sugammadex in children

Analysis of the factors contributing to residual weakness after sugammadex administration in pediatric patients under 2 years of age

Sugammadex Is Not a Silver Bullet: Caveats Regarding Unmonitored Reversal

A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis

Sugammadexand Women, Hormonal Regulation, and Contraceptives

A prospective observational study of the effects of sugammadex on peri-operative oestrogen and progesterone levels in women who take hormonal contraception

What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives

Safety of Sugammadex in Pregnancy, Pediatrics, and Renal Failure

Neostigmine

Rocuronium-Sugammadex Versus Cisatracurium-Neostigmine in Kidney Disease: Making Sense of Surprising Results

Management of Muscle Relaxation With Rocuronium and Reversal With Neostigmine or Sugammadex Guided by Quantitative Neuromuscular Monitoring

Anaphylaxis

Sugammadex and rocuronium-induced anaphylaxis

Sugammadex in the management of rocuronium-induced anaphylaxis

Role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: Extrapolation from adult and animal reports

The cyclodextrin sugammadex and anaphylaxis to rocuronium: is rocuronium still potentially allergenic in the inclusion complex form?

Pholcodine exposure increases the risk of perioperative anaphylaxis to neuromuscular blocking agents: the ALPHO case-control study

Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort

Drug challenge testing: a critical step in the investigation of neuromuscular blocking agent hypersensitivity

Incidence of immediate hypersensitivity to sugammadex in Aotearoa New Zealand: a retrospective cohort study

Sugammadex hypersensitivity: a national retrospective cohort study from the French pharmacovigilance database

Historic

Gallamine

Micacurium

Neuromuscular effects of mivacurium in 2- to 12-yr-old children with burn injury

Curare

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1. Vanlinthout LE, Driessen JJ, Stolker RJ, Lesaffre EM, Berghmans JM, Staals LM: Effect of neuromuscular blocking agents on tracheal intubation quality in paediatric patients: a systematic review using network meta-analysis and meta-regression. British journal of anaesthesia 2025, 135(6):1787–1802.

2. Martyn JAJ, Richtsfeld M, Warner DO: Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology 2006, 104(1):158–169.

3. Lerman J: Perioperative management of the paediatric patient with coexisting neuromuscular disease. British journal of anaesthesia 2011, 107 Suppl 1:i79–89.

4. Park S, Kim JH, Bae JC, Lee JR, Kim MS. Tracheal intubation with or without a neuromuscular blocking agent for a short surgical procedure in children: Prospective, randomized, double-blind trial. Paediatr Anaesth. 2021 Aug;31(8):863-870.

5. Viby-Mogensen J, Engbaek J, Eriksson LI, Gramstad L, Jensen E, Jensen FS, Koscielniak-Nielsen Z, Skovgaard LT, Ostergaard D. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996 Jan;40(1):59-74.

6. Gera S, Dali JS, Sharma KR, Garg R, Arya M. Evaluation of intubating conditions in children after sevoflurane induction using propofol or rocuronium bromide--a randomised, prospective, double blind study. Acta Anaesthesiol Belg. 2015;66(4):25-30.