Abstract
Vecuronium is currently the first-choice muscle relaxant in Japan. Suxamethonium is no longer widely used because of associated side effects. However, vecuronium does not provide such a rapid onset of action as suxamethonium, despite strategies such as priming or the use of higher doses.
Rocuronium, which has a faster onset than vecuronium and has been used in the US and Europe for over 10 years, should soon be available in Japan and may replace vecuronium. However, the shorter duration of action of suxamethonium means it may still be used in some patients.
Sugammadex is able to rapidly and completely reverse rocuronium-induced muscle relaxation with a novel mechanism of action. Once sugammadex is introduced, the combination of a high dose of rocuronium with sugammadex allows rapid onset and reversal as needed. As such, the use of suxamethonium may no longer be an issue. Unlike cholinesterase inhibitors, sugammadex also allows recovery from deep blocks which may change how muscle relaxants are used.
