The Role of Sugammadex in the JSA Airway Management Guideline：Does Induction of Anesthesia Become Safer by Using Sugammadex?

Abstract

Sugammadex restores neuromuscular contraction by encapsulating rocuronium molecules inside its structure within the plasma, decreasing plasma rocuronium concentrations, and then decreasing rocuronium concentrations at the neuromuscular junction. The JSA airway guideline recommends administering 16 mg/kg sugammadex in cannot intubate/cannot ventilate situations during anesthesia induction with rocuronium. However, many case reports suggest the usefulness of much smaller doses of sugammadex for managing difficult airway situations. I discuss the advantages of using muscle relaxant during anesthesia induction and potential mechanisms for the usefulness of sugammadex for avoiding disaster in “cannot intubate/cannot ventilate” situations.