[Sugammadex--two years in clinical practice].

Sugammadex is a modified gamma cyclodextrin, specifically designed for the reversal of neuromuscular blockade (NMB) induced by the steroidal neuromuscular blocking agents, rocuronium and vecuronium. Sugammadex acts by encapsulating the unbound drug molecules and reducing their concentration at the neuromuscular junction, allowing rapid reversal of NMB at every stage. Unlike acetylcholinesterase inhibitors, sugammadex is also effective in the reversal of profound NMB and is well tolerated. The recommended doses are in the range of 2-16 mg kg(-1), depending on the intensity of the block. Perioperative neuromuscular transmission monitoring is mandatory in enabling the choice of the right doses of sugammadex. This review presents various aspects of the use of sugammadex in adult and paediatric patients, and provides guidelines for practical administration.