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NMBD
NMBD


Standards/Guidelines


Monitoring
<b>Standards/Guidelines</b>


Agents
[https://pubmed.ncbi.nlm.nih.gov/41766420/ 2025 ESAIC and ESPA Guidelines on neuromuscular block in anaesthetised children: Indications, monitoring and reversal]
:Succinylcholine
:Rocuronium
:Vecuronium
:Cis-atracurium
:Sugammadex
:Historic
::Micacurium
::Curare


[https://pubmed.ncbi.nlm.nih.gov/36520073/ 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]
[https://pubmed.ncbi.nlm.nih.gov/10983014/ Neuromuscular blockade in children]
[https://pubmed.ncbi.nlm.nih.gov/30594097/ Incidence, risk factors, and consequences of residual neuromuscular block in the United States: The prospective, observational, multicenter RECITE-US study]
[https://pubmed.ncbi.nlm.nih.gov/36377554/ Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care]
<b>Physiology</b>
[https://pubmed.ncbi.nlm.nih.gov/40905255/ Development of the neuromuscular junction and neuromuscular blocking agents in neonates, infants and children: A narrative review]
[https://pubmed.ncbi.nlm.nih.gov/7114542/ Pharmacokinetics and pharmacodynamics of d-tubocurarine in infants, children, and adults.]
[[Pseudocholinesterase Deficiency]]
[https://link.springer.com/article/10.2165/00003088-200443020-00001 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.


[https://pubmed.ncbi.nlm.nih.gov/36520073/ 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. Anesthesiology 2023;138:13-41]
 
<b>Monitoring</b>


[https://www.bjaed.org/article/S2058-5349(23)00143-9/fulltext Neuromuscular block management: evidence-based principles and practice]
[https://www.bjaed.org/article/S2058-5349(23)00143-9/fulltext Neuromuscular block management: evidence-based principles and practice]


[https://pubmed.ncbi.nlm.nih.gov/7114542/ Pharmacokinetics and pharmacodynamics of d-tubocurarine in infants, children, and adults.]
[https://pubmed.ncbi.nlm.nih.gov/34813652/ Quantitative Neuromuscular Monitoring and Postoperative Outcomes: A Narrative Review]
 
[https://pubmed.ncbi.nlm.nih.gov/28795964/ Neuromuscular Monitoring in the Perioperative Period]
 
[https://pubmed.ncbi.nlm.nih.gov/6990835/ Leg lift and maximum inspiratory force, clinical signs of neuromuscular blockade reversal in neonates and infants]
 
[https://pubmed.ncbi.nlm.nih.gov/31607388/ Use of a train-of-four ratio of 0.95 versus 0.9 for tracheal extubation: an exploratory analysis of POPULAR data]
 
[https://pubmed.ncbi.nlm.nih.gov/23001053/ Intraoperative neuromuscular monitoring site and residual paralysis]
 
[https://pubmed.ncbi.nlm.nih.gov/35188958/ Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative]
 
[https://journals.lww.com/anesthesia-analgesia/fulltext/2024/07000/pediatric_intraoperative_electromyographic.7.aspx Pediatric Intraoperative Electromyographic Responses at the Adductor Pollicis and Flexor Hallucis Brevis Muscles: A Prospective, Comparative Analysis]
 
[https://pubs.asahq.org/anesthesiology/article/141/2/262/141383/Accuracy-and-Precision-of-Three-Acceleromyographs Accuracy and Precision of Three Acceleromyographs, Three Electromyographs, and a Mechanomyograph Measuring the Train-of-four Ratio in the Absence of Neuromuscular Blocking Drugs]
 
[https://journals.lww.com/anesthesiology/fulltext/2025/08000/skin_injury_after_removal_of_electrode_used_for.26.aspx Skin Injury after Removal of Electrode Used for Quantitative Monitoring of Neuromuscular Transmission]
 


[https://pubmed.ncbi.nlm.nih.gov/31584918/ Retrospective Analysis of the Safety and Efficacy of Sugammadex Versus Neostigmine for the Reversal of Neuromuscular Blockade in Children]
<b>Agents</b>


[https://pubs.asahq.org/anesthesiology/article/doi/10.1097/ALN.0000000000004442/137334/Encapsulation-dynamics-of-neuromuscular-blocking Encapsulation dynamics of neuromuscular blocking drugs by sugammadex]
''Depolarizing''


[https://pubmed.ncbi.nlm.nih.gov/34878707/ Sugammadex for reversal of neuromuscular blockade in pediatric patients: Results from a phase IV randomized study]


[https://pubmed.ncbi.nlm.nih.gov/10983014/ Neuromuscular blockade in children]
Succinylcholine


[https://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2009.03032.x The place of suxamethonium in pediatric anesthesia]
[https://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2009.03032.x The place of suxamethonium in pediatric anesthesia]


[[TYK6 |Test Your Knowledge]]: unique advantage of rocuronium
[https://pubmed.ncbi.nlm.nih.gov/3946815/ Failure of succinylcholine to alter plasma potassium in children with myelomeningocoele]
 
 
''Non-Depolarizing''
 
 
Rocuronium
 
[https://pubmed.ncbi.nlm.nih.gov/9054273/ Intramuscular rocuronium]
 
[https://pubmed.ncbi.nlm.nih.gov/9366462/ Bioavailability of intramuscular rocuronium in infants and children]
 
[https://pubs.asahq.org/anesthesiology/article/139/1/A16/138250/Goldilocks-and-the-Three-Rocuronium-Reversals-A Goldilocks and the Three Rocuronium Reversals: A Sugammadex Dose-finding Study]


[https://pubmed.ncbi.nlm.nih.gov/21474022/ Assessment of neuromuscular blockade in children at the time of block reversal and the removal of the endotracheal tube]
[https://pubmed.ncbi.nlm.nih.gov/12378667/ Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children]


[https://www.bjanaesthesia.org/article/S0007-0912(19)30835-9/fulltext Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study]
[https://pubmed.ncbi.nlm.nih.gov/10485771/ Intramuscular rocuronium in infants and children: a multicenter study to evaluate tracheal intubating conditions, onset, and duration of action]


[https://pubmed.ncbi.nlm.nih.gov/33543867/ A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade]
[[TYK6 |Test Your Knowledge]]: unique advantage of rocuronium


[https://pubmed.ncbi.nlm.nih.gov/28806470/ Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults]
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


[https://pubmed.ncbi.nlm.nih.gov/29280475/ 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]


[https://pubmed.ncbi.nlm.nih.gov/30594097/ Incidence, risk factors, and consequences of residual neuromuscular block in the United States: The prospective, observational, multicenter RECITE-US study]
Vecuronium


[https://pubmed.ncbi.nlm.nih.gov/26646837/  Sugammadex and rocuronium-induced anaphylaxis]


[https://www.bjaopen.org/article/S2772-6096(22)00091-0/fulltext Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study]
Cis-atracurium


[https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15902 A prospective observational study of the effects of sugammadex on peri-operative oestrogen and progesterone levels in women who take hormonal contraception]


[[Pseudocholinesterase Deficiency]]
<b>Antagonism/Reversal</b>


[https://pubmed.ncbi.nlm.nih.gov/10638896/ Neuromuscular effects of mivacurium in 2- to 12-yr-old children with burn injury]
[https://pubmed.ncbi.nlm.nih.gov/21474022/ Assessment of neuromuscular blockade in children at the time of block reversal and the removal of the endotracheal tube]


[https://pubmed.ncbi.nlm.nih.gov/33543867/ A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade]
[https://pubmed.ncbi.nlm.nih.gov/33543867/ A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade]
Line 63: Line 101:
[https://pubmed.ncbi.nlm.nih.gov/36520074/ Measuring Success of Patient Safety Initiatives: The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade]
[https://pubmed.ncbi.nlm.nih.gov/36520074/ Measuring Success of Patient Safety Initiatives: The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade]


[https://pubmed.ncbi.nlm.nih.gov/34813652/ Quantitative Neuromuscular Monitoring and Postoperative Outcomes: A Narrative Review]
[https://pubs.asahq.org/anesthesiology/article/139/1/6/138070/A-Dose-finding-Study-of-Sugammadex-for-Reversal-of A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis]
 
 
Sugammadex
 
[https://www.statpearls.com/ArticleLibrary/viewarticle/29661 StatPearls: Sugammadex]
 
[https://pubmed.ncbi.nlm.nih.gov/31584918/ Retrospective Analysis of the Safety and Efficacy of Sugammadex Versus Neostigmine for the Reversal of Neuromuscular Blockade in Children]
 
[https://pubs.asahq.org/anesthesiology/article/doi/10.1097/ALN.0000000000004442/137334/Encapsulation-dynamics-of-neuromuscular-blocking Encapsulation dynamics of neuromuscular blocking drugs by sugammadex]


[https://pubmed.ncbi.nlm.nih.gov/28795964/ Neuromuscular Monitoring in the Perioperative Period]
[https://pubmed.ncbi.nlm.nih.gov/28806470/ Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults]


[https://pubmed.ncbi.nlm.nih.gov/31607388/ Use of a train-of-four ratio of 0.95 versus 0.9 for tracheal extubation: an exploratory analysis of POPULAR data]
[https://pubmed.ncbi.nlm.nih.gov/29280475/ 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]


[https://pubmed.ncbi.nlm.nih.gov/23001053/ Intraoperative neuromuscular monitoring site and residual paralysis]
[https://pubmed.ncbi.nlm.nih.gov/34878707/ Sugammadex for reversal of neuromuscular blockade in pediatric patients: Results from a phase IV randomized study]


[https://pubmed.ncbi.nlm.nih.gov/35188958/ Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative]
[https://www.bjanaesthesia.org/article/S0007-0912(19)30835-9/fulltext Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study]


[https://pubmed.ncbi.nlm.nih.gov/26646837/ Sugammadex and rocuronium-induced anaphylaxis]
[https://www.bjaopen.org/article/S2772-6096(22)00091-0/fulltext Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study]


[https://pubmed.ncbi.nlm.nih.gov/33329823/ Advantages and pitfalls of clinical application of sugammadex]
[https://pubmed.ncbi.nlm.nih.gov/33329823/ Advantages and pitfalls of clinical application of sugammadex]
Line 81: Line 128:
[https://pubs.asahq.org/anesthesiology/article/138/2/152/137334/Encapsulation-Dynamics-of-Neuromuscular-Blocking Encapsulation Dynamics of Neuromuscular Blocking Drugs by Sugammadex]
[https://pubs.asahq.org/anesthesiology/article/138/2/152/137334/Encapsulation-Dynamics-of-Neuromuscular-Blocking Encapsulation Dynamics of Neuromuscular Blocking Drugs by Sugammadex]


[https://pubmed.ncbi.nlm.nih.gov/9054273/ Intramuscular rocuronium]
[https://pubs.asahq.org/anesthesiology/article/139/1/6/138070/A-Dose-finding-Study-of-Sugammadex-for-Reversal-of A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis]
 
[https://www.bjanaesthesia.org/article/S0007-0912(23)00385-9/fulltext 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]
 
[https://pubs.asahq.org/anesthesiology/article/139/1/108/138037/Sugammadex-Vial-Wastage-Implications-for-the-Cost Sugammadex Vial Wastage: Implications for the Cost of Anesthesia Care in Children: Research Letter]
 
[https://www.bjanaesthesia.org/article/S0007-0912(23)00548-2/fulltext Recurarisation after sugammadex in children: review of case reports and recommendations]
 
[https://journals.lww.com/anesthesia-analgesia/fulltext/2025/01000/factors_associated_with_decision_to_use_and_dosing.14.aspx Factors Associated With Decision to Use and Dosing of Sugammadex in Children: A Retrospective Cross-Sectional Observational Study]
 
[https://pubmed.ncbi.nlm.nih.gov/39058621/ Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study]
 
[https://x.com/apsforg/status/1898792243835883675?s=46&t=X_9iaGrsYZbY5PJKh6nAPQ X tweet about sugammadex]


[https://pubmed.ncbi.nlm.nih.gov/9366462/ Bioavailability of intramuscular rocuronium in infants and children]
[https://pubmed.ncbi.nlm.nih.gov/39976619/ Unintended Consequences: Is Sugammadex Changing the Way We Deliver Anesthesia?]


[https://pubmed.ncbi.nlm.nih.gov/10485771/ https://pubmed.ncbi.nlm.nih.gov/10485771/]
[https://pubmed.ncbi.nlm.nih.gov/31980926/ Heart rate changes following the administration of sugammadex in children: a prospective, observational study]


[https://pubs.asahq.org/anesthesiology/article/139/1/6/138070/A-Dose-finding-Study-of-Sugammadex-for-Reversal-of A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis]
[https://journals.lww.com/anesthesiology/abstract/9900/sugammadex_for_reversal_of_neuromuscular_blockade.682.aspx Sugammadex for reversal of neuromuscular blockade in neonates and infants <2 years old: results from a phase IV randomized clinical trial]


[https://www.bjanaesthesia.org/article/S0007-0912(23)00385-9/fulltext 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]
[https://pubmed.ncbi.nlm.nih.gov/32324657/ Sugammadex and neuromuscular reversal: Special focus on neonatal and infant populations]


[https://www.bjanaesthesia.org/article/S0007-0912(23)00104-6/fulltext Pholcodine exposure increases the risk of perioperative anaphylaxis to neuromuscular blocking agents: the ALPHO case-control study]
[https://pubmed.ncbi.nlm.nih.gov/31584918/ Retrospective analysis of the safety and efficacy of sugammadex versus neostigmine for the reversal of neuromuscular blockade in children]


Suárez Delgado JM, Hernández Soto R, Vilches Martín MJ, Romero RR, Vaz Calderón MA, García Perla JL. Anaesthetic considerations for myelomeningocele in neonates. Paediatr Anaesth. 1998; 8(4): 363-4. PMID: 9672939
[https://pubmed.ncbi.nlm.nih.gov/27859917/ Current evidence for the use of sugammadex in children]


Dierdorf SF, McNiece WL, Rao CC, Wolfe TM, Means LJ. Failure of succinylcholine to alter plasma potassium in children with myelomeningocoele. Anesthesiology. 1986 Feb; 64(2): 272-3. PMID: 3946815
[https://pubmed.ncbi.nlm.nih.gov/37792601/ Analysis of the factors contributing to residual weakness after sugammadex administration in pediatric patients under 2 years of age]


[https://pubs.asahq.org/anesthesiology/article/139/1/108/138037/Sugammadex-Vial-Wastage-Implications-for-the-Cost Sugammadex Vial Wastage: Implications for the Cost of Anesthesia Care in Children: Research Letter]
[https://pubmed.ncbi.nlm.nih.gov/37279102/ Sugammadex Is Not a Silver Bullet: Caveats Regarding Unmonitored Reversal]


[https://pubmed.ncbi.nlm.nih.gov/21149287/ Sugammadex in the management of rocuronium-induced anaphylaxis]
[https://pubmed.ncbi.nlm.nih.gov/37027807/ A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis]


[https://pubmed.ncbi.nlm.nih.gov/35212434/ Role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: Extrapolation from adult and animal reports]
[https://journals.lww.com/anesthesiology/fulltext/2025/08000/sugammadex_for_reversal_of_neuromuscular_blockade.17.aspx Sugammadex for Reversal of Neuromuscular Blockade in Neonates and Infants Less than 2 Years Old: Results from a Phase IV Randomized Clinical Trial]


[https://pubmed.ncbi.nlm.nih.gov/22512555/ The cyclodextrin sugammadex and anaphylaxis to rocuronium: is rocuronium still potentially allergenic in the inclusion complex form?]
Wachtendorf LJ, Kaiser L, Ahrens E, Tenge T, Riesemann S, Xu X, Shay D, von Wedel D, Paschold BS, Chen G et al: Changes in Intraoperative Rocuronium Dosing after the Introduction of Sugammadex and Association with Postoperative Respiratory Complications: A Retrospective Cohort Study. Anesthesiology 2026, 144(3):597–610.


Analysis of the factors contributing to residual weakness after sugammadex administration in pediatric patients under 2 years of age. Paediatr Anaesth. 2023 Oct 4. doi: 10.1111/pan.14773. Epub ahead of print. PMID: 37792601
Brown SES, Cassidy R, Zhao X, Nause-Osthoff R, Wade M, Wagner D, Haydar B, Chimbira W, Kheterpal S, Colquhoun DA: Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study. Anesthesia and analgesia 2025, 140(3):539–549.


[https://www.bjanaesthesia.org/article/S0007-0912(23)00548-2/fulltext Recurarisation after sugammadex in children: review of case reports and recommendations]
Brown SES, Spellman K, Cassidy R, Nause-Osthoff R, Bailey M, Mentz G, Wagner D, Haydar B, Chimbira W, Kheterpal S et al: 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(☆). British journal of anaesthesia 2023, 131(4):e117–e120.


[https://link.springer.com/article/10.2165/00003088-200443020-00001 Antiepileptic-Induced Resistance to Neuromuscular Blockers: Mechanisms and Clinical Significance]
Faulk DJ, Austin TM, Thomas JJ, Strupp K, Macrae AW, Yaster M: A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade. Anesthesia and analgesia 2021, 132(6):1518–1526.


[https://journals.lww.com/anesthesia-analgesia/fulltext/2024/07000/pediatric_intraoperative_electromyographic.7.aspx Pediatric Intraoperative Electromyographic Responses at the Adductor Pollicis and Flexor Hallucis Brevis Muscles: A Prospective, Comparative Analysis]
Kotake Y, Ochiai R, Suzuki T, Ogawa S, Takagi S, Ozaki M, Nakatsuka I, Takeda J: Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesthesia and analgesia 2013, 117(2):345–351.


[https://pubs.asahq.org/anesthesiology/article/141/2/262/141383/Accuracy-and-Precision-of-Three-Acceleromyographs Accuracy and Precision of Three Acceleromyographs, Three Electromyographs, and a Mechanomyograph Measuring the Train-of-four Ratio in the Absence of Neuromuscular Blocking Drugs]
Scheffenbichler FT, Rudolph MI, Friedrich S, Althoff FC, Xu X, Spicer AC, Patrocínio M, Ng PY, Deng H, Anderson TA et al: Effects of high neuromuscular blocking agent dose on post-operative respiratory complications in infants and children. Acta anaesthesiologica Scandinavica 2020, 64(2):156–167.


Thilen SR, Sherpa JR, James AM, Cain KC, Treggiari MM, Bhananker SM. Management of Muscle Relaxation With Rocuronium and Reversal With Neostigmine or Sugammadex Guided by Quantitative Neuromuscular Monitoring. Anesth Analg. 2024 Sep 1;139(3):536-544. doi: 10.1213/ANE.0000000000006511. Epub 2023 May 12. PMID: 37171989.
Salaün JP, Décary E, Veyckemans F: Recurarisation after sugammadex in children: review of case reports and recommendations. British journal of anaesthesia 2024, 132(2):410–414.


Mason LJ, Betts EK. Leg lift and maximum inspiratory force, clinical signs of neuromuscular blockade reversal in neonates and infants. Anesthesiology. 1980 May;52(5):441-2. doi: 10.1097/00000542-198005000-00015. PMID: 6990835.
Veyckemans F, Debouche S, Kaufmann J, Disma N, Amigoni A, Bonatti G, Christensen MI, Engelhardt T, Fuchs A, Fuchs-Buder T et al: 2025 ESAIC and ESPA Guidelines on neuromuscular block in anaesthetised children: Indications, monitoring and reversal. European journal of anaesthesiology 2026, 43(4):295–323.


[https://pubs.asahq.org/anesthesiology/article/139/1/A16/138250/Goldilocks-and-the-Three-Rocuronium-Reversals-A Goldilocks and the Three Rocuronium Reversals: A Sugammadex Dose-finding Study]


[https://www.bjanaesthesia.org/article/S0007-0912(24)00560-9/fulltext Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort]
<b>Sugammadexand Women, Hormonal Regulation, and Contraceptives</b>


[https://journals.lww.com/anesthesia-analgesia/fulltext/2025/01000/factors_associated_with_decision_to_use_and_dosing.14.aspx Factors Associated With Decision to Use and Dosing of Sugammadex in Children: A Retrospective Cross-Sectional Observational Study]
[https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15902 A prospective observational study of the effects of sugammadex on peri-operative oestrogen and progesterone levels in women who take hormonal contraception]


[https://anesth-pain-med.org/m/journal/view.php?doi=10.17085/apm.23041 What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives]
[https://anesth-pain-med.org/m/journal/view.php?doi=10.17085/apm.23041 What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives]


[https://www.statpearls.com/ArticleLibrary/viewarticle/29661 StatPearls: Sugammadex]
[https://www.apsf.org/article/safety-of-sugammadex-in-pregnancy-pediatrics-and-renal-failure/ Safety of Sugammadex in Pregnancy, Pediatrics, and Renal Failure]
 
 
 
Neostigmine
 
[https://journals.lww.com/anesthesia-analgesia/fulltext/2025/05000/rocuronium_sugammadex_versus.1.aspx Rocuronium-Sugammadex Versus Cisatracurium-Neostigmine in Kidney Disease: Making Sense of Surprising Results]
 
[https://pubmed.ncbi.nlm.nih.gov/37171989/ Management of Muscle Relaxation With Rocuronium and Reversal With Neostigmine or Sugammadex Guided by Quantitative Neuromuscular Monitoring]
 
'''Anaphylaxis'''
 
[https://pubmed.ncbi.nlm.nih.gov/26646837/ Sugammadex and rocuronium-induced anaphylaxis]
 
[https://pubmed.ncbi.nlm.nih.gov/21149287/ Sugammadex in the management of rocuronium-induced anaphylaxis]
 
[https://pubmed.ncbi.nlm.nih.gov/35212434/ Role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: Extrapolation from adult and animal reports]
 
[https://pubmed.ncbi.nlm.nih.gov/22512555/ The cyclodextrin sugammadex and anaphylaxis to rocuronium: is rocuronium still potentially allergenic in the inclusion complex form?]
 
[https://www.bjanaesthesia.org/article/S0007-0912(23)00104-6/fulltext Pholcodine exposure increases the risk of perioperative anaphylaxis to neuromuscular blocking agents: the ALPHO case-control study]
 
[https://www.bjanaesthesia.org/article/S0007-0912(24)00560-9/fulltext Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort]


[https://www.bjanaesthesia.org/article/S0007-0912(24)00716-5/fulltext Drug challenge testing: a critical step in the investigation of neuromuscular blocking agent hypersensitivity]
[https://www.bjanaesthesia.org/article/S0007-0912(24)00716-5/fulltext Drug challenge testing: a critical step in the investigation of neuromuscular blocking agent hypersensitivity]


[https://pubmed.ncbi.nlm.nih.gov/12378667/ Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children]
[https://www.bjanaesthesia.org/article/S0007-0912(25)00284-3/fulltext Incidence of immediate hypersensitivity to sugammadex in Aotearoa New Zealand: a retrospective cohort study]
 
[https://pubmed.ncbi.nlm.nih.gov/41238516/ Sugammadex hypersensitivity: a national retrospective cohort study from the French pharmacovigilance database]
 
 
<b>Historic</b>
 
Gallamine
 
Micacurium
 
[https://pubmed.ncbi.nlm.nih.gov/10638896/ Neuromuscular effects of mivacurium in 2- to 12-yr-old children with burn injury]


[https://x.com/apsforg/status/1898792243835883675?s=46&t=X_9iaGrsYZbY5PJKh6nAPQ X tweet about sugammadex]


[https://www.apsf.org/article/safety-of-sugammadex-in-pregnancy-pediatrics-and-renal-failure/ Safety of Sugammadex in Pregnancy, Pediatrics, and Renal Failure]
Curare


[https://pubmed.ncbi.nlm.nih.gov/39058621/ Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study]


[https://pubmed.ncbi.nlm.nih.gov/39976619/ Unintended Consequences: Is Sugammadex Changing the Way We Deliver Anesthesia?]


[https://pubmed.ncbi.nlm.nih.gov/33543867/ A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade]
-----
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.


[https://pubmed.ncbi.nlm.nih.gov/36520073/ 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]
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.


[https://pubmed.ncbi.nlm.nih.gov/26418126/ Intraoperative Electroencephalogram Suppression Predicts Postoperative Delirium]
3. Lerman J: Perioperative management of the paediatric patient with coexisting neuromuscular disease. British journal of anaesthesia 2011, 107 Suppl 1:i79–89.


[https://pubmed.ncbi.nlm.nih.gov/31980926/ Heart rate changes following the administration of sugammadex in children: a prospective, observational study]
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.


[https://journals.lww.com/anesthesia-analgesia/fulltext/2025/05000/rocuronium_sugammadex_versus.1.aspx Rocuronium-Sugammadex Versus Cisatracurium-Neostigmine in Kidney Disease: Making Sense of Surprising Results]
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.


[https://journals.lww.com/anesthesiology/abstract/9900/sugammadex_for_reversal_of_neuromuscular_blockade.682.aspx Sugammadex for reversal of neuromuscular blockade in neonates and infants <2 years old: results from a phase IV randomized clinical trial]
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.


[Grigg E. Sugammadex and neuromuscular reversal: Special focus on neonatal and infant populations. Curr Opin Anaesthesiol. 2020 Jun; 33(3): 374-380. PMID: 32324657
Wachtendorf LJ, Kaiser L, Ahrens E, Tenge T, Riesemann S, Xu X, Shay D, von Wedel D, Paschold BS, Chen G et al: Changes in Intraoperative Rocuronium Dosing after the Introduction of Sugammadex and Association with Postoperative Respiratory Complications: A Retrospective Cohort Study. Anesthesiology 2026, 144(3):597–610.


Gaver RS, Brenn BR, Gartley A, Donahue BS. Retrospective analysis of the safety and efficacy of sugammadex versus neostigmine for the reversal of neuromuscular blockade in children. Anesth Analg. 2019 Oct; 129(4): 1124-1129. PMID: 31584918
3. Brown SES, Cassidy R, Zhao X, Nause-Osthoff R, Wade M, Wagner D, Haydar B, Chimbira W, Kheterpal S, Colquhoun DA: Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study. Anesthesia and analgesia 2025, 140(3):539–549.


Tobias JD. Current evidence for the use of sugammadex in children. Paediatr Anaesth. 2017 Feb; 27(2): 118-125. PMID: 27859917
4. Fuchs-Buder T, Romero CS, Lewald H, Lamperti M, Afshari A, Hristovska AM, Schmartz D, Hinkelbein J, Longrois D, Popp M et al: Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care. European journal of anaesthesiology 2023, 40(2):82–94.


[https://pmc.ncbi.nlm.nih.gov/articles/PMC12227211/ Sugammadex for Reversal of Neuromuscular Blockade in Neonates and Infants Less than 2 Years Old: Results from a Phase IV Randomized Clinical Trial]
5. Thilen SR, Weigel WA, Todd MM, Dutton RP, Lien CA, Grant SA, Szokol JW, Eriksson LI, Yaster M, Grant MD et al: 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. Anesthesiology 2023, 138(1):13–41.

Latest revision as of 14:39, 13 April 2026

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Relevant Article Depot:

NMBA NMBD


Standards/Guidelines

2025 ESAIC and ESPA Guidelines on neuromuscular block in anaesthetised children: Indications, monitoring and reversal

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

Sugammadex for Reversal of Neuromuscular Blockade in Neonates and Infants Less than 2 Years Old: Results from a Phase IV Randomized Clinical Trial

Wachtendorf LJ, Kaiser L, Ahrens E, Tenge T, Riesemann S, Xu X, Shay D, von Wedel D, Paschold BS, Chen G et al: Changes in Intraoperative Rocuronium Dosing after the Introduction of Sugammadex and Association with Postoperative Respiratory Complications: A Retrospective Cohort Study. Anesthesiology 2026, 144(3):597–610.

Brown SES, Cassidy R, Zhao X, Nause-Osthoff R, Wade M, Wagner D, Haydar B, Chimbira W, Kheterpal S, Colquhoun DA: Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study. Anesthesia and analgesia 2025, 140(3):539–549.

Brown SES, Spellman K, Cassidy R, Nause-Osthoff R, Bailey M, Mentz G, Wagner D, Haydar B, Chimbira W, Kheterpal S et al: 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(☆). British journal of anaesthesia 2023, 131(4):e117–e120.

Faulk DJ, Austin TM, Thomas JJ, Strupp K, Macrae AW, Yaster M: A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade. Anesthesia and analgesia 2021, 132(6):1518–1526.

Kotake Y, Ochiai R, Suzuki T, Ogawa S, Takagi S, Ozaki M, Nakatsuka I, Takeda J: Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesthesia and analgesia 2013, 117(2):345–351.

Scheffenbichler FT, Rudolph MI, Friedrich S, Althoff FC, Xu X, Spicer AC, Patrocínio M, Ng PY, Deng H, Anderson TA et al: Effects of high neuromuscular blocking agent dose on post-operative respiratory complications in infants and children. Acta anaesthesiologica Scandinavica 2020, 64(2):156–167.

Salaün JP, Décary E, Veyckemans F: Recurarisation after sugammadex in children: review of case reports and recommendations. British journal of anaesthesia 2024, 132(2):410–414.

Veyckemans F, Debouche S, Kaufmann J, Disma N, Amigoni A, Bonatti G, Christensen MI, Engelhardt T, Fuchs A, Fuchs-Buder T et al: 2025 ESAIC and ESPA Guidelines on neuromuscular block in anaesthetised children: Indications, monitoring and reversal. European journal of anaesthesiology 2026, 43(4):295–323.


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


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.

Wachtendorf LJ, Kaiser L, Ahrens E, Tenge T, Riesemann S, Xu X, Shay D, von Wedel D, Paschold BS, Chen G et al: Changes in Intraoperative Rocuronium Dosing after the Introduction of Sugammadex and Association with Postoperative Respiratory Complications: A Retrospective Cohort Study. Anesthesiology 2026, 144(3):597–610.

3. Brown SES, Cassidy R, Zhao X, Nause-Osthoff R, Wade M, Wagner D, Haydar B, Chimbira W, Kheterpal S, Colquhoun DA: Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study. Anesthesia and analgesia 2025, 140(3):539–549.

4. Fuchs-Buder T, Romero CS, Lewald H, Lamperti M, Afshari A, Hristovska AM, Schmartz D, Hinkelbein J, Longrois D, Popp M et al: Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care. European journal of anaesthesiology 2023, 40(2):82–94.

5. Thilen SR, Weigel WA, Todd MM, Dutton RP, Lien CA, Grant SA, Szokol JW, Eriksson LI, Yaster M, Grant MD et al: 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. Anesthesiology 2023, 138(1):13–41.

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