الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The use of muscle relaxant is not only revolutionized the
practice of anesthesia but also started the modem era of surgery
and made possible the explosive development of cardiothoracic,
neurologic and organ transplantation.
Currently, only succinylcholine, a depolarizing short acting
muscle relaxant with a high degree of side effects, allows
anesthetists to quickly control the airway and intubate the trachea
without the risk of extended paralysis should ventilation or
intubation become difficult.
The duration of action of all currently available
nondepolarizing muscle relaxants is too long if an
anesthesiologist is faced with a short case or an unexpected
cannot intubate, cannot ventilate scenario.
The inability of cholinesterase inhibitors to reverse a profound
nondepolarizing blockade may be one important reason for the
unrelenting persistence of succinylcholine in current anesthetic
practice, in particular for its two principal indications, relaxation
for rapid sequence induction and ultra short procedures.
Rocuronium, a non-depolarizing NMBA, at doses of 1.2
mglkg and higher allows quick onset and rapid sequence
intubation ability with minimal side effects, the reluctance to use
rocuronium is due to its extended duration of neuromuscular
blockade.
An ideal reversal agent should, among other things, facilitate
rapid and complete reversal of any level of neuromuscular
blockade (NMB), even profound blockade, at any time, and
should be devoid of muscarinic effects.
To fulfill these criteria, a new concept for the reversal ofNMB
has been developed, sugammadex, a water-soluble, modified
cyclodextrin, was selected for clinical development it rapidly
reverses rocuronium- induced NMB by encapsulating the
unbound rocuronium molecules, thereby enhancing the transfer
of rocuronium from the effect compartment.
Sugammadex is expected to provide the ability to rapidly
terminate rocuronium-induced paralysis , and restore motor
function and spontaneous ventilation should intubation fail.
Sugammadex termination of rocuronium’s effects is faster than
succinylcholine degradation by plasma enzymes (at the
appropriate dose) and may provide another option for rapid
sequence intubations.