Degree Name

Master of Science in Nursing (MSN)

Document Type

Major Paper


School of Nursing



Date of Original Version



Postoperative residual muscle paralysis can lead to very serious complications, such as hypoxia, airway obstruction, and generalized muscle weakness after surgical procedures. Traditional anesthesia practice has utilized a class of medications called cholinesterase inhibitors to mitigate these complications. Cholinesterase inhibiting agents have the potential to create adverse effects of their own, such as bradycardia, due to the drug class’s indirect mechanism of action. An ideal reversal agent would reverse quickly, and reliably, with minimal adverse effects. Recently, sugammadex, a selective relaxant- binding agent, has been introduced as an alternative reversal agent. The purpose of this systemic review was to compare the administration of sugammadex versus neostigmine and time to re-establish normal muscular function, as evidenced by a train-of-four (TOF) ratio of 0.9. Databases were searched for pertinent randomized control trials and literature regarding the topic of this review. Inclusion and exclusion criteria were utilized to finalize the five studies that were included in this systematic review. The PRISMA checklist and CASP tool was utilized to extract and critically appraise each study. Additionally, a cross study analysis was performed. Overall, sugammadex was found to be a faster and more reliable reversal agent, with mild-to-moderate adverse effects reported, when compared to the anticholinesterase, neostigmine. Consistently and reliably reversing neuromuscular blocking agents and educating other health care professionals about the negative consequences of postoperative residual muscle paralysis, are initiatives that the advance practice nurse, particularly the CRNA, can lead.

Included in

Nursing Commons