Sahar Shekoohi

Neuromuscular blockade reversal is essential in perioperative care of pediatric patients undergoing general anesthesia, as delayed recovery may generate a plethora of complications. Traditional reversal agents like neostigmine, an acetylcholinesterase inhibitor, are widely used but have variable efficacies, adverse side effects, and the need for additional sugammadex, a novel selective relaxant binding agent with a rapid and predictable pharmacologic profile, is effective in adults and has growing interest in pediatric populations. This narrative review summarizes findings from clinical trials evaluating sugammadex safety, such as the incidence of bradycardia, hypotension, anaphylaxis, and efficacy, such as time to recovery and need for reintubation, in comparison to standard reversal agents. Available data suggest that sugammadex provides faster and more predictable reversible patterns with a more favorable safety profile. However, there are limitations in study design and dosing strategies, which demonstrate the need for additional data to compare clinical findings. Overall, sugammadex provides a promising alternative to current therapies with vast implications for clinical anesthesia practice in pediatrics. Further studies are needed to investigate optimal practices in dosing, safety, and cost-effectiveness in pediatric subgroups.