Sugammadex reverses neuromuscular blockade by which mechanism?

• A Encapsulating rocuronium and vecuronium molecules in its hydrophobic core ✓
• B Inhibiting acetylcholinesterase at the neuromuscular junction
• C Competitively displacing rocuronium from nicotinic receptors
• D Chelating calcium ions that are required for NMBA receptor binding

Explanation

Sugammadex is a modified gamma-cyclodextrin that encapsulates steroidal NMBAs — primarily rocuronium and to a lesser degree vecuronium — within its hydrophobic core cavity with extremely high affinity. This removes free NMBA from the plasma, creating a concentration gradient that draws NMBA away from the NMJ back into the bloodstream, where it is further trapped by sugammadex. Unlike neostigmine, sugammadex does not inhibit acetylcholinesterase and therefore does not require concurrent anticholinergic administration. It is effective even at deep levels of blockade and can reverse sugammadex-rocuronium complexes within minutes.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.