Sugammadex Use in Pregnant Patients

Pharmacological Considerations

Sugammadex is a large, highly polar molecule, which theoretically limits placental transfer to the fetus, according to the Association of Anaesthetists 1
When used for reversal of neuromuscular blockade, sugammadex (16 mg/kg) can fully reverse rocuronium within 3 minutes compared with 9 minutes for spontaneous offset of suxamethonium 2, 3
High-dose rocuronium (1.0-1.2 mg/kg) with sugammadex backup is a suitable alternative to suxamethonium for rapid sequence induction in obstetric anesthesia, as recommended by the American Society of Anesthesiologists 2, 3, 4
The dose of sugammadex should be pre-calculated and immediately available for an assistant to draw up and administer, as suggested by the American Society of Anesthesiologists 2

The Association of Anaesthetists guideline states that sugammadex is acceptable to use during breastfeeding, as it is a large, highly polar molecule with likely very low levels in milk and unlikely oral absorption by the infant 1

For emergency situations like failed intubation in obstetric anesthesia, the benefits of sugammadex may outweigh theoretical risks, according to the American College of Obstetricians and Gynecologists 2, 5