Real-world Experience With Neuromuscular Blockade Reversal

Neuromuscular blocking agents (NMBAs) are used in many surgical procedures and have enabled new surgical advances. The expanded landscape of NMB reversal drugs allows for fast and complete neuromuscular blockade (NMB) reversal and the reduction of postoperative complications from residual block. In the United States, neostigmine/ glycopyrrolate and sugammadex are the primary agents for pharmacologic antagonism of NMBAs. While neostigmine and an anticholinergic have been available for decades, sugammadex has only recently become available. We present real-world cases in a variety of surgeries and clinical settings in which the use of NMB reversal agents played a significant role in the patients' clinical outcome.


This activity has been designed to meet the educational needs of anesthesiologists and anesthesia providers.


Upon completion of this activity, participants will be better able to do the following:

  1. Analyze clinical scenarios in which rapid NMB reversal contributes to patient safety
  2. Review efficacy, safety, and appropriate use of NMB reversal agents


Scott B. Groudine, MD
Professor of Anesthesiology and Surgery
Albany Medical Center
Albany, New York

Harold S. Minkowitz, MD
Clinical Investigation
HD Research Corp
Staff Anesthesiologist
Memorial Hermann Memorial City Medical Center
Houston, Texas


Danny L. Valentine, MD
American Board of Anesthesiology
Anesthesia Service Medical Group, Inc (ASMG)
San Diego, California
Scripps Green Hospital
La Jolla, California

Disclosure of Conflicts of Interest

It is the policy of the Elsevier Office of Continuing Medical Education that all faculty, instructors, and planners disclose any real or apparent conflicts of interest relating to the topics of this educational activity. 

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or PresenterRelationship Identified With:

Scott B. Groudine, MD

Consultant/Advisor: Merck & Co, Inc.

Grant/Research Support: Merck & Co, Inc.

Speakers’ Bureau: Mallinckrodt, Merck & Co, Inc., and Grifols Inc.

Harold S. Minkowitz, MD

Consultant/Advisor: AcelRx Pharmaceuticals, Inc and Heron Therapeutics, Inc

Grant/Research Support: AcelRx Pharmaceuticals, Inc, Heron Therapeutics, Inc , and Pacira Pharmaceuticals

Speakers’ Bureau: Mallinckrodt, Merck & Co, Inc., and Pacira Pharmaceuticals

Danny L. Valentine, MD

Declare that I or my spouse/partner does not have a financial relationship with any commercial interest within the last 12 months.

Non-faculty: Lyerka Miller, PhD; Sandy Breslow; Alison Kemp; and Bernard M. Abrams, MD, hereby state that neither they nor their spouse/life partner have any financial relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

Peer Review

This CME activity has been peer-reviewed by the Journal of Clinical Anesthesia.

Financial Support

This activity has been supported by an independent educational grant from Merck & Co, Inc.

Provider Information

Jointly provided by the Elsevier Office of Continuing Medical Education and Miller Medical Communications, LLC.

CME Credit (Physicians)

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Elsevier Office of Continuing Medical Education and Miller Medical Communications, LLC. The Elsevier Office of Continuing Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

The Elsevier Office of Continuing Medical Education designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


For all CME inquiries or special needs, please contact

Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The Elsevier Office of Continuing Medical Education, Miller Medical Communications, LLC., and Merck & Co, Inc.,  do not recommend the use of any agent outside of the labeled indications.

Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit(s)™
  • 1.00 Non-physician
Course opens: 
Course expires: 

Available Credit

  • 1.00 AMA PRA Category 1 Credit(s)™
  • 1.00 Non-physician
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