Era of Sugammadex: A Paradigm Shift in Airway Management

Sugammadex reverses the effects of steroidal neuromuscular blocking agents rapidly and completely. Unlike neostigmine, its antagonism is long lasting, has no ceiling effect, and minimizes the risk of residual neuromuscular block. These unique pharmacologic properties may influence not only the emergence from anesthesia but also induction and tracheal intubation strategies across perioperative settings, including critical care, emergency medicine, and prehospital resuscitation, especially in the context of difficult airway management. However, the full impact of sugammadex on airway management has been underappreciated. As a reversal agent for difficult airways, it remains underutilized, largely due to limited awareness of its unique properties. This narrative review synthesizes the current literature, highlights practical considerations in daily airway management, and examines the potential paradigm shift introduced by sugammadex while also outlining future directions for research.