Is there still a place for fast-acting neuromuscular blockade agents: fast onset or safe and prompt reversal?

Purpose of reviewThis review is timely as it addresses the ongoing challenge of developing an ideal short-acting, nondepolarizing muscle relaxant. It emphasizes the need for agents that combine a rapid onset, brief duration of action, and a favorable safety profile-paralleling succinylcholine's speed while reducing adverse effects.Recent findingsRecent investigations have identified promising compounds such as gantacurium and its analogs (CW002 and CW001), which enable rapid reversal of neuromuscular blockade via L-cysteine-mediated chemical antagonism. In addition, novel encapsulation agents such as sugammadex and calabadions have emerged, offering dose-dependent and effective recovery of neuromuscular transmission even at deeper levels of blockade, with minimal hemodynamic impact.SummaryThe emerging data suggest that these novel agents could significantly enhance clinical outcomes by improving the precision and safety of neuromuscular blockade management during surgery. Further research is warranted to optimize dosing protocols and verify long-term safety, potentially leading to refined anesthetic practices and better postoperative recovery.