Sugammadex Sodium

To facilitate tracheal intubation, mechanical ventilation, and surgical access, NMB agents are frequently used as non-anesthetic adjuncts in surgical procedures. Sugammadex is able to function as a pharmacologic sink of rocuronium and vecuronium, another non-depolarizing neuromuscular blocker, without the cardiovascular adverse effects experienced with reversal agents that directly interact with the cholinergic system. The γ-cyclodextrin has been designed to enhance binding of the guest by incorporating acidic side chains to promote an electrostatic interaction with the positive nitrogen of the blocker. Starting with γ-cyclodextrin, these side chains are readily installed by first halogenating with iodine or bromine to provide a handle for nucleophilic displacement with either 3-mercaptopropio acid methyl ester and cesium carbonate. The latter requires hydrolysis with sodium hydroxide to generate sugammadex sodium.