OBJECTIVES: Sugammadex is registered for decurarization of moderate/deep neuromuscular blockade induced by rocuronium or vecuronium. The advantages compared to the well-known decurarization drugs like neostigmine is that undesirable side-effects (bradycardia-bronchoconstriction-hypersalivation-nausea-vomiting) are avoided and deeper levels of blockade can be reversed. In Belgium its reimbursement is restricted to certain conditions (impossible intubation or rapid decurarization of deep blockade when medically required or rapid decurarizaton moderate blockade in patients with obstructions (stomach/bowel, bile duct, urinary tract) or when administration of neostigmine is contra-indicated). The objective of this study was to evaluate Belgian real-life use of sugammadex one year after reimbursement was granted. METHODS: The medical records of 330 adult patients being treated with sugammadex during the first half year of 2011 (6 hospitals selecting 55 consecutive patients) were retrospectively reviewed. Data collection included baseline patient-characteristics, hospital-, surgery- and sugammadex-related info. In addition, a 2-round expert-panel among 12 physicians was organized. RESULTS: Based on the expert-panel (in combination with published data), it was estimated that in Belgium rocuronium is used in about 58,100 surgical interventions per year. Reversal with sugammadex is performed in 21.5% of them. Mean age of the patients using sugammadex was 54 years (+/- 17 SD), 45% of the patients belonged to ASA (American Society of Anesthesiologists) category I-II (healthy-mild systemic disease), 33% to category>III, 84% had co-morbidities. Sugammadex is mainly used after gastroenterological surgery (53%; high contribution of bariatric-surgery), followed by gynaecological interventions (12%), estimates confirmed by the expert-panel. According to the experts, in 29% of the patients reversal with sugammadex was used outside the reimbursement conditions. CONCLUSIONS: The study confirms that, in Belgium, sugammadex is used when medically needed, a substantial part being used outside the reimbursement conditions.