Sugammadex Is Faster Than Neostigmine for Reversing Profound Rocuronium Block

Sugammadex, a novel agent that binds to steroid-based neuromuscular blocking agents (e.g., rocuronium, vecuronium), has been shown to promptly reverse rocuronium-induced neuromuscular blockade (JW Emerg Med Aug 8 2008). In a multicenter randomized study, researchers compared the safety and efficacy of sugammadex (4 mg/kg) and the standard, neostigmine (70 µg/kg) plus glycopyrrolate (14 µg/kg), for reversal of profound rocuronium-induced blockade in 88 patients who were undergoing general anesthesia for elective surgery. Generally, neostigmine is used only when significant partial motor recovery has occurred and not for reversal of profound neuromuscular block.

Profound block was induced with rocuronium (0.6 mg/kg) and maintained (0.15 mg/kg)…