A 50-year-old patient receives rocuronium 0.6 mg/kg for intubation. At the end of surgery, train-of-four (TOF) ratio is 0.6 at the adductor pollicis. The BEST reversal agent combination is:
- A Neostigmine 2.5 mg + glycopyrrolate 0.5 mg IV
- B Physostigmine 1 mg IV
- C Edrophonium 0.5 mg/kg + atropine IV
- D Sugammadex 2 mg/kg IV ✓
Explanation
Sugammadex is a modified gamma-cyclodextrin that selectively encapsulates rocuronium (and vecuronium) molecules in a 1:1 complex, providing rapid and complete reversal independent of receptor blockade depth. At a TOF ratio of 0.6 (moderate residual block), sugammadex 2 mg/kg is appropriate and reliably restores TOF ratio to ≥0.9 within minutes. Neostigmine at TOF less than 0.9 carries a risk of incomplete reversal and post-operative residual neuromuscular blockade (PORNB). Physostigmine is a centrally acting anticholinesterase not used for reversal of neuromuscular blockade.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.