Sugammadex reverses rocuronium-induced neuromuscular blockade by which unique mechanism?

• A Inhibition of acetylcholinesterase at the neuromuscular junction
• B Competitive displacement of rocuronium from nicotinic acetylcholine receptors
• C Allosteric modulation of nicotinic receptors restoring affinity for acetylcholine
• D Encapsulation of rocuronium molecules within its cyclodextrin core, forming an inactive complex ✓

Explanation

Sugammadex is a modified gamma-cyclodextrin whose hydrophobic cavity selectively encapsulates steroidal neuromuscular blocking agents (especially rocuronium > vecuronium), forming a tight 1:1 inactive complex with extremely high affinity. This sequesters free rocuronium in plasma, creating a concentration gradient that draws rocuronium away from the NMJ. Unlike neostigmine (which inhibits acetylcholinesterase), sugammadex works independently of the cholinergic system and does not require co-administration of an antimuscarinic. It can reverse even deep block (post-tetanic count of 1–2) rapidly with 16 mg/kg.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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