Rocuronium 1.2 mg/kg is used for rapid sequence induction. Which reversal agent can specifically reverse even this high-dose rocuronium, and at what dose?

• A Neostigmine 5 mg IV
• B Physostigmine 2 mg IV
• C Sugammadex 16 mg/kg IV ✓
• D Sugammadex 4 mg/kg IV

Explanation

Sugammadex is a modified gamma-cyclodextrin that encapsulates aminosteroidal agents (rocuronium > vecuronium). For immediate reversal of high-dose rocuronium (1.2 mg/kg) when given within 3 minutes of administration, sugammadex 16 mg/kg is required. For routine reversal at T2 reappearance on TOF monitoring, 2 mg/kg is used. For deep block (post-tetanic count 1–2), 4 mg/kg is required. Sugammadex does not work for benzylisoquinoliniums (atracurium, cisatracurium) and is the only agent capable of reversing profound rocuronium-induced block reliably.

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

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