Sugammadex reverses rocuronium blockade by encapsulation. When administered after rocuronium for a 'cannot intubate, cannot oxygenate' scenario with a dose of 16 mg/kg, the minimum time before rocuronium can be safely re-administered to re-paralise the patient is approximately:

• A 5–10 minutes once the patient is awake
• B 5 minutes with a double dose of rocuronium (2.4 mg/kg)
• C At least 24 hours to allow sugammadex-rocuronium complex excretion ✓
• D No waiting required; sugammadex does not affect free rocuronium binding

Explanation

After a 16 mg/kg sugammadex dose (rescue dose), circulating sugammadex-rocuronium complex is excreted renally over several hours, but residual sugammadex in the circulation will bind any newly administered rocuronium. Guidelines recommend waiting at least 24 hours before re-administering rocuronium because the plasma pool of free sugammadex available to complex new rocuronium is unpredictable. If neuromuscular blockade is urgently required within this window, succinylcholine 1.2 mg/kg is the alternative, as its action is not affected by sugammadex.

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

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Written and medically reviewed by the StethoPrep medical team.