Rocuronium-induced neuromuscular block of 1.2 mg/kg (RSI dose) can be reversed by sugammadex at a dose of:

• A 2 mg/kg when TOF count ≥2
• B 4 mg/kg when spontaneous recovery to at least TOF count ≥2 reappears
• C 8 mg/kg at any depth of block
• D 16 mg/kg for immediate reversal of RSI dose (profound block — no twitch responses) ✓

Explanation

Sugammadex dosing is depth-dependent: 2 mg/kg when TOF ratio ≥0.2 (mild residual block); 4 mg/kg when TOF count ≥2 (moderate block); 16 mg/kg for immediate reversal of profound block within 3 minutes of RSI dose (no twitch responses on post-tetanic count). The 16 mg/kg dose achieves complete reversal (TOF >0.9) in approximately 1.5–2 minutes of rocuronium 1.2 mg/kg RSI dose, which is critical in the 'cannot intubate, cannot oxygenate' (CICO) scenario as an alternative rescue strategy. This is a key advantage of rocuronium+sugammadex over succinylcholine in anticipated difficult airway situations.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.