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Reversal Agent

Sugammadex

γ-cyclodextrin encapsulator · Bridion

Mechanism: Encapsulates rocuronium/vecuronium 1:1, removing them from NMJ.

Calculate dose for your patient

Enter weight (kg or lb). Always verify before administration.

Computed weight
70.0 kg · 154.3 lb
Routine reversal (TOF ≥ 2)
140 mg
= 1.40 mL (100 mg/mL)
Deep reversal (PTC 1–2)
280 mg
= 2.80 mL (100 mg/mL)
Immediate (post-RSI roc)
1120 mg
= 11.20 mL (100 mg/mL)
Wait 24 h before re-dosing rocuronium.

Weight is saved on this device for the next calculator you open.

Full dose calculator
Onset
1–3 min
Duration
Pharmacologic effect ~24 h
Metabolism
Renal excretion (unchanged).

Dosing

Adult
Routine: 2 mg/kg (TOF ≥2). Deep: 4 mg/kg (PTC 1–2). Immediate: 16 mg/kg.
Pediatric
Same dosing as adults.

Indications

  • Reversal of rocuronium/vecuronium NMB

Contraindications

  • Severe renal impairment (CrCl <30 — caution)

Side Effects

  • Bradycardia (rare but possible cardiac arrest reported)
  • Hypersensitivity / anaphylaxis (~0.3%)
  • Reduced efficacy of hormonal contraceptives (counsel × 7 days)

Clinical Pearls

116 mg/kg can rescue 'cannot intubate, cannot ventilate' after high-dose rocuronium RSI.
2Wait 5 min before redosing rocuronium after 2–4 mg/kg; 24 h after 16 mg/kg.

References & Further Reading

  1. 1
    Textbook

    Flood P, Rathmell JP, Shafer S. Stoelting's Pharmacology and Physiology in Anesthetic Practice. 5th ed. Philadelphia: Wolters Kluwer; 2015.

  2. 2
    Textbook

    Gropper MA, Miller RD, Cohen NH, et al., eds. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.

  3. 3
    Textbook

    Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R, Sharar SR, Holt NF. Clinical Anesthesia. 8th ed. Philadelphia: Wolters Kluwer; 2017.

  4. 4
    Textbook

    Adriano A, Morris R, eds. 2021 CA-1 Tutorial Textbook (15th Ed.). Stanford University Medical Center, Department of Anesthesiology.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.