Anaes · Neuromuscular blockade & reversal

Sugammadex reversal and residual neuromuscular blockade

Also known as Modified gamma-cyclodextrin · Selective relaxant binding agent · Encapsulation reversal of rocuronium/vecuronium · Sugammadex depth-based dosing

Sugammadex is a modified gamma-cyclodextrin — a selective relaxant binding agent — that reverses rocuronium and vecuronium by ENCAPSULATION: it forms a complex with the blocker in plasma, lowering the free plasma concentration so the blocker diffuses off the nicotinic receptor and transmission is restored, acting in plasma rather than at the receptor or at acetylcholinesterase (Rex 2010; Kronauer 2026). It reverses block at any depth, with depth-based dosing — 2 mg per kg once the second twitch (T2) has reappeared, 4 mg per kg for deep block at 1 to 2 post-tetanic counts, and 16 mg per kg for immediate reversal (about 3 minutes) of a 1.2 mg per kg rocuronium intubating dose (Hristovska 2017; Chambers 2010). It needs no anticholinergic — it does not raise acetylcholine — and it is excreted unchanged in the urine, so it is not recommended in severe renal impairment (Panhuizen 2015; Elkhateb 2025). It reduces signs of residual blockade versus neostigmine (Hristovska 2017) with a small pulmonary-complication reduction in the SNaPP trial (Leslie 2026). The principal hazards are anaphylaxis, sometimes severe (Lee 2026), recurarisation after apparent reversal (Felix 2026), delayed airway oedema (Habib 2026), marked bradycardia around administration, and reduced hormonal-contraceptive efficacy requiring additional non-hormonal contraception for a week after the dose (Devoy 2023).

Checked against its sources on 14 Oct 2026