Sugammadex versus neostigmine

Stimulus

A depth-of-block scale is presented, annotated with the three sugammadex doses — 2 mg per kg once the second twitch has reappeared, 4 mg per kg for a deep block (post-tetanic count 1 to 2), and 16 mg per kg for immediate reversal of a 1.2 mg per kg intubating dose — beside a neostigmine dose (given with an antimuscarinic, only once spontaneous recovery is underway) and a comparison of the two agents' properties. Discuss the mechanism of each agent, interpret the depth-based dosing, and contrast the two drugs on applicability, speed, residual blockade and cost.