Sugammadex is used for reversal of the amino steroid neuromuscular blocking drugs rocuronium, vecuronium and pancuronium. It does not work on non-amino steroid neuromuscular blocking drugs (atracurium, cisatracurium and suxamethonium).

Sugammadex can be titrated in theatre with the use of TOF but this post will focus on the emergency reversal in the emergency department.


Immediate reversal of neuromuscular blockade by rocuronium, vecuronium and pancuronium:

  • Undiluted intravenous bolus, 16 mg/kg given within 10 seconds
  • Compatible fluids: Glucose 5%, sodium chloride 0.9%, Hartmann’s, Gelofusin.

Sugammadex dosing per weight

Sugammadex dosing per weight
Sugammadex dosing per weight

Therapeutic endpoints:

  • Onset approximately 1-3 minutes
  • Elderly 65-74 years old: median time to recovery 2.6 minutes
  • Very Elderly >75: median time to recovery 3.6 minutes

Adverse reactions:

  • Hypo/hypertension, tachycardia, hypoxia
  • Hypersensitivity
  • Nausea, vomiting
  • Prolonged QT (rare)
  • Prolonged neuromuscular blockade
  • Metallic, bitter taste

Length of action

Rocuronium will not be effective for:

  • 6 hours post administration in patients with a normal renal function
  • 12 hours CrCl 50-80mL/min
  • 18 hours CrCl 30-50mL/min
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Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.

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