| Type of block | Dose of sugammadex | Time to TOF T4/T1>0.9 |
|---|---|---|
| Moderate (Train-of-four count ≥2) |
2 mg/kg | 2 minutes |
| Deep (Post-tetanic count 1-2) |
4 mg/kg | 3 minutes |
| Immediate reversal of rocuronium-induced blockade | 16 mg/kg | 1.5 minutes |
Re-administration of sugammadex: In the exceptional situation of recurrence of neuromuscular blockade post-operatively after an initial dose of 2 mg/kg or 4 mg/kg sugammadex, a repeat dose of 4 mg/kg sugammadex is recommended. Following a second dose of sugammadex, the patient should be closely monitored to ascertain sustained return of neuromuscular function.
Re-administration of rocuronium or vecuronium after routine reversal (up to 4 mg/kg sugammadex):
| Minimum waiting time | Dose to be administered |
|---|---|
| 5 minutes | Rocuronium 1.2 mg/kg |
| 4 hours | Rocuronium Vecuronium |
The onset of neuromuscular blockade may be prolonged up to approximately 4 minutes, and the duration of neuromuscular blockade may be shortened up to approximately 15 minutes after re-administration of rocuronium 1.2 mg/kg within 30 minutes after sugammadex administration.
The recommended waiting time in patients with mild or moderate renal impairment for re-use of 0.6 mg/kg rocuronium or 0.1 mg/kg vecuronium after routine reversal with sugammadex should be 24 hours.
If a shorter waiting time is required, the rocuronium dose for a new neuromuscular blockade should be 1.2 mg/kg.Re-administration of rocuronium or vecuronium after immediate reversal (16 mg/kg sugammadex):
For the very rare cases where this might be required, a waiting time of 24 hours is suggested.