Selective relaxant binding agent
Sugammadex
Bridion NMB reversal — red/white stripes 100 mg/mL
Encapsulates rocuronium (and vecuronium) — reverses any depth with the right dose.
Typical adult doses
| Indication | Dose | Onset | Duration |
|---|---|---|---|
| TOF count ≥ 2 (moderate) | 2 mg/kg IV (actual body weight) | ≈2–3 min | — |
| TOF 0, post-tetanic count 1–2 (deep) | 4 mg/kg IV | — | — |
| Immediate reversal after 1.2 mg/kg rocuronium | 16 mg/kg IV | — | — |
Mechanism
Modified γ-cyclodextrin that encapsulates aminosteroid NMBAs in plasma.
Key effects
- Rapid recovery of neuromuscular function
Watch out for
- Hormonal contraceptives: counts as a missed dose — backup non-hormonal method for 7 days (label). Tell the patient.
- Marked bradycardia (rarely asystole)
- Anaphylaxis
- Transient PT/aPTT prolongation
- No effect on succinylcholine or cisatracurium
Pimp questions
Pimp question
What must you tell a patient on oral contraceptives who got sugammadex?
Answer
Use a backup non-hormonal method for 7 days.