• How Much Paralysis?
  • Indiscriminate use of large doses of rocuronium (and vecuronium) would mandate large doses of sugammadex, which would be expensive.
  • If second surgery is required within minutes or hours of sugammadex, the need to produce paralysis may be impaired.
• Reparalysis
  • Possible if less than adequate doses of sugammadex are administered initially, allowing redistribution of rocuronium to cause reparalysis
• Moderate to Profound Blockade
  • When two twitches are present, sugammadex 2 mg/kg restores neuromuscular function to a TOF ratio of 0.9 within 2–4 minutes.
• Shallow to Moderate Blockade
  • Currently unclear how effective a smaller dose (<2 mg/kg) of sugammadex may be
• Rapid Sequence Induction
  • Rocuronium may replace SCh for rapid sequence induction with sugammadex as a backup

SCh = succinylcholine; TOF = train-of-four.