Sugammadex (Bridion)

Rocuronium and Vecuronium - Sugammadex works to reverse aminosteroid non-depolarizing neuromuscular blockade - specifically Rocuronium and Vecuronium. The effectiveness of sugammadex on these drugs is equal. Succinylcholine or benzylisoquinoline neuromuscular blocking drugs - This drug will NOT reverse succinylcholine or benzylisoquinoline NDNMB agents (eg. mivacurium, atracurium, cisatracurium). Rapid NDNMB reversal - Sugammadex will reverse neuromuscular blockade much faster than using neostigmine. In fact, Sugammadex will reverse deep blockade faster than neostigmine can reverse a moderate blockade. Non-reversible - Once Sugammadex has bound to the NDNMB agent, it cannot be reversed. Incompatable Drugs - Ondansetron, ranitidine, and verapamil are all incompatible with Sugammadex. Make sure to keep these drugs separate if administering through the same IV line. Reinitiating Neuromuscular Blockade AFTER Sugammadex - The recommendation is 1.2 mg/kg of Rocuronium 5 minutes after administering a sugammadex reversal. However, receiving a dose of Rocuronium this early will result in a delayed onset and shortened duration. Alternatively, the recommendation is 0.6 mg/kg (or 0.1 mg/kg of Vecuronium) after a minimum waiting period of 4 hours after sugammadex reversal. If a 16mg/kg dose was administered, a minimum wait time of 24 hours is most likely needed. cisatracurium (Nimbex) - Neuromuscular blockade using Nimbex will have a faster onset and deeper level of blockade when administered after a sugammadex reversal. Neostigmine - Sugammadex does NOT inhibit neostigmine. Actual Body Weight - Sugammadex should be dosed by ACTUAL body weight. If dosed according to ideal body weight, the dose will not likely be enough for the obese. Hormonal Contraceptives - Sugammadex may interfere with hormonal contraceptives such as the pill, vaginal ring, implants, and intrauterine devices (IUDs). This is thought to be the equivalent of missing a single oral contraceptive pill. The patient should be counseled to use ADDITIONAL non-hormone contraceptives for 7 days after surgery (eg. condoms).

2 mg/kg - 16 mg/kg ACTUAL body weight. 2mg/kg for moderate blockade (two twitches TOF) 4 mg/kg for deep blockade (1-2 post-tetanic counts after a 5 second 50-hertz tetany) 16 mg/kg for immediate reversal of an intubating dose of rocuronium or vecuronium

Sugammadex is a modified gamma-cyclodextrin that selectively encapsulates rocuronium and vecuronium. This encapsulation prevents binding at the nicotinic acetylcholine receptor, which effectively renders these drugs ineffective.

Renal