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Neuromuscular Blockade Reversal Pregnancy: B — limited data

Sugammadex

Brand names: Bridion

Adult dose

Dose: 2–16mg/kg IV depending on depth of block
Route: IV bolus
Frequency: Single dose
Routine reversal (T2 reappearance): 2mg/kg. Deep block (1–2 post-tetanic counts): 4mg/kg. Immediate reversal after rocuronium: 16mg/kg. Give as rapid IV bolus.

Paediatric dose

Dose: 2 mg/kg
Route: IV
Frequency: Single dose
Children 2–17 years: same weight-based dosing as adults (2 or 4 mg/kg). Not licensed for infants <2 years.
Paediatric weight-based calculator

Children 2–17 years: same weight-based dosing as adults (2 or 4 mg/kg). Not licensed for infants <2 years.

Clinical pearls

  • Encapsulates rocuronium and vecuronium — does NOT work for other muscle relaxants (suxamethonium, atracurium)
  • Much faster and more reliable than neostigmine — preferred for routine and emergency reversal
  • Hormonal contraceptive warning: advise additional contraception for 7 days post-dose (equivalent to missing one oral pill)
  • Cannot be re-used within 24h — complex persists for extended period
  • Bradycardia reported — have atropine available

Contraindications

  • Hypersensitivity to sugammadex

Side effects

  • Bradycardia
  • Hypersensitivity/anaphylaxis (rare but can be severe)
  • Recurrence of neuromuscular block (rare)

Interactions

  • Toremifene, fusidic acid — may displace rocuronium from sugammadex (reduced reversal efficacy)
  • Hormonal contraceptives — sugammadex may reduce efficacy of OCP (use additional contraception for 7 days)

Monitoring

  • Neuromuscular function (TOF ratio — confirm T4/T1 ≥0.9 before extubation)
  • SpO2 post-reversal
  • HR

Reference: BNFc; AAGBI/RCoA Neuromuscular Block Guidelines; BNF. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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