Low-dose Sugammadex Reversal

Abstract

THIS issue of ANESTHESIOLOGY contains a clinical study that has important implications regarding how best to manage residual neuromuscular block once the train-of-four (TOF) count at the adductor pollicis muscle has returned spontaneously to four detectable responses, but when tactile or visual fade to TOF stimulation is still present.1 The article makes two important contributions. First, contrary to “common wisdom,” it confirms that neostigmine cannot be relied on to produce prompt and adequate recovery of neuromuscular function, even when administered at a threshold TOF-count of four. Second, it fills an important gap in our knowledge: what is the recommended dosage of sugammadex for reversal of rocuronium at this modest level of neuromuscular block?