Neuromuscular Block Reversal — FRCA Final MCQ

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EasyGeneral AnaesthesiaNeuromuscular Block ReversalFRCA Final

A 32-year-old woman (ASA I, 72 kg) undergoes laparoscopic cholecystectomy. Neuromuscular blockade was produced with rocuronium. At the end of surgery, quantitative neuromuscular monitoring shows two responses to train-of-four stimulation. What dose of sugammadex should be administered for routine reversal?

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Reveal the answer and explanation

Correct answer: B — 2 mg/kg

The correct answer is B: 2 mg/kg. Two responses to train-of-four stimulation indicate that T2 has reappeared, representing moderate neuromuscular block. The UK SmPC recommends sugammadex 2 mg/kg for routine reversal of rocuronium- or vecuronium-induced block at this point. In this 72 kg patient, the calculated dose is 144 mg intravenously. A dose of 4 mg/kg is used for deeper block when only 1–2 post-tetanic counts are present and there are no train-of-four responses; post-tetanic count must not be confused with train-of-four count. Sugammadex 16 mg/kg is reserved for immediate reversal shortly after rocuronium 1.2 mg/kg. Doses of 8 and 12 mg/kg are not licensed routine reversal regimens.

Reference: electronic Medicines Compendium. Sugammadex 100 mg/ml solution for injection, Summary of Product Characteristics, section 4.2 Posology and method of administration. 2026. https://www.medicines.org.uk/emc/product/15280/smpc