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Sugammadex Moderate Block Dose — FRCA Final MCQ

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EasyGeneral AnaesthesiaSugammadex Moderate Block DoseFRCA Final

A 35-year-old man (ASA I, 75 kg) undergoes emergency appendicectomy under GA with rocuronium 50 mg. At the end of surgery (45 minutes), TOF count is 4 with fade present (TOF ratio approximately 0.5). He needs extubation. What is the correct dose of sugammadex?

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Correct answer: C — 16 mg/kg

At a TOF count of 4 with fade (TOF ratio <0.9), this represents moderate neuromuscular block with reappearance of T2 (second twitch visible). The correct sugammadex dose is 2 mg/kg. This will achieve a TOF ratio >0.9 within approximately 2 minutes. The dosing schedule: TOF count ≥2 (moderate block) = 2 mg/kg; PTC 1-2 (deep block) = 4 mg/kg; immediate reversal of RSI dose rocuronium = 16 mg/kg. Quantitative neuromuscular monitoring (TOF ratio measurement, not just TOF count) should confirm TOF ratio ≥0.9 before extubation.

Reference: BNF – 2025 – Sugammadex dosing; RCOA – 2023 – Neuromuscular monitoring