Rocuronium reusable after sugammadex

Sugammadex currently has no role in my own emergency / critical care practice. However a helpful paper informs us that patients whose rocuronium-induced neuromuscular blockade had been reversed by sugammadex may be effectively re-paralysed by a second high dose (1.2 mg/kg) of rocuronium. Onset was slower and duration shorter if the second dose of rocuronium was given within 25 minutes of the sugammadex.

The study was done with sixteen volunteers and the initial dose of roc was only 0.6 mg/kg – less than that used for rapid sequence intubation by many emergency & critical care docs.
When repeat dose roc was given five minutes after sugammadex (n=6), mean (SD) onset time maximal block was 3.06 (0.97) min; range, 1.92–4.72 min. For repeat dose time points ≥25 min after sugammadex (n=5), mean onset was faster (1.73 min) than for repeat doses <25 min (3.09 min) after sugammadex. The duration of block ranged from 17.7 min (rocuronium 5 min after sugammadex) to 46 min (repeat dose at 45 min) with mean durations of 24.8 min for repeat dosing <25 min vs 38.2 min for repeat doses ≥25 min.
Repeat dosing of rocuronium 1.2 mg kg−1 after reversal of neuromuscular block by sugammadex 4.0 mg kg−1 in anaesthetized healthy volunteers: a modelling-based pilot study
Br J Anaesth. 2010 Oct;105(4):487-92

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