First-lineBridion
Sugammadex
Cyclodextrin — selective NMB reversal
Rapid reversal of rocuronium and vecuronium — game-changer in obstetric anaesthesia.
IV
First-line for
- Reversal of rocuronium/vecuronium blockade at end of case
- Emergency 'cannot intubate cannot ventilate' after rocuronium RSI
Mechanism
Encapsulates aminosteroid NMBs (rocuronium ≫ vecuronium) in 1:1 complex → excreted renally within minutes.
"Sugammadex saves seconds"
- CICV rescue dose: 16 mg/kg IV
- Reduces COC efficacy — advise back-up 7 days
- Rare bradycardia and anaphylaxis
Dosing
- Routine reversal (T2 present)
- 2 mg/kg IV
- Deep block
- 4 mg/kg IV
- CICV rescue
- 16 mg/kg IV
Contraindications
- CautionSevere renal impairment (CrCl <30)
Side effects
- Bradycardia
- Hypersensitivity/anaphylaxis (higher than atracurium)
- Nausea
Fetal & maternal notes
- • Limited human pregnancy data — used when clinical need outweighs uncertainty
Key interactions
Progestogen contraception (COC, POP, implant)
CautionEffectiveness ↓ — additional contraception 7 days
Clinical pearls
- 💡 Enables rocuronium 1.2 mg/kg RSI as alternative to suxamethonium
- 💡 Document COC counselling in perioperative record
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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