Authors: Morita T et al.
European Journal of Anaesthesiology 42(12):1094–1101, December 2025. DOI: 10.1097/EJA.0000000000002286
Summary
This single-centre observational study from Osaka University Hospital evaluated whether sugammadex dosing could be optimized by calculating the residual amount of rocuronium in each patient using pharmacokinetic simulation. Patients without cardiac, hepatic, renal, or neuromuscular disease underwent elective surgery and received standard rocuronium induction (0.6 mg/kg) with maintenance targeted to an effect-site concentration above 1 μg/ml.
Postoperatively, the investigators estimated the remaining amount of rocuronium in the body and assigned patients to one of four groups: standard sugammadex 2 mg/kg (control) or doses equal to four, six, or eight times the residual rocuronium amount. Sugammadex was given immediately after surgery, and recovery was measured as time from administration to achieving a TOF ratio of 0.9.
Among 123 patients, all were extubated successfully without any evidence of recurarization. Although sugammadex dosing varied substantially across groups, recovery times were similar (approximately 120–160 seconds), and no statistically significant differences were observed. This suggests that even the standard 2 mg/kg dose provides rapid and dependable reversal under these controlled conditions, and that tailoring sugammadex to the calculated rocuronium burden does not produce meaningfully faster recovery.
Overall, pharmacokinetic simulation reliably predicted residual rocuronium, and all sugammadex strategies produced excellent recovery profiles.
Key Points
• Investigators simulated residual rocuronium levels to determine individualized sugammadex dosing.
• All 123 patients were safely extubated with no recurarization.
• Recovery times were rapid and did not differ significantly across dosing strategies.
• Standard 2 mg/kg sugammadex appeared as effective as higher, simulation-based doses.
• Pharmacokinetic modeling may support individualized dosing but did not improve speed of recovery in this study.
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