The sugammadex doses recommended for reversal of neuromuscular block are based on the train-of-four response to nerve stimulation. However, the efficacy varies with such fixed doses. In a prospective study of 97 surgical patients who received rocuronium for paralysis, 13% had residual neuromuscular block after reversal with the recommended sugammadex doses. This finding reinforces the need to confirm complete reversal of block with neuromuscular monitoring before extubation at the end of surgery.