Side discussion -
16 mg/kg is what the manufacturer says.
But ... I would bet real money that you could reverse an RSI dose of roc in less than a minute with two 200 mg vials.
1.2 mg/kg of roc in an adult is somewhere around 100 mg for non-morbidly-obese people.
How many times have you seen 200 mg of sugammadex completely reverse 50 mg of roc? I see it aaaaaaall the time when supervising. People get real generous with roc, even toward the end of surgeries, now that sugammadex exists. It works and it's fast.
Anyway. I bet two little vials of sugammadex, not eight, would rapidly reverse a 100ish mg RSI dose of roc. Give what you've got. By the time someone fetches more vials from another room I bet you won't need it.
Recently had an LMA on spont vent/sevo go south after a TURBT. Must be said I do keep two capped vials of sug, roc 50mg predrawn and a tube ready at hand for any and all cases involving urologists. This pt had pretty decent hyperkalemia(5.5), so doc didn't want sux anywhere near. Pt had poor dentition, big tongue, huge head, thick neck, but mallampati 2. 125kg, BMI of 40.
1) after induction with my doctor (pt was ASA3,whole host of issues, but no pulmonary ones), became apparent that controlled PP ventilation with the LMA wasn't going to happen. Mask ventilation with bilateral Larson's maneuver, two oropharyngeal airways and the doc on the bag was possible, but difficult.
After two minutes of fiddling with the LMA, though, got the patient to draw breath, used PSV at something like 2cmH2O, which was enough to stay away from hypercarbic country, but not so much that the LMA started leaking. At the start of surgery, got enough drive from the patient to turn off the PS completely, just had 3cmH2O of PEEP.
2) Surgery went well, as did the anesthetic, until the second the urologist decided she was done, and withdrew the scope. Patient at this point was at MAC 0.8,had received 50 mcg of fent a few minutes earlier(total of 150mcg, 65minutes). FiO2 at 0.5.
3) Laryngospasm, oh joy. Remember this pt responding badly to PPvent on the LMA? Sats dropped from 95 to 73 in a short minute. Called for help, pushed roc and intubated, had to bag with 30cmH2O to recruit for a minute.Sats up to 92. When doc arrived,we pushed 400mg sugammadex, back to 100% TOF after a total of 4 minutes since induction dose of roc. Woke the pt, extubated, no issues either at emergence or postop.
Lessons learned: LMAs are evil. Urologists are more often than others just suddenly done. It's better to have an anesthesiologist a max of three minutes away than further.
I believe we'd be fine with just one vial of sugammadex, but erred on the side of caution.
Apologies for a further derailing of this thread.
