About This Calculator

The Sugammadex Dose Calculator is a clinical support tool designed to help healthcare professionals determine the appropriate dose of sugammadex for the reversal of neuromuscular blockade (NMB) induced by rocuronium or vecuronium. It calculates the total dose in milligrams and the corresponding volume to administer based on patient weight and the clinical scenario.

Outputs Explained

After entering the required patient data, the calculator provides two primary outputs for safe and effective administration:

• Total Sugammadex Dose (mg): This is the total mass of the drug required, calculated as the patient’s actual body weight in kilograms multiplied by the selected dosing rate (2, 4, or 16 mg/kg).
• Volume to Administer (mL): This is the volume of the drug solution to be drawn into a syringe for administration. It is based on the standard sugammadex concentration of 100 mg/mL.

How to Use the Tool

To ensure an accurate dose calculation, follow these steps:

1. Enter Patient’s Actual Body Weight (ABW): Input the patient’s weight. You can use either kilograms (kg) or pounds (lbs); the tool will automatically convert lbs to kg. Per prescribing information, ABW should be used for all patients, including those with obesity.
2. Select the Indication for Reversal: Choose one of the three clinical scenarios that best matches the patient’s level of neuromuscular blockade, which determines the dosing rate:
   • Moderate Blockade (2 mg/kg): For routine reversal when there is a reappearance of the second twitch in the Train-of-Four (T2).
   • Deep Blockade (4 mg/kg): For routine reversal when there are 1-2 post-tetanic counts (PTCs) but no response to TOF stimulation.
   • Immediate Reversal (16 mg/kg): Reserved for urgent situations (e.g., “can’t intubate, can’t ventilate”) shortly after administering rocuronium 1.2 mg/kg.
3. Calculate and Verify: Click the “Calculate” button. Review the results, including the on-screen note about vial selection. Always verify the calculation against institutional protocols and official prescribing information before administration.

Dosing Overview

Sugammadex dosing is straightforward but requires careful attention to patient weight and the depth of blockade. The dose is always based on Actual Body Weight (ABW). The recommended dose is administered as a single intravenous bolus injection over 10 seconds.

• Routine Reversal (Moderate Block): 2 mg/kg
• Routine Reversal (Deep Block): 4 mg/kg
• Immediate Reversal of Rocuronium: 16 mg/kg

Re-administration of Neuromuscular Blocking Agents

After reversal with sugammadex, if there is a clinical need to re-establish neuromuscular blockade, waiting times are required. The waiting time and the dose of the NMB agent depend on the initial sugammadex dose and the patient’s renal function. Consult the official prescribing information for specific guidance on re-dosing rocuronium or vecuronium after sugammadex administration.

Managing Underdosing or Recurrence of Blockade

Administering an insufficient dose of sugammadex can lead to incomplete reversal or recurrence of neuromuscular blockade. Patients should be carefully monitored for signs of returning muscle weakness. If recurrence is observed, the patient may require mechanical ventilation and administration of an additional dose of sugammadex, as clinically indicated.

Safety Alerts

Clinicians using sugammadex must be aware of several key safety considerations:

• Anaphylaxis: Potentially life-threatening hypersensitivity reactions can occur. Patients should be monitored closely, and appropriate medical support must be immediately available.
• Marked Bradycardia: Cases of profound bradycardia, sometimes leading to cardiac arrest, have been reported within minutes of administration. Continuous hemodynamic monitoring is essential during and after administration.
• Hormonal Contraceptives: Sugammadex may temporarily reduce the efficacy of hormonal contraceptives. Female patients of reproductive potential should be advised to use an alternative, non-hormonal contraceptive method for 7 days.
• Severe Renal Impairment: Sugammadex is not recommended for use in patients with a creatinine clearance (CrCl) of less than 30 mL/min due to delayed clearance of the sugammadex-rocuronium complex.

Frequently Asked Questions

References

• BRIDION® (sugammadex) Injection – Official FDA Prescribing Information. U.S. Food and Drug Administration.
• Bridion® (sugammadex) Official HCP Site. Merck & Co., Inc.
• Nag, K., et al. (2022). Sugammadex. In: StatPearls [Internet]. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559092/
• Hristovska, A. M., et al. (2018). The optimal dose of sugammadex for reversal of shallow neuromuscular block with rocuronium. Anesthesia and analgesia, 126(1), 127-134. PMID: 28682914.