The aim of this literature review was to compare the duration of the recovery effects of
sugammadex. We therefore systematically searched Medline for relevant reports that investigated the recovery time to a train-of-four (TOF) ratio of 0.9 after
sugammadex administration. Thirty-three reports were retrieved. For the recommended dose of 2 mg/kg of
sugammadex, some studies noted maximum reversal times to a TOF ratio of 0.9 of up to 12 minutes. One study recorded a maximum delay of 22.3 minutes after the recommended dose of 4 mg/kg of
sugammadex. Regarding the reversal of
rocuronium immediately after its administration, a maximum delay of 16.6 minutes was noted after 16 mg/kg of
sugammadex. Whereas reversal with
sugammadex is likely within 2-3 minutes, unexpectedly long
sugammadex recovery times were occasionally recognized in elderly patients, patients with slower hemodynamic circulation, patients with
pulmonary disease, some obese patients, and some cases of
renal failure. Additionally, variability in the onset of
sugammadex effect was observed in healthier patients (up to 22.3 minutes). This review confirms the known rapid reversal by the recommended doses of
sugammadex. However, due to possibility of an increased recovery time, any patient who receives
sugammadex to reverse neuromuscular block should have his or her TOF checked prior to extubation.