This multicenter retrospective cohort study evaluated the proportion of ED patients with TBI or spontaneous intracranial hemorrhage (sICH) who had a positive neurologic response (GCS increase ≥1 point within 30 min) after sugammadex reversed rocuronium-induced neuromuscular blockade, across 11 US EDs (Dec 2015–Jun 2024).
54% of 362 patients (n=196) had a GCS increase within 30 min, with a median GCS change of 3 (IQR 2–4). Responders were significantly more likely to require a new analgesic (30.6% vs. 13.9%, difference +16.8%, 95% CI 8.4–25.1) or sedation agent (33.7% vs. 14.5%, difference +19.2%, 95% CI 10.7–27.7); the increase in neurosurgical procedures (43.4% vs. 33.7%) was not statistically significant.
Retrospective design limits causal inference. No control group without sugammadex, so GCS changes may partly reflect natural NMB offset rather than true neurologic recovery. Study does not report longer-term functional outcomes.
When sugammadex is given to reverse rocuronium in TBI or sICH patients in the ED, expect roughly half to show a meaningful GCS improvement—and be prepared to promptly escalate analgosedation in those responders. Closely monitor for increased sedation and analgesia needs within the first 30 minutes post-reversal.
