The dose of sugammadex recommended by the manufacturer for reversal of rocuronium is 2 mg/kg when the train-of-four count is 2 or more, and 4 mg/kg when it is less than 2 but there is a posttetanic count of at least 1. In this issue of Anesthesiology, Bowdle et al. titrate sugammadex after cardiac surgery with the hypothesis that many patients would require less than the recommended dose of sugammadex, some patients would require more, and recurrent paralysis would not occur. In an accompanying editorial, Todd and Kopman review previous guidelines on the monitoring of neuromuscular blockade and how new observations affect patient care. Cover illustration: A. Johnson, Vivo Visuals Studio.

  • Bowdle et al.: A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis, p. 6

  • Todd and Kopman: Sugammadex Is Not a Silver Bullet: Caveats Regarding Unmonitored Reversal, p. 1