neuromuscular junction (NMJ). Meanwhile, non-depolarizing blockers competitively blocks the NMJ without activating the motor end plate. Depolarizing blockers Succinylcholine – This drug has rapid onset of action and fast duration. Its dosages are between 1 and 2 mg/kg body weight with common dosage of 100 mg. The drug can only be kept under room temperature for 14 days. Therefore, for longer shelf life, it has to be kept under temperatures from to . When the intravenous access is not obtainable, the 3 to 4 mg/kg of intramuscular doses can be given (usual dose of 300 mg). However, duration of onset will be delayed to 3 to 4 minutes. Repetitive dosages of succinylcholine are discouraged to prevent vagal stimulation which leads to bradycardia. There are many absolute contraindications to succinylcholine including recent stroke, hyperkalemia, burn patients, immobilized patients (i.e. wheelchair bound). This is due to the upregulation of neuromuscular junctions. Additionally, cautions should be used in patients with reduced serum plasma cholinesterase, as this is how the drug removed from the body. In patients with decreased plasma cholinesterase, the paralysis from succinylcholine can increase significantly in duration. A common side effect of succinylcholine includes myalgias after neuromuscular induced fasciculations upon induction. Non-depolarizing blockers Rocuronium – The dosage of rocuronium is between 0.6 and 1.2 mg/kg. Since rocuronium has longer duration of onset, caution should be taken for those who are difficult to bag-mask ventilate. While rare, anaphylactic reactions have been known to occur with rocuronium. While historically this was not the paralytic of choice in RSI due to the longer duration of action, with the recent approval of Sugammadex as a reversal agent the concern for a long duration of paralysis is reduced. Vecuronium – The dosage of this drug is between 0.08 and 0.1 mg/kg. Vecuronium is only used when there is a shortage of drugs such as succinylcholine and rocuronium. Reversal agents Sugammadex – It is used as a reversal agent for rocuronium and vecuronium. It works by encapsulating the paralytic drug thus preventing it from acting on the binding sites. The dose of 16 mg/kg is used for immediate reversal after administration such as during RSI. Doses of 2 mg/kg and 4 mg/kg are used if the patient has twitches evident on a twitch monitor and terminates the rocuronium action within 3 minutes. The FDA initially did not approve Sugammadex due to concerns over potential allergic reactions, however