BACKGROUND: The dose of Sugammadex for rescue reversal of intense neuromuscular block has not been studied in children. The only recommended dose of Sugammadex in children is 2mg/kg to reverse a shallow block. OBJECTIVES: To assess the efficacy and safety of Sugammadex 2mg/kg and 4mg/kg as immediate rescue reversal of intense rocuronium-induced neuromuscular block in pediatric patients METHODS: 80 children, aged 2 to 11 years old, requiring general anesthesia were enrolled in this randomized prospective study. Group 1 given Sugammadex 2mg/kg (40 subjects) while Group 2 received Sugammadex 4mg/kg (40 subjects), at the end of the procedure if PTC=0. The Recovery Time was recorded (TOF ratio ≥0.9) (Primary Outcome). Discharge readiness in the PACU was assessed using Modified Aldrete Scale (Secondary Outcome). Monitoring of adverse effects in the ward continued until 24 hours postoperatively. RESULTS: There were significantly more patients in the Sugammadex 4mg/kg that had a recovery time of ≤2min as compared to those given Sugammadex 2mg/kg (p=0.012). There was no significant difference in the Aldrete score between the two groups (p=0.2776). All patients achieved a very satisfactory discharge score in the PACU. The adverse effects experienced by the patients in the two doses of Sugammadex in the PACU and up to 24 hours postoperatively were not significantly different. CONCLUSION: Sugammadex 4mg/kg can be considered safe and effective as an immediate reversal agent for rocuronium-induced intense neuromuscular blockade in children. RECOMMENDATIONS Clinicians should identify if Sugammadex 6mg/kg, compared with 4mg/kg, would translate to a shorter Recovery time to a TOF ratio of 0.9. The time from TOF ratio of 0.9 to the time of extubation should be measured to increase the efficacy and safety assessment of Sugammadex in this age group.