It has been proven that at a TOF ratio of 0,9, i.e. when clinical muscle relaxation has nearly disappeared and the patient can be safely extubated, 70-80% of the nicotine receptors are still blocked by the NMBA. An explanation for the possible increase of alertness after reversal with sugammadex could be that sugammadex very efficiently and quickly reverses this rest blockade, resulting in a quick return of alertness and cognitive functions due to an arousal from incoming signals from the γ-motor system. Because sugammadex is inert, it is less likely that an unknown pharmacological effect of sugammadex, a cyclodextrin, is responsible for this supposed effect.