OBJECTIVES: Sugammadex significantly shortens time and variability to recovery from neuromuscular blockade (NMB) compared to neostigmine. Our objective is to explore the potential impact on operating room (OR) efficiency with use of sugammadex versus neostigmine for NMB reversal in Canada. METHODS: A discrete event simulation (DES) model was developed to compare two OR suites, one using neostigmine and the other sugammadex. The same OR parameters, including OR day start and end time, time to start first surgery, and time between surgeries, are shared by the two ORs. The same surgeries are scheduled in the two ORs. In the OR using sugammadex, a reduction in OR time per procedure is applied. Base-case time reductions (17.1 minutes) are derived from a head-to-head randomized controlled trial where tracheal extubation occurs when the patient achieves the recommended recovery of a Train-of-Four (TOF) ratio ≥0.9. In real-life, patients, however, may be extubated irrespective of recovering to a TOF ratio ≥0.9; therefore, exploratory analyses were also conducted with a range of values (0 to 25 minute reductions) for potential time savings with sugammadex. The model can also consider reduction in variability of OR time with sugammadex use. During each run, the model calculates a value for each parameter according to a statistical distribution.  RESULTS: For the base-case analysis, the primary outcome, percentage of days in which all procedures were completed within the scheduled OR day, was higher in the OR using sugammadex (79.8%) compared to the OR using neostigmine (40.7%) [range for sugammadex values was 40.7% to 93.1% in the exploratory analyses]. Base-case total overtime over a one-month period was less with sugammadex use compared to neostigmine use (3.6 and 15.0 hours, respectively). CONCLUSIONS: Even relatively modest reductions in procedure times with use of sugammadex for NMB reversal might lead to meaningful improvement in OR efficiency and reduced overtime.