The influence of unrestricted use of sugammadex on clinical anaesthetic practice in a tertiary teaching hospital

• Published in: Anaesthesia and intensive care Vol. 40; no. 2; pp. 333 - 339
• Main Authors: WATTS, R. W, LONDON, J. A, VAN WIJK, R. M. A. W, LUI, Y.-L
• Format: Journal Article
• Language: English
• Published: Edgecliff Anaesthesia Society of Anaesthetists 01.03.2012; Sage Publications Ltd. (UK); Sage Publications Ltd
• Subjects: Adult; Aged; Aged, 80 and over; Androstanols; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics; Biological and medical sciences; Cholinesterase Inhibitors - therapeutic use; Drug Utilization; Female; Financial Audit; gamma-Cyclodextrins - economics; gamma-Cyclodextrins - therapeutic use; Health aspects; Hospitals, Teaching; Humans; Intubation, Intratracheal; Male; Medical sciences; Medicine; Middle Aged; Muscle Relaxants, Central - antagonists & inhibitors; Neostigmine - therapeutic use; Neuromuscular Blockade - methods; Neuromuscular blocking agents; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Operating Rooms - organization & administration; Practice; Retrospective Studies; Rocuronium; Services; Software; Succinylcholine; Sugammadex; Treatment Outcome; Australia; Teaching hospital; rocuronium use; hospital stay; theatre time; unrestricted use; Anesthesia; Sugammadex
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057X1204000218

This retrospective casenote audit involving 374 patients requiring intubation for an anaesthetic found that when the availability of sugammadex became unrestricted, its use increased from 7.1 to 65.3% (P <0.0001) of all muscle relaxant reversals, while neostigmine use decreased from 59.6 to 12.5%. Rocuronium use decreased slightly (90.8 to 79.2%, P=0.006) but vecuronium use increased (2.1 to 8.3%, P=0.02). Cisatracurium and suxamethonium use were unchanged. Total rocuronium dose (55.9 ± 24.1 vs 60.4 ± 22.3 mg) and the number of doses (1.9 ± 1.48 to 1.96 ± 1.27) were unchanged, but the time between the last dose and reversal decreased (91.7 ± 68.1 to 62 ± 52.4 minutes, P=0.0002). There appeared to be no change in postoperative nausea and vomiting, or post-anaesthesia care unit time or oxygen saturation levels. Anaesthetic theatre time fell from 143.5 ± 85.8 to 120 ± 71.2 minutes (P=0.01) and remained significant when adjusted for confounding variables (ratio of means 1.17, 95% confidence interval 1.03 to 1.34, P=0.02), although inferences in relation to causality are limited by the retrospective and observational design of the study. Hospital stay also appeared to fall (4.2 ± 3.5 to 3.4 ± 3.0 days, P=0.035), but was not statistically significant when adjusted for confounding variables (ratio of means 1.04, 95% confidence interval 0.89 to 1.2, P=0.59). These observations suggest that the unrestricted availability of sugammadex will change how steroid-based neuromuscular blocking drugs are used and reversed, but further research is needed to determine if patient outcomes will improve.