Trends in the use of Sugammadex for the Reversal of Neuromuscular Blockade in a Tertiary Care Academic Center

Abstract

Introduction: Neuromuscular blockade plays an integral role in anesthesia and surgery. However, residual paralysis has been associated with postoperative respiratory complications and increased airway collapsibility. Sugammadex, is a modified gamma-cyclodextrin used for the reversal of rocuronium and vecuronium. The aim of this retrospective descriptive study was to summarize the use of Sugammadex after non-cardiac surgery and identify factors that may be associated with any Sugammadex use.

Methods: 133,121 adult non cardiac surgeries were evaluated retrospectively, of these, 61,936 met inclusion criteria. Four descriptive aims were explored; dose of Sugammadex used, situational use of Sugammadex, Sugammadex use given type of steroidal muscle relaxant administered and class of muscle relaxant used before vs. after introduction of Sugammadex. 31 selected factors were used in a multivariable logistic regression model to find association with Sugammadex use.

Results: Of the 2,475 surgeries where Sugammadex was utilized, it was used as a primary reversal agent in 2,248 (90.8%) cases and as a secondary reversal after routine reversal with neostigmine in 225(9.1%) cases. The use of Sugammadex as a rescue reversal is limited to 3 cases (0.12%). Of 31 a priori selected factors believed to be potential influences in the decision to use Sugammadex, 12 were found to be associated.

Conclusions: Neostimine still remains the most commonly used reversal agent. Sugammadex is mostly being used as a primary reversal agent and its use is rising dramatically. The use of Sugammadex as a rescue agent in a cannot intubate/cannot ventilate event is exceedingly rare.