title: The influence of unrestricted use of sugammadex on clinical anaesthetic practice in a tertiary teaching hospital.
abstract: 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.
authors.affiliation: Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, South Australia, Australia. richard.watts@health.sa.gov.au
authors.forename: R W
authors.initials: RW
authors.lastname: Watts
authors.forename: J A
authors.initials: JA
authors.lastname: London
authors.forename: R M A W
authors.initials: RM
authors.lastname: van Wijk
authors.forename: Y-L
authors.initials: YL
authors.lastname: Lui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000732:Androstanols; D000758:Anesthesia; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D004363:Drug Utilization; D005260:Female; D005375:Financial Audit; D006784:Hospitals, Teaching; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000037:antagonists & inhibitors*; D009388:Neostigmine / Q000627:therapeutic use; D019148:Neuromuscular Blockade / Q000379:methods*; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D009873:Operating Rooms / Q000458:organization & administration; D012189:Retrospective Studies; D000077123:Rocuronium; D012984:Software; D013390:Succinylcholine; D000077122:Sugammadex; D016896:Treatment Outcome; D047408:gamma-Cyclodextrins / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000732:Androstanols; D002800:Cholinesterase Inhibitors; D009125:Muscle Relaxants, Central; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D009388:Neostigmine; D013390:Succinylcholine; D000077123:Rocuronium