A single center analysis of sugammadex and neostigmine/glycopyrrolate utilization for post-operative neuromuscular blockade reversal

Elsevier

Available online 16 July 2022

Trends in Anaesthesia and Critical CareHighlights•

First neuromuscular blocking agent reversal dose to recovery room time was similar.

No differences in reintubation rates were identified.

While sugammadex had a statistically significant higher total drug cost compared to neostigmine/glycopyrrolate, the total cost was not statistically different between groups.

Further research is needed to assess these safety and economic implications.

AbstractBackground

Previous cost-effective analyses and studies analyzing post-anesthesia care unit length of stay between sugammadex and neostigmine/glycopyrrolate for neuromuscular blockade reversal revealed mixed results. Baseline characteristics between adult surgical patients receiving these agents were controlled and matched in this study to describe these differences in cost and first neuromuscular blocking agent reversal dose to recovery room time.

Aim

To evaluate the differences in the time from the first neuromuscular blocking agent (NMBA) reversal dose to recovery room arrival between sugammadex and neostigmine/glycopyrrolate.

Methods

In this retrospective matched cohort study, 142 adult surgical patients who received sugammadex were matched to 142 neostigmine/glycopyrrolate adult surgical patients that received at least one dose of rocuronium or vecuronium. The primary outcome was the time from the first NMBA reversal dose to recovery room arrival. Secondary outcomes included: differences in the time from the recovery room to the floor, evaluation of the total cost, and total drug cost.

Results

The time from first NMBA reversal dose to recovery room arrival was similar between groups (neostigmine/glycopyrrolate 19.5 minutes (14–31 minutes) versus sugammadex 19.0 minutes (13.8–24.3 minutes); p = 0.165). The medium time from the recovery room to the floor is 91.0 and 94.5 minutes in the sugammadex and neostigmine/glycopyrrolate groups, respectively (p = 0.302). The incidence of reintubation was not statistically different (p = 1.00). The total drug cost was higher in the sugammadex group versus the neostigmine/glycopyrrolate group, $97.00 USD (97–114.48) versus $8.99 USD (6.23–11.52), respectively (p < 0.05). However, the medium total cost was $985.32 USD for neostigmine/glycopyrrolate whereas it was $1047.00 USD for sugammadex.

Conclusion

The time from the first NMBA reversal dose to recovery room and time from recovery room to the floor were comparable between sugammadex and neostigmine/glycopyrrolate. There were no differences in reintubation rates. While the difference in total drug cost was statistically significant between the two groups, the total cost was not. Further analysis is needed to assess these safety and economic implications of these findings.

Keywords

Sugammadex

Neostigmine

Neuromuscular blockade

View full text

© 2022 Published by Elsevier Ltd.

留言 (0)

沒有登入
gif