Korean J Anesthesiol.  2018 Oct;71(5):374-385. 10.4097/kja.d.18.00063.

Initial experience with the unrestricted introduction of sugammadex at a large academic medical center: a retrospective observational study examining postoperative mechanical ventilation and efficiency outcomes

• O'Reilly-Shah VN
• Lynde GC
• Mitchell M
• Maffeo CL
• Jabaley CS
• Wolf FA

• KMID: 2424681
• DOI: http://doi.org/10.4097/kja.d.18.00063

Abstract

BACKGROUND
Sugammadex rapidly reverses deep neuromuscular blockade, but owing to cost, questions remain about its optimal utilization. After the unrestricted introduction of sugammadex at Emory University Hospital, we hypothesized that reductions would be demonstrated in the primary outcome of post-anesthesia care unit (PACU) mechanical ventilation (MV) and secondary outcomes of PACU length of stay (LOS) and emergence time (surgery end to anesthesia end time in the PACU). METHODS: This retrospective observational study included patients undergoing general anesthesia over a 12-month period. Using multiple variable penalized logistic regression in a one-group before-and-after design, we compared the categorized rates of PACU MV to examine the effect of sugammadex introduction following a post-hoc chart review to ascertain the reason for postoperative MV. Additionally, multiple variable linear regression was used to assess for differences in PACU LOS and emergence time within a propensity-matched set of patients receiving neostigmine or sugammadex. RESULTS: In total, 7,217 surgical cases met the inclusion criteria: 3,798 before and 3,419 after sugammadex introduction. The incidence of PACU MV was 2.3% before and 1.8% after (P = 0.118) sugammadex introduction. PACU MV due to residual neuromuscular blockade (rNMB) decreased from 0.63% to 0.20% (P = 0.005). Ventilation because of other causes was unchanged. PACU LOS and emergence time were unchanged in the propensity-matched set of 1,444 patients. CONCLUSIONS: rNMB was an important contributor to PACU MV utilization and its incidence significantly decreased after sugammadex introduction. The selected efficiency measures may not have been sufficiently granular to identify improvements following introduction.

Keyword

Neostigmine; Neuromuscular blockade; Rocuronium; Sugammadex

MeSH Terms

Academic Medical Centers*
Anesthesia
Anesthesia, General
Delayed Emergence from Anesthesia
Humans
Incidence
Length of Stay
Linear Models
Logistic Models
Neostigmine
Neuromuscular Blockade
Observational Study*
Respiration, Artificial*
Retrospective Studies*
Ventilation
Neostigmine