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.

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Authors

Watts RW, London JA, van Wijk RM, Lui YL

Institution

Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, South Australia, Australia. richard.watts@health.sa.gov.au

Source

Anaesthesia and intensive care 40:2 2012 Mar pg 333-9

MeSH

Adult
Aged
Aged, 80 and over
Androstanols
Anesthesia
Cholinesterase Inhibitors
Drug Utilization
Female
Financial Audit
Hospitals, Teaching
Humans
Intubation, Intratracheal
Male
Middle Aged
Muscle Relaxants, Central
Neostigmine
Neuromuscular Blockade
Neuromuscular Depolarizing Agents
Neuromuscular Nondepolarizing Agents
Operating Rooms
Retrospective Studies
Software
Succinylcholine
Treatment Outcome
gamma-Cyclodextrins

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22417030