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.

• Type of Material: Article
• Authors: Vikas O'Reilly-Shah, Emory University; Grant Lynde, Emory University; Matthew L. Mitchell, Emory University; Carla L. Maffeo, Emory University; Francis A. Wolf, Emory University; Craig S. Jabaley, Emory University
• Language: English
• Date: 2018-10
• Publisher: Korean Society of Anesthesiologists
• Publication Version: Final Published Version
• Copyright Statement: © The Korean Society of Anesthesiologists, 2018
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4097/kja.d.18.00063
• Title of Journal or Parent Work: Korean Journal of Anesthesiology
• ISSN: 2005-6419
• Volume: 71
• Issue: 5
• Start Page: 374
• End Page: 385
• Grant/Funding Information: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.; This work was supported by the Emory University Department of Anesthesiology.
• Keywords: Neostigmine; Neuromuscular blockade; Rocuronium; Sugammadex
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

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.