Impact of Neostigmine and Sugammadex on Time to Leaving the Operating Room in a Community Hospital

  • Julie John Hendrick Medical Center
  • Greg Perry Hendrick Medical Center
  • Jeremie Perry Hendrick Medical Center
  • Viktoria Guttenberg Texas Tech University Health Sciences Center, School of Pharmacy
  • Nicole Asonganyi Texas Tech University Health Sciences Center, School of Pharmacy
  • Sana Laheji Texas Tech University Health Sciences Center, School of Pharmacy
  • Jaffar Raza Texas Tech University Health Sciences Center, School of Pharmacy
  • Ronald G Hall Texas Tech University Health Sciences Center, School of Pharmacy
Keywords: sugammadex, neostigmine, neuromuscular blocker reversal, anesthesia, surgery

Abstract

Purpose: The purpose of this study was to evaluate the impact of sugammadex on operating room (OR) times versus neostigmine in patients recovering from rocuronium or vecuronium induced neuromuscular blockade.

Methods: This retrospective cohort study evaluated patients 18 years or older with an American Society of Anesthesiologists (ASA) physical status of I-III who received sugammadex or neostigmine (January- October 2017) for reversal of rocuronium or vecuronium at a 500 bed, community hospital. Patients who were pregnant or breastfeeding were excluded. The primary outcome measure was the time from sugammadex or neostigmine administration to OR exit. The primary outcome was evaluated using a linear regression model adjusting for inpatient procedures, age, sex, body mass index, and ASA score. Secondary outcomes included the incidence of bradycardia as well as nausea and vomiting.

Results: The baseline characteristics of the patients in the cohort (sugammadex=134, neostigmine=143) were similar. The median time from drug administration to OR exit was similar for neostigmine and sugammadex (16 vs. 15.5 minutes, p=0.11). Sugammadex had a statistically significant reduction in time from drug administration to OR exit (coefficient -2.7 minutes, 95% confidence interval -5.2 to -0.2 minutes) in the multivariable linear regression model. Sugammadex had lower rates of bradycardia (5.6 vs. 2.2%) or nausea and vomiting (18 vs. 11%) that did not reach statistical significance.

Conclusions: Sugammadex had statistically shorter OR exit times after drug administration in the cohort. The mean 2.7 minute benefit is unlikely to be clinically meaningful and limits its application in practice unless larger cohorts detect a benefit due to a significant reduction.in.adverse.events.

 

Original Research

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Dates
Received 2020-06-02
Accepted 2020-07-13
Published 2020-08-12
Section
Practice-Based Research