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2020-08-12
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Copyright (c) 2020 Julie John, Greg Perry, Jeremie Perry, Viktoria Guttenberg, Nicole Asonganyi, Sana Laheji, Jaffar Raza, Ronald G Hall
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of content published in INNOVATIONS in pharmacy belongs to the author(s).
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
DOI: https://doi.org/10.24926/iip.v11i3.3329
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
