Sugammadex administration shortens reversal times but not operating room turnover times

Abstract

Objective: Current literature debates whether administration of sugammadex translates into a higher operating room (OR) efficiency when compared to neostigmine. This study is a blinded assessment of the effects of sugammadex versus neostigmine on OR efficiency as determined by time of reversal to time of the next case.Methods: 50 patients undergoing abdominal surgery were randomized and evenly distributed into two groups, one receiving sugammadex (4 mg/kg) and the other, neostigmine (0.06 mg/kg) plus glycopyrrolate (0.004 mg/kg). Muscle paralysis was induced with intravenous rocuronium (0.6 mg/kg). Train of four (TOF) was monitored using acceleromyography every 10 minutes until reversal. Reversal agents were blindly prepared and administered during closing. TOF was then recorded every minute until a T4/T1 ratio ≥ 0.9 was achieved. This was designated as time of complete reversal. Subsequently, post-reversal outcome measures were collected.Results: Patients receiving sugammadex experienced a significantly shorter reversal time compared to those receiving neostigmine and glycopyrrolate (2.92 ± 1.71 minutes vs. 7.68 ± 5.63 minutes; p = .0002). No other outcome measures were significantly different between groups: time of OR ready for next case was 55.4 min vs. 56.1 min respectively; not significant.Conclusions: While sugammadex was significantly faster at reversing patient neuromuscular blockade the time from reversal to patient extubation after Sugammadex was prolonged. . This could be due to blinding, as blinded providers are unable to anticipate time of reversal and must compensate by making decisions at safe fixed intervals. This is reflected in that the time gained by administration of sugammadex is approximately equal to the delay experienced across all endpoints collected to the patients’ actual discharge.

Sugammadex Reduces PACU Recovery Time after Abdominal Surgery Compared with Neostigmine

“…4,[8][9][10] We have previously demonstrated, however, that when providers are blinded to the reversal agent, the use of sugammadex or neostigmine results in a similar OR turnover time and comparable discharge readiness from the PACU. 11 Similarly, Chae et al 12 measured nearly identical PACU stay times following sugammadex (50.0 ± 24.5 minutes) or acetylcholinesterase inhibitor (49.3 ± 20.5 minutes) reversal for colorectal surgery (P = 0.821), although this was a retrospective study. 12 A randomized controlled trial involving 100 laparoscopic hysterectomy patients revealed no significant difference in PACU stay times after sugammadex versus neostigmine reversal (sugammadex: 47.75 ± 31.77 minutes vs neostigmine: 53.43 ± 40.57 minutes; P = 0.543).…”

“…As a selective encapsulator of steroidal neuromuscular blocking agents, sugammadex operates with a distinct mechanism of action that reverses NMB more rapidly and effectively than traditional acetylcholinesterase inhibitors 4,8–10 . We have previously demonstrated, however, that when providers are blinded to the reversal agent, the use of sugammadex or neostigmine results in a similar OR turnover time and comparable discharge readiness from the PACU 11 . Similarly, Chae et al 12 measured nearly identical PACU stay times following sugammadex (50.0 ± 24.5 minutes) or acetylcholinesterase inhibitor (49.3 ± 20.5 minutes) reversal for colorectal surgery ( P = 0.821), although this was a retrospective study 12 .…”

“…4,[8][9][10] It remains unclear, however, whether the shorter reversal time translates into improved downstream efficiency, such as operating room (OR) turnover and shorter length of stay (LOS) in the postanesthesia care unit (PACU). [11][12][13] Shortly after introducing sugammadex at our quaternary medical center, a 12-month utilization review completed by our pharmacy analyzed the use of sugammadex in 7443 surgical procedures, compared with neostigmine for 1064 operations. The analysis was completed to compare costs for the two agents.…”

“…It has been well established in the literature that sugammadex, compared with neostigmine, significantly decreases NMB reversal times 4,8–10 . It remains unclear, however, whether the shorter reversal time translates into improved downstream efficiency, such as operating room (OR) turnover and shorter length of stay (LOS) in the postanesthesia care unit (PACU) 11–13 …”