785: EVALUATION OF SUGAMMADEX DOSING FOR DEEP NEUROMUSCULAR BLOCKADE REVERSAL IN THE EMERGENCY DEPARTMENT

Abstract

Introduction: Neuromuscular blocking agents (NMBAs) are often administered to facilitate rapid sequence intubation (RSI). The effects of neuromuscular blockade may be prolonged in the setting of organ dysfunction or need for rapid attainment of a neurological examination may be necessary. The primary objective of this study is to evaluate low (2 mg/kg) versus standard dose (4 mg/kg) sugammadex for reversal of deep neuromuscular blockade in the emergency department (ED) to facilitate neurological examination. Methods: A single-center, retrospective cohort study was performed and approved by the local Institutional Review Board. Patients were identified using sugammadex charge codes between 01/01/2017 - 07/15/2022. Adult patients were included if they received sugammadex in the ED to facilitate neurological examination, were given rocuronium or vecuronium for RSI, and had a documented train-of-four (TOF) before and after sugammadex administration. Patients were excluded if records were incomplete, initial sugammadex dose other than 2 mg/kg or 4 mg/kg was used and if initial TOF was 1 – 4. The primary outcome of this study was successful deep neuromuscular blockade reversal defined by achieving a post-treatment TOF of 4. Results: Of 36 sugammadex doses administered in the ED, 26 patients were included in the final analysis, with 10 in the low-dose group and 16 patients in the standard-dose group. The median dose was 2.28 mg/kg and 4.09 mg/kg for low- and standard-dose, respectively. The overall cohort was predominantly male (65.4%) with a median age of 68.4 years (49.7-76.9). Most patients presented for intraparenchymal hemorrhage (53.8%), with 57.7% of bleeds being traumatic in origin. Median initial Glasgow Coma Score was 3, and all initial TOF were zero. Paralytics were administered in the pre-hospital setting in 85% of patients, with rocuronium use predominating (92.3%). No significant difference in success rate of NMBA reversal was found between low-dose versus standard-dose sugammadex (100.0% vs. 93.8%, P = 1.000). Conclusions: Low-dose sugammadex did not result in a significantly different success rate of NMBA reversal when compared to standard-dose. Low-dose sugammadex may be a viable option for deep NMBA reversal in the ED to facilitate neurological examinations.