Neuromuscular monitoring, muscle relaxant use, and reversal at a tertiary teaching hospital 2.5 years after introduction of sugammadex: changes in opinions and clinical practice.

Thomas Ledowski,Tom Flett,Jing Shen Ong

doi:10.1155/2015/367937

Abstract

Sugammadex was introduced to Royal Perth Hospital in early 2011 without access restriction. Two departmental audits (26-page online survey and 1-week in-theatre snapshot audit) were undertaken to investigate the change of beliefs and clinical practice related to the use of neuromuscular blocking agents at the Royal Perth Hospital since this introduction. Results were compared with data from 2011. We found that, in the 2.5 years since introduction of Sugammadex, more anesthetists (69.5 versus 38%) utilized neuromuscular monitoring, and aminosteroidal neuromuscular blocking agents were used in 94.3% of cases (versus 77% in 2011). Furthermore, 53% of anesthetists identified with a practice of “deeper and longer” intraoperative paralysis of patients. All 71 patients observed during the 5-day in-theatre audit were reversed with Sugammadex. Since the introduction of Sugammadex, 69% (n = 20) of respondents felt it provided “faster turnover,” less postoperative residual neuromuscular blockade (n = 23; 79%), and higher anesthetist satisfaction (n = 17; 59%). 45% (n = 13) of colleagues reported that they would feel professionally impaired without the unrestricted availability of Sugammadex, and 1 colleague would refuse to work in a hospital without this drug being freely available. In clinical practice Sugammadex was frequently (57%) mildly overdosed, with 200 mg being the most commonly administered dose.

Highlights

Sugammadex was introduced to Royal Perth Hospital (RPH) in early 2011 without access restriction
Two previously published audits [1, 2] comparing the “pre-” and “post-”Sugammadex practice of neuromuscular blocking agent (NMBA) use and reversal in 2011 identified an approximate 50% decline in the use of neostigmine since introduction of Sugammadex. They revealed a low rate of neuromuscular monitoring (38%) and, correspondingly, a very high incidence of postoperative residual neuromuscular blockade (RNMB) and associated complications
In contrast to studying the status quo as well as “short term” changes, it was the aim of the current audit to investigate whether the introduction of Sugammadex has resulted in a long term (2 years) change of anesthetists’ NMBA associated practice and beliefs

Summary

Introduction

Sugammadex was introduced to Royal Perth Hospital (RPH) in early 2011 without access restriction. Two previously published audits [1, 2] comparing the “pre-” and “post-”Sugammadex practice of neuromuscular blocking agent (NMBA) use and reversal in 2011 identified an approximate 50% decline in the use of neostigmine since introduction of Sugammadex. They revealed a low rate of neuromuscular monitoring (38%) and, correspondingly, a very high incidence of postoperative residual neuromuscular blockade (RNMB) and associated complications. In contrast to studying the status quo as well as “short term” changes, it was the aim of the current audit to investigate whether the introduction of Sugammadex has resulted in a long term (2 years) change of anesthetists’ NMBA associated practice and beliefs

Objectives

Methods

Results