Sugammadex introduction is associated with increased dosing of neuromuscular blocking drugs

Abstract

BackgroundThe introduction of sugammadex, a relatively new medication that can quickly and effectively reverse deeper states of neuromuscular blockade, may cause anesthesiology clinicians to change dosing patterns of neuromuscular blocking agents. MethodsWe retrospectively examined intraoperative aminosteroid neuromuscular blocking agent (NMBA) usage at a large tertiary care hospital from 15 months before until 39 months after the introduction of sugammadex. For each surgical case using commonly used aminosteroid NMBAs, we normalized the observed dose to a predicted dose of NMBA calculated using case duration and patient weight. An observed-to-predicted aminosteroid NMBA dose ratio was calculated for all surgical cases in the QI project and this metric was used to compare NMBA dosage in the pre-sugammadex epoch with that in the post-sugammadex epoch. ResultsThe observed-to-predicted dose ratio increased from 0.509 ± 0.007 (n = 25,132) in the pre-sugammadex epoch to 0.524 ± 0.007 (n = 51,801) in the post-sugammadex epoch (p= 0.007). Using segmented regression with co-variate analysis, the regression slope representing daily change in aminosteroid NMBA observed-to-predicted dosage ratio increased from -1.06×10−4± 4.4 × 10−5 (n= 24,779) in the pre-sugammadex epoch to 9.01×10−5± 1.8 × 10−5 in the post-sugammadex epoch (n= 51,218) (p < 0.001). ConclusionAminosteroid NMBA dosage increased after the introduction of sugammadex. Potential explanations for this increased dosage include risk compensation, which is the tendency to engage in higher risk activities after a new safety measure is available.