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.

Keywords

Neuromuscular reversal agents / Sugammadex / Neostigmine / Operating room turnover time

SUMMARY

This study is a double blinded assessment of the effects of sugammadex versus neostigmine on OR efficiency as deter-mined by time of reversal to time of the next case.

APPROVAL

This study was approved by the Western IRB on June 9, 2016.

FUNDING

This study was sponsored in part by an Investigator Initiated grant with funds from Merck & Co. Pharmaceutical Com-pany, and by the TEAMHealth Research Institute (THRI).

CLINICAL TRIALS REGISTRY

NCT02860507.

PRESENTATIONS

Results of this paper were presented at the 113th ASA An-nual Meeting October 11-14, 2018 in San Francisco, CA.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare they have no conflicts of interest.

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