The use of sugammadex to prevent morbidity associated with residual paralysis following general anaesthesia

Abstract

Background:

The use of neuromuscular blocking agents intraoperatively is associated with post-operative pulmonary complications (PPCs). Effective reversal of neuromuscular block through the use of sugammadex has been proposed as a method of reducing the incidence of residual neuromuscular block, and peri-operative pulmonary morbidity. Given there are over 2.7 million surgical procedures performed in Australia each year, with 5-10% of patients reported to experience PPCs, interventions that reduce PPCs would be expected to significantly reduce the health burden.

Methods:

A single centre retrospective cohort study after the introduction of the routine availability of sugammadex showed an association between the routine availability of sugammadex and a reduction in post-operative respiratory diagnoses.

To examine the association between sugammadex and pulmonary complications, we performed a research program, to assess how sugammadex was being used by anaesthetists, to define other specific situations where sugammadex is used and to

strengthen the association seen between sugammadex and improvements in clinical outcomes when compared with neostigmine reversal.

Results:

While sugammadex was the preferred reversal agent of anaesthetists in Australia and New Zealand, cost and anaphylaxis risk were a concern preventing the routine use of sugammadex. The use of sugamamdex was shown to be associated with

anaphylaxis events and severe bradycardia, while also being given as a treatment of critical events during anaesthesia.

Sugammadex was then shown to be associated with a reduction in the odds ratio of PPCs (OR 0.67 (95%CI 0.47-0.95), however did not result in a reduced hospital stay, reduced mortality or reduced patient satisfaction.

Conclusions:

The use of sugammadex is likely associated with a reduced incidence of postoperative pulmonary complications however, these complications may be mild in nature and do not change patient satisfaction, hospital stay or mortality.