Background and Goal of Study: Our hospital has a total of 13 in-patient theatres and we report on a one year audit of our department's experience of the use of Sugammadex for the reversal of neuromuscular blockade. We sought to gain an idea of common specific indications for its use, following pressure to justify the rising drug budget for this relatively new agent.
Anaesthetists were asked to fill in an audit form every time Sugammadex was used.
Materials and Methods: The reason for using the drug, which NDMR, time from last dose, TOF count, whether the patient was extubated, age, discharge destination, co-morbidities, operation, and other comments were all recorded. We also asked if Sugammadex was used to reverse blockade, did the drug prevent an ITU admission. The audit form was kept next to the Sugammadex in theatre recovery's drug cupboard.
Results and Discussion: 72 audit forms were completed (6 patients had no form or missing data) over a one year period. While many patients had multiple co-morbidities, obesity (30), IHD (27), Age>75 (20), Tachycardia (20) and COPD (19) were the most common. 47 patients were admitted to the ward, 21 to HDU, 2 to labour ward and interestingly, only 2 in a year were admitted to ITU. Added comments (though subjective) showed that at least 7 ITU admissions were prevented, and about the same number of HDU admissions. Only one patient received Sugammadex following an RSI, though he was extubated successfully 20 minutes later. All patients got rocuronium as the NDMR. No patients were given Sugammadex in a “Can't Intubate, Can't Ventilate” situation.
Conclusion(s): While Sugammadex has been available in Scotland for over 3 years, at present the SMC only recommends its use in the reversal of profound blockade following RSI using rocuronium1. The use to facilitate extubation in the context of serious co-morbidities has been studied and its ability to reverse profound blockade has also been shown2,3. We conclude that our use has been appropriate and has reduced costs by preventing ITU and HDU admissions.
1. Sugammadex 100mg/ml solution for injection (Bridion) No.(527/09) Schering-Plough.Scottish Medicines Consortium: 09 January 2009
2. European Journal of Anaesthesiology: June 2011 - Volume 28 -Issue -p 136
3. Anesthesiology: February 2011 - Volume 114 - Issue 2 - pp 318-329