Sugammadex versus neostigmine for reversal of rocuronium-induced neuromuscular blockade: A randomized, double-blinded study of thoracic surgical patients evaluating hypoxic episodes in the early postoperative period

Moon, Tiffany S.; Reznik, Scott I.; Pak, Taylor; Jan, Kathryn; Pruszynski, Jessica; Kim, Agnes; Smith, Katelynn M.; Lu, Rachael; Chen, Joy; Gasanova, Irina; Fox, Pamela E.; Ogunnaike, Babatunde

doi:10.1016/j.jclinane.2020.109804

Cited by 19 publications

(20 citation statements)

References 22 publications

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“…Further, real-world data demonstrate that sugammadex administration is subsequently associated with reduced PPC [ 17 , 29 , 54 , 56 ], on which the current analysis is based [ 17 ]. While some studies come to similar conclusions [ 29 , 30 , 54 , 56 , 57 ], others come to different conclusions [ 57 – 61 ]. These studies were not considered to be appropriate for this analysis because they met one or more of the following exclusion criteria: reflected different practice in either a randomized controlled trial (measuring efficacy not effectiveness) or ex-US settings, were underpowered to detect a difference in treatment groups, were less representative (e.g., reflected a single site practice), or assessed different outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…These studies were not considered to be appropriate for this analysis because they met one or more of the following exclusion criteria: reflected different practice in either a randomized controlled trial (measuring efficacy not effectiveness) or ex-US settings, were underpowered to detect a difference in treatment groups, were less representative (e.g., reflected a single site practice), or assessed different outcomes. Had these studies been considered, the model evaluated in this resource would be less reflective of routine care in the US setting and estimated cost offsets would vary, depending on endpoints incorporated [ 29 , 30 , 54 , 56 – 58 , 60 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

“…The clinical outcome considered in the model was the number of PPC events, a composite endpoint which included pneumonia, respiratory failure, and/or other major pulmonary complications, components which were consistent with those previously defined among standard definitions of perioperative outcomes measures [28], and further refined to be related more conservatively to NMB management, as described by Kheterpal et al [17]. Outcomes were based on an analysis of real-world US data from the Multicenter Perioperative Outcomes Group consortium by Kheterpal et al (2020) (the STRONGER study) [17], and similar to those described elsewhere [29,30]. The STRONGER study represents 45,712 patients treated between January 2014 and August 2018.…”

Section: Clinical Outcomesmentioning

confidence: 99%

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A Clinical and Budgetary Impact Analysis of Introducing Sugammadex for Routine Reversal of Neuromuscular Blockade in a Hypothetical Cohort in the US

2021

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Introduction Sugammadex rapidly reverses the effects of rocuronium- and vecuronium-induced neuromuscular blockade (NMB), offering a more complete and predictable NMB recovery than cholinesterase inhibitors. Despite clinical benefits, cost pressures on hospital budgets influence the choice of the NMB reversal method. This study evaluated clinical and healthcare system payer’s budget impacts associated with sugammadex in the US for routine reversal of moderate or deep rocuronium- or vecuronium-induced NMB in adults undergoing surgery. Methods A 1-year decision analytic model was constructed reflecting a set of procedures using rocuronium or vecuronium that resulted in moderate or deep NMB at the end of surgery. Two scenarios were considered for a hypothetical cohort of 100,000 patients: without sugammadex versus with sugammadex . Comparators included neostigmine (+glycopyrrolate) and no neuromuscular blocking agents (NMBAs). Total costs (in 2019 US dollars) to a healthcare system [net of costs of reversal agents and overall cost offsets via reduction in postoperative pulmonary complications (PPC)] were compared. Results A total of 9971 surgical procedures utilized rocuronium or vecuronium, resulting in moderate (91.0% of cases) or deep (9.0%) blockade at the end of surgeries. In the with sugammadex scenario, sugammadex replaced neostigmine in 4156 of 9585 procedures versus the without sugammadex scenario that used only neostigmine for NMB reversal. Introducing sugammadex reduced PPC events by 12% (58 cases) among the modeled procedures, leading to a budget impact of –$3,079,703 (–$309 per modeled procedure, or a 10.9% reduction in total costs). The results did not vary qualitatively in one-way sensitivity analyses. Conclusions The additional costs of sugammadex for the reversal of rocuronium- or vecuronium-induced NMB could be offset by improved outcomes (i.e., reduced PPC events), and potentially lead to overall healthcare budgetary savings versus reversal with neostigmine or spontaneous recovery. This study provides insights into savings that can be obtained beyond the anesthesia budget, reducing the broader clinical and budgetary burden on the hospital.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

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A Clinical and Budgetary Impact Analysis of Introducing Sugammadex for Routine Reversal of Neuromuscular Blockade in a Hypothetical Cohort in the US

2021

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“…Previous meta-analyses have shown that sugammadex reversed NMB more rapidly than neostigmine and was associated with fewer residual NMB rate (TOF ratio of less than 0.9) (30,31). However, prior observational(16, 18, 32) and randomized trials (15,17,33) have reported con icting results on the effect of sugammadex on PPCs.…”

Section: Discussionmentioning

confidence: 99%

Comparison Effects of two Muscle Relaxant Strategies on Postoperative Pulmonary Complications in Transapical Transcatheter Aortic Valve Implantation: A Propensity Score-Matched Analysis

Hong

Zuo

et al. 2021

Preprint

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Background: Prior studies have reported conflicting results on the effect of sugammadex on postoperative pulmonary complications (PPCs) and research on this topic in transapical-transcatheter aortic valve implantation (TA-TAVI) was sparse. The current study aimed to investigate whether there were differences in the incidence of PPCs between two muscle relaxant strategies (rocuronium/sugammadex vs. cisatracurium/neostigmine) in patients undergoing TA-TAVI. Methods: This retrospective observational study enrolled 245 adult patients underwent TA-TAVI between October 2018 and January 2021. The patients were grouped according to the type of muscle relaxant strategies (115 with rocuronium/sugammadex in the R/S group and 130 with cisatracurium/neostigmine in the C/N group, respectively). Pre- and intraoperative variables were managed by propensity score match (PSM) at a 1:2 ratio. PPCs (i.e., respiratory infection, pleural effusion, pneumothorax, atelectasis, respiratory failure, bronchospasm and aspiration pneumonitis) were evaluated from the radiological and laboratory findings. Results: After PSM, 91 patients in the R/S group were selected and matched to 112 patients in the C/N group. Patients in the R/S group showed lower PPCs rate (45.1% vs. 61.6%, p=0.019) compared to the C/N group. In addition, the R/S group showed significant shorter extubation time (7.2±6.2 vs. 10.3±8.2 min, p=0.003) and length of hospital stay (6.9±3.3 vs. 8.0±4.0 days, p=0.034). Conclusions: The rocuronium/sugammadex muscle relaxant strategy decreases the incidence of PPCs in patients undergoing TA-TAVI when compared to cisatracurium/neostigmine strategy. Trial registration: ChiCTR, ChiCTR2100044269. Registered March 14, 2021-Prospectively registered, http://www.Chictr.org.cn

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“…Recently, a large multicenter mixed-sex study found that sugammadex reversal, compared to neostigmine, reduced the risk of postoperative pulmonary complications by 30% and respiratory failure by 55% [ 28 ]. Two other recent studies found sugammadex decreased postoperative hypoxic episodes and intervention rates for postoperative respiratory failure, reducing both postoperative reintubation and non-invasive ventilation requirements [ 29 , 30 ]. The apparently emerging benefit of this relatively newer reversal agent will need to be examined in future prospective trials.…”

Section: Discussionmentioning

confidence: 99%

Postoperative respiratory depression after hysterectomy

Laporta

Kinney

Schroeder

et al. 2020

Bosn J of Basic Med Sci

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To investigate if sex-specific physiologic characteristics could impact postoperative respiratory depression risks in women, we studied incidence and risk factors associated with postoperative respiratory depression in a gynecologic surgical cohort. Only hysterectomies performed under general anesthesia from 2012 to 2017 were included to minimize interprocedural variability. Respiratory depression was defined as episodes of apnea, hypopnea, hypoxemia, pain-sedation mismatch, unplanned positive airway pressure device application, or naloxone administration in the post-anesthesia care unit. Multivariable logistic regression was used to explore the association with clinical characteristics. From 1,974 hysterectomies, 253 had postoperative respiratory depression, yielding an incidence of 128 (95% confidence interval, 114–144) per 1,000 surgeries. Risk factors associated with respiratory depression were older age (odds ratio 1.22 [95% confidence interval 1.02–1.46] per decade increase, p = 0.03), lower body weight (0.77 [0.62–0.94] per 10 kg/m2, p = 0.01), and higher intraoperative opioid dose (1.05 [1.01–1.09] per 10 mg oral morphine equivalents, p = 0.01); while sugammadex use was associated with a reduced risk (0.48 [0.30–0.75], p = 0.002). Respiratory depression was not associated with increased hospital stay, postoperative complications, or mortality. Postoperative respiratory depression risk in women increased with age, lower weight, and higher intraoperative opioids and decreased with sugammadex use; however, it was not associated with postoperative pulmonary complications.

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Sugammadex versus neostigmine for reversal of rocuronium-induced neuromuscular blockade: A randomized, double-blinded study of thoracic surgical patients evaluating hypoxic episodes in the early postoperative period

Cited by 19 publications

References 22 publications

A Clinical and Budgetary Impact Analysis of Introducing Sugammadex for Routine Reversal of Neuromuscular Blockade in a Hypothetical Cohort in the US

A Clinical and Budgetary Impact Analysis of Introducing Sugammadex for Routine Reversal of Neuromuscular Blockade in a Hypothetical Cohort in the US

Comparison Effects of two Muscle Relaxant Strategies on Postoperative Pulmonary Complications in Transapical Transcatheter Aortic Valve Implantation: A Propensity Score-Matched Analysis

Postoperative respiratory depression after hysterectomy

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