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Clinical pharmacy and clinical trials (including case series)
Sugammadex for neuromuscular blockade reversal: a review of its use in a general hospital†
  1. C. Calderón-Acedos,
  2. M.A. Rodriguez-Cabezas,
  3. M. Segura-Bedmar,
  4. B. Rubio-Cebrián,
  5. P. San Miguel-Torvisco,
  6. R.M. Catalá-Pizarro
  1. 1Hospital Universitario de Móstoles, Pharmacy, Móstoles, Spain

Abstract

Background Sugammadex is a newly-developed agent indicated to reverse the neuromuscular blockade (NMB) induced by rocuronium or vecuronium during general anaesthesia in surgical procedures. It can improve patient safety in particular cases in which commonly-used reversal agents should not be employed.

Purpose To evaluate the use of sugammadex for reversal of NMB in surgical patients. To assess their effect on the consumption of neuromuscular blocking agents.

Materials and methods The authors performed a retrospective study from February 2010 to April 2011, which included all patients treated with sugammadex. The variables studied were age, sex, indication, dosage, neuromuscular blocking agent used and surgical department by which the patient was treated. The authors also collected rocuronium and vecuronium consumption data from 2009 and 2010.

Results The authors included 137 patients (51% women) with a mean age of 58.3 years (19-92). The most common reason for use was the need to maintain NMB until the end of the intervention (39.43%), followed by premature termination of surgery (34.5%), history of cardiovascular and/or lung disease (21.8%), rapid sequence intubation (1.4%), neuromuscular disorder (1.4%), change of procedure (0.7%) and inoperable process (0.7%). The most common dose was 4 mg/kg (52.55%), followed by 2 mg/kg (43.79%). Rocuronium was the most frequently used muscle relaxant (68.61%). Vecuronium was used only once. In the remaining patients (29.92%) no blocker was identified. Clinical departments involved were general surgery (51.09%), otolaryngology (27.73%), gynaecology (8.75%), traumatology (5.10%), urology (5.10%) and pneumology (0.72%). Consumption of rocuronium and vecuronium increased (by 230% and 390%) between 2009 and 2010.

Conclusions The availability of sugammadex has generated an increased use of more expensive drugs such as rocuronium and vecuronium. These results suggest incorporation of the drug into the surgical routine replacing physiological reversal.

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