(954) Evaluation of the Use of Sugammadex for Reversal of Neuromuscular Blockade Outside Procedural Areas

Introduction: Sugammadex has gained popularity for emergent reversal of neuromuscular blocking agents (NMBA) outside of procedural areas. While several studies have investigated sugammadex use in procedural settings, limited data exist for its utilization outside of these areas. This study aimed to describe the dosing, timing, indications, and side effects of sugammadex administration in adult patients outside of procedural areas.

Methods: A retrospective analysis of medical records was conducted at a tertiary academic medical center. The study included adult patients who received sugammadex to reverse rocuronium or vecuronium, between January 2016 and December 2022. Patients who received sugammadex perioperatively were excluded. The main outcomes of interest were sugammadex dose, time between NMBA and sugammadex administration, and indications for sugammadex use.
Regarding the dosage of sugammadex, it was classified into three categories: 2-4 mg/kg, >4-10 mg/kg, and >10 mg/kg. The time interval between the administration of NMBA and sugammadex was divided into three categories as well: < 1 hour, 1 to 6 hours, and >6 hours.

Results: A total of 119 patients were included in the final analysis. The most frequently administered sugammadex dose (106, 89%) was 2-4mg/kg. Most patients (79, 66.4%) received sugammadex within 1-6 hours after paralytic administration. The most common indications for sugammadex use were reversal of residual NMBA (82, 68.9%), followed by neurological examination (27, 22.7%). Surgical services accounted for the majority of sugammadex utilization (88, 73.9%). Among the studied patients, 52% remained intubated within 24 hours after sugammadex administration. No significant adverse effects were reported following sugammadex administration.

Conclusions: These findings emphasize the common use of sugammadex at our institution to reverse residual NMBA, or to obtain a neurological examination. The dosage of sugammadex administered to most patients ranged from 2 to 4 mg/kg, and it was often given between 1 to 6 hours following the administration of NMBA.