THE AVAILABILITY AND FREE USE OF SUGAMMADEX AFFECTS THE CHOICE OF THE NEUROMUSCULAR BLOCKING AGENT (NMBA) AND THE COST OF NEUROMUSCULAR BLOCKADE IN GENERAL ANAESTHESIA

Ypsilanti E.1, Ftikos P.1, Sotiriou K.1,Karoni A.2, Plesia E.1
1. Anesthesiology Department, Evangelismos General Hospital, Athens, Greece  
2.Chief Nurse, Anesthesiology Department, Evangelismos General Hospital, Athens, Greece


Aim: Aim of the present study was to investigate the degree in which the free use and availability of sugammadex affects the choice of the NMBA used, the total consumption of rocuronium, as well as the cost of the induction and the reversal of neuromuscular blockade in a large general hospital.

Sources & Methods:  Following the Ethics Committee’s approval, we recorded the kind and the total dosage of NMBAs used, from all anesthesiologists, in all but cardiothoracic, elective procedures, over a week’s time , during which sugammadex was available without any limitations in its use.(Group 1).This was followed by a week’s period, during which sugammadex was withdrawn from clinical practice, due to artificial shortage in the drug’s stock ( Group 2), and the same parameters were recorded. Finally, we compared the total cost of induction and reversal of neuromuscular blockade, between the two groups. All medical and nursing staff but the authors, were blinded to the study.

Results: Ninety seven out of one hundred eleven patients of Group 1 received rocuronium for neuromuscular blockade whereas only fourteen received cis-atracurium . The reversal of neuromuscular blockade in the patients that received rocuronium took place with sugammadex in ninety six patients and, only one patient received neostigmine. The total amount of rocuronium used in this group was 7140mg whereas that of cis-atracurim 256mg. Regarding the reversal agent in this group, suggamadex was used in a total amount of 21500mg and neostigmine in a total quantity of 37,5 mg. In fourty five out of one hundred ten patients of Group 2 rocuronium was administered and the rest sixty five of them received cis- atracurium . In this Group for the reversal of neuromuscular blockade suggamadex was administered in only 12 patients, a number significantly statistically smaller( p<0.005) respectively to Group 1. The rest ninety eight patients received neostigmine. The total amount of rocuronium used during this week was 3080 mg and that of cis-atracurium was 1204 mg, whereas 2450 mg of suggamadex and 247,5 mg of neostigmine where used. Based on the prices of these pharmacological agents in Greece the total cost of induction and reversal of neuromuscular blockade in Group 1 was 6.832,71 Euros whereas in Group 2 was 941,83 Euros.
    

Conclusion: The availability and free use of sugammadex for the reversal of neuromuscular blockade affects the choice of MNBA in favor of rocuronium  with statistical significance, regardless of the indications, the contraindications or the possible side effects of these two medications. This practice causes a sevenfold rise in the cost of anesthesia due to neuromuscular blockade and reversal. The comparison between the reversal time is going to be presented in a future abstract.

The availability and free use of sugammadex affects the choice of the neuromuscular blocking agent (NMBA) and the cost of neuromuscular blockade in general anaesthesia