Background: With the introduction of any new medication or technology, there is a chance that it will significantly affect the way a physician chooses to practice. Sugammadex, approved in the US in December 2015, has been introduced as a new agent capable of reversing neuromuscular blockade by rocuronium and vecuronium. With its ability to cause rapid reversal of neuromuscular blockade following varying durations of time following administration of a steroidal non-depolarizing agent based on the dosage used, it is even more so inclined to truly affect the manner in which an anesthesiologist may practice. It potentially may alter the choice of nondepolarizing agent, doses administered, as well as timing of administration. Under an IRB approved protocol, we are interested in finding out if sugammadex has changed practice habits in the operating rooms of our hospital since its introduction to our formulary in December 2016. We hypothesize that the introduction of sugammadex will significantly alter the choice of neuromuscular agents used at our institution, increasing the amount and number of times rocuronium and vecuronium are used, compared to cisatracurium.
Methods: The study utilized retrospective data as was collected by the pharmacy department from June 2016 to February 2017. Data was collected from anesthesia intra-operative orders, excluding any orders from other areas in the hospital. The data collected the number of orders per drug and did not take into account the dose used. We compared the number of times rocuronium, cisatracurium, and vecuronium were used with one another as percentages. Additionally, we collected data looking at the percentage of times neostigmine versus sugammadex was selected when a reversal agent was used.
Results: Rocuronium usage went from 39.4%, 41.1%, 42.8%, 41.7%, 34.7%, 40.7%, and 48.3% from June 2016 to November 2016 to 48.3%, 55.6%, and 57.4% from December 2016 to February 2017. Cisatracurium usage went from 39.6%, 34.5%, 34%, 37.4%, 34.5%, and 36.5% from June 2016 to November 2016 to 30.6%, 27.8%, and 25.5% from December 2016 to February 2017. Vecuronium usage went from 20.9%, 24.34%, 23.2%, 20.8%, 30.8%, and 22.8% from June 2016 to November 2016 to 21.1%, 16.6%, and 17.1% from December 2016 to February 2017. Additionally, neostigmine usage since the introduction of sugammadex became 91.3%, 80.8%, and 95.3% from December 2016 to February 2017. Sugammadex usage during the same months was 8.7%, 19.2%, and 4.6%, respectively.
Conclusion: The introduction of sugammadex has, in fact, altered anesthesiologists’ choice of non-depolarizing agent intraoperatively. Rocuronium has been used more often since the introduction of sugammadex. Interestingly, the use of cisatracurium only decreased slightly, while vecuronium usage decreased as well though it also can be reversed by sugammadex. Another point to note was that there was a significant decline in usage of sugammadex in February 2017, possibly explained by a couple of reasons. In February, a review of proper indications and usage of sugammadex was presented to the anesthesia. Additionally, it is possible that practitioners were using sugammadex more in the first months of introduction to help familiarize themselves with the drug.
