Whitney Madeline, Sharpe Emily E, Harbell Monica W, Buckner-Petty Skye, Kraus Molly B
From the Mayo Clinic Alix School of Medicine, Phoenix, Arizona.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Anesth Analg. 2025 Jan 1;140(1):145-154. doi: 10.1213/ANE.0000000000007081. Epub 2024 Oct 4.
Sugammadex, aprepitant, and fosaprepitant are increasingly used perioperatively. These medications may interfere with the effectiveness of hormonal contraception. This study assessed anesthesia providers' use of sugammadex and aprepitant, their knowledge of interactions with hormonal birth control, and patient counseling practices to identify possible knowledge gaps or opportunities for practice improvement.
In January 2023, an electronic survey was distributed to all anesthesia providers at Mayo Clinic sites (Mayo Clinic Rochester, Mayo Clinic Arizona, Mayo Clinic Florida, and Mayo Clinic Health System hospitals). The survey included 32 questions assessing providers' use of sugammadex and aprepitant, their knowledge of the medications' interactions with hormonal contraceptives (HC), their perceptions regarding education of these interactions during training, and their perioperative patient counseling practices. The collected data were analyzed using descriptive statistics.
A total of 337 of 1092 (31%) providers completed the survey. While almost all respondents (324; 96%) knew that sugammadex may interfere with oral contraceptive effectiveness, only 158 (47%) knew about aprepitant's potential contraceptive interference. Only 176 providers (52%) knew the recommended duration for alternative contraceptive methods after use after sugammadex, and 119 providers (35%) knew the recommended duration after aprepitant exposure. Most respondents considered the interference of these perioperative drugs with HCs to be clinically relevant (sugammadex, 217, 64%; aprepitant, 191, 58%). Despite the common belief that the decision between these medications and alternatives should be shared between provider and patient, most providers reported rarely engaging in such shared decision-making (SDM) in practice. Most providers recognized the need for preoperative discussions on sugammadex (280, 83%) and aprepitant (257, 76%), yet 184 providers (73%) never or rarely discussed contraception use before surgery for aprepitant, and 135 (36%) never or rarely did so for sugammadex. Lastly, many providers believed that the interference between sugammadex, aprepitant, and HC was poorly taught during training.
The results of this study highlight the need for increased education and awareness among anesthesia providers regarding drug interactions with HCs during the perioperative period. To facilitate SDM, it is imperative that providers discuss alternative medications and the potential need for additional contraception methods after drug administration and communicate the risks with patients preoperatively to enable informed and SDM. The patient's preferences should be accounted for, especially if they are unwilling or unable to use an alternative contraceptive for 7 to 30 days, thereby avoiding the complexities and burdens of altering birth control methods.
舒更葡糖钠、阿瑞匹坦和磷丙泊酚二钠在围手术期的使用越来越广泛。这些药物可能会干扰激素避孕的效果。本研究评估了麻醉医生对舒更葡糖钠和阿瑞匹坦的使用情况、他们对与激素避孕相互作用的了解以及患者咨询实践，以识别可能存在的知识差距或实践改进机会。
2023年1月，向梅奥诊所各院区（梅奥诊所罗切斯特院区、梅奥诊所亚利桑那院区、梅奥诊所佛罗里达院区以及梅奥诊所医疗系统医院）的所有麻醉医生发放了一份电子调查问卷。该问卷包含32个问题，评估医生对舒更葡糖钠和阿瑞匹坦的使用情况、他们对这些药物与激素避孕药（HC）相互作用的了解、他们对培训期间这些相互作用教育的看法以及他们的围手术期患者咨询实践。使用描述性统计分析收集到的数据。
1092名医生中有337名（31%）完成了调查。虽然几乎所有受访者（324名；96%）都知道舒更葡糖钠可能会干扰口服避孕药的效果，但只有158名（47%）知道阿瑞匹坦潜在的避孕干扰作用。只有176名医生（52%）知道使用舒更葡糖钠后替代避孕方法的推荐持续时间，119名医生（35%）知道阿瑞匹坦暴露后替代避孕方法的推荐持续时间。大多数受访者认为这些围手术期药物与激素避孕药的相互作用具有临床相关性（舒更葡糖钠，217名，64%；阿瑞匹坦，191名，58%）。尽管人们普遍认为在这些药物与其他药物之间的决策应该由医生和患者共同做出，但大多数医生报告称在实践中很少进行这种共同决策（SDM）。大多数医生认识到术前讨论舒更葡糖钠（280名，83%）和阿瑞匹坦（257名，76%）的必要性，然而184名医生（73%）从未或很少在术前讨论阿瑞匹坦的避孕使用情况，135名医生（36%）从未或很少讨论舒更葡糖钠的避孕使用情况。最后，许多医生认为在培训期间对舒更葡糖钠、阿瑞匹坦和激素避孕药之间的相互作用讲解不足。
本研究结果凸显了提高麻醉医生对围手术期药物与激素避孕药相互作用的教育和认识的必要性。为了促进共同决策，医生必须在给药后讨论替代药物以及额外避孕方法的潜在需求，并在术前与患者沟通风险，以使患者能够做出明智的共同决策。应考虑患者的偏好，特别是如果他们不愿意或无法在7至30天内使用替代避孕方法，从而避免改变避孕方法带来的复杂性和负担。
