Kowalsky Markus, Montejano Julio, Pattee Jack, Rist Scott, Fernandez-Bustamante Ana, Gilliland Samuel, Weitzel Nathaen
Anesthesiology, University of Colorado School of Medicine, Aurora, USA.
Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, USA.
Cureus. 2025 Jun 13;17(6):e85929. doi: 10.7759/cureus.85929. eCollection 2025 Jun.
Background Sugammadex rapidly became the standard of care for neuromuscular blockade reversal at our institution, leading to a substantial increase in pharmacy costs. We hypothesized that administering sugammadex in 75 mg aliquots, rather than 200 mg vials, would improve adherence to FDA dosing guidelines, reduce costs, and promote greater use of quantitative neuromuscular monitoring. Methods This retrospective study analyzed a departmental process improvement initiative. Baseline sugammadex use (Phase 1) was assessed between July 2021 and January 2022, during which only qualitative neuromuscular monitoring was employed. From February to August 2022 (Phase 2), pre-filled 75 mg sugammadex syringes were introduced. In Phase 3, from September 2022 to January 2023, these aliquots were used alongside quantitative twitch monitoring. The primary outcome was the average sugammadex dose per case. Patient characteristics and secondary outcomes, including neuromuscular blockade monitoring and documentation, as well as safety event reporting, were also evaluated. Results There were no significant differences in patient demographics or comorbidities across phases. With the introduction of 75 mg sugammadex aliquots, the average dose per case decreased by 55.4 mg (95% CI: 52.1-58.8). Following the implementation of quantitative monitoring, the dose increased by 10.8 mg (95% CI: 7.3-14.3). Documentation of neuromuscular blockade improved, and no changes in reported safety events were observed across phases. Conclusions The use of smaller compounded sugammadex aliquots, combined with quantitative monitoring and appropriate education, can improve neuromuscular blockade reversal practices while reducing healthcare costs.
舒更葡糖钠在我们机构迅速成为逆转神经肌肉阻滞的护理标准，导致药房成本大幅增加。我们推测，以75毫克分装而非200毫克瓶装的形式给药舒更葡糖钠，将提高对美国食品药品监督管理局（FDA）给药指南的依从性，降低成本，并促进更多地使用定量神经肌肉监测。方法：这项回顾性研究分析了一项部门流程改进举措。在2021年7月至2022年1月期间评估了舒更葡糖钠的基线使用情况（第1阶段），在此期间仅采用定性神经肌肉监测。从2022年2月至8月（第2阶段），引入了预填充75毫克舒更葡糖钠注射器。在第3阶段，从2022年9月至2023年1月，这些分装与定量抽搐监测一起使用。主要结局是每例患者的舒更葡糖钠平均剂量。还评估了患者特征和次要结局，包括神经肌肉阻滞监测与记录以及安全事件报告。结果：各阶段患者人口统计学特征或合并症无显著差异。随着75毫克舒更葡糖钠分装的引入，每例患者的平均剂量减少了55.4毫克（95%置信区间：52.1 - 58.8）。实施定量监测后，剂量增加了10.8毫克（95%置信区间：7.3 - 14.3）。神经肌肉阻滞的记录有所改善，各阶段报告的安全事件无变化。结论：使用较小的复合舒更葡糖钠分装，结合定量监测和适当教育，可以改善神经肌肉阻滞逆转实践，同时降低医疗成本。
