An uptick in sugammadex (Bridion) use for neuromuscular blocker reversal will raise questions about cost-saving strategies.
Prescribers like sugammadex because it reverses rocuronium or vecuronium within 3 minutes...versus about 20 minutes for neostigmine.
Plus sugammadex can reverse deep blockade...neostigmine can't.
But data are mixed about whether sugammadex leads to faster throughput or fewer complications.
And sugammadex costs about $110 or $200, depending on the dose...versus about $25 for neostigmine plus glycopyrrolate.
Work with anesthesia to review sugammadex criteria.
Consider giving sugammadex to reverse MODERATE blockade in patients at high risk of pulmonary complications from incomplete reversal...such as those with obstructive sleep apnea or COPD.
Also use sugammadex to reverse DEEP blockade in LIMITED cases.
When deep blockade is needed (neurosurgery, etc), there's usually time for it to wear off to a moderate level by the end of surgery...and then reverse with neostigmine.
But if deep blockade is required for a short surgery or one that takes less time than expected, consider sugammadex to help throughput.
Verify correct sugammadex dosing... 2 mg/kg to reverse moderate blockade or 4 mg/kg for deep blockade.
Think about using an adjusted body weight in patients with a BMI of 40 or more. An adjusted weight seems to work as well as total body weight...and may avoid the cost of a second vial in some patients.
Round down to the nearest vial size if it's within 10% of the calculated dose...such as using a 200 mg vial for a 220 mg dose.
When a higher dose is needed, choose a 500 mg vial...it costs about $20 less than using two 200 mg vials.
Promote appropriate use by requiring an indication for removal from automated dispensing cabinets. Also consider storing in lock-lidded pockets...and using a blind count.
Routinely evaluate that sugammadex is given according to criteria...to identify areas of opportunity and provide education.
See our checklist, Cost-Effective Use of Sugammadex, for more.
- A A Pract. 2020 May;14(7):e01223
- Anesth Analg. 2021 Jun 1;132(6):1666-1676
- J Clin Anesth. 2020 Dec;67:110027
- J Int Med Res. 2021 Jan;49(1):300060520985679
- Medication pricing by Elsevier, accessed Dec 2021
- Checklist: Cost-Effective Use of Sugammadex