Key result
Patient factors including female sex, non-white race, increased BMI, greater comorbidity burden, and thoracic surgery predicted the need for rescue sugammadex after neostigmine with an AUC of 0.681.
Why the study?
Sugammadex is superior to neostigmine for neuromuscular blockade reversal, but its cost remains a barrier. This study aimed to compare outcomes of neostigmine alone versus neostigmine with rescue sugammadex and identify risk factors for requiring rescue sugammadex.
What are the risk factors for requiring rescue sugammadex after neostigmine for neuromuscular blockade reversal in patients undergoing general anesthesia?
Observational (n=7,104)
No
What are the risk factors for requiring rescue sugammadex after neostigmine for neuromuscular blockade reversal in patients undergoing general anesthesia?
Effect estimate: AUC 0.681 (95% CI 0.654-0.708)
Female sex, non-white race, BMI ≥ 35, and specific comorbidities including pulmonary hypertension are independent predictors for requiring rescue sugammadex after neostigmine for neuromuscular blockade reversal.
Background: Previous studies have demonstrated the superiority of sugammadex over neostigmine for reversal of nondepolarizing neuromuscular blockade (NMB) reversal. However, its increased cost over neostigmine remains a barrier to use in many institutions. Aims: The purposes of this study were to compare the outcomes of patients receiving neostigmine alone vs. patients receiving neostigmine and sugammadex and to identify the risk factors for patients requiring sugammadex as a rescue neuromuscular blockade reversal agent. Methods: A retrospective observational study of general anesthesia cases using rocuronium or vecuronium for NMB at a single regional medical center from January 1, 2019 to March 30, 2021 was performed. Demographics, surgical details, and outcomes of patients receiving neostigmine only (N) were compared to those of patients receiving neostigmine followed by sugammadex (NS). A conditional logistic regression model was developed to identify predictors of patients requiring a rescue dose of sugammadex for NMB reversal. Results: A total of 7104 patients were included (N=6684, NS=420). In comparison to patients in the N group, those in the NS group experienced shorter duration from last NMB administration to first reversal, longer PACU recovery times, longer length of stay, and higher rates of reintubation. After risk adjustment, patients receiving NS were more likely to be female, of non-white race, have increased BMIs, and a greater comorbidity burden than those requiring N only. In comparison to patients undergoing general surgery, those undergoing thoracic surgery are at increased risk for requiring NS. A model for predicting which patients would receive NS was generated with an AUC of 0.681 (95% CI: 0.654-0.708), sensitivity of 78% and specificity of 48%. Conclusion: These findings may assist anesthesiologists in identifying which patients are likely to require sugammadex for rescue NMB reversal after use of neostigmine and are therefore suitable candidates for using sugammadex as a first-line therapy.
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Turcotte et al. (2022) conducted an observational in Neuromuscular blockade during general anesthesia (n=7,104). Neostigmine followed by sugammadex (rescue reversal) vs. Neostigmine alone was evaluated on Predictive model for requiring rescue sugammadex (AUC 0.681, 95% CI 0.654-0.708). Patient factors including female sex, non-white race, increased BMI, greater comorbidity burden, and thoracic surgery predicted the need for rescue sugammadex after neostigmine with an AUC of 0.681.
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