The Financial and Humanistic Costs Associated with Residual Neuromuscular Blockade

To review the financial and humanistic costs associated with residual neuromuscular blockade (rNMB). A recent systematic review and meta-analysis of randomized controlled trials suggested that sugammadex was superior to neostigmine in producing faster and more reliable reversal of neuromuscular blockade (NMB). The literature on clinical effectiveness of reversal agents, including time to recovery from NMB, time to tracheal extubation, incidence of postoperative residual NMB, and adverse events, indicate that sugammadex is superior to neostigmine. Cost-effectiveness including costs related to postoperative complications, hospital length of stay, operating room and postanesthesia care unit time, drug acquisition, and objective neuromuscular monitoring remain unclear. Objective neuromuscular monitoring was shown to be clinically effective and is universally recommended. Some recent data suggest that objective monitoring can be cost-effective, regardless of the selected antagonist, in confirming complete recovery of neuromuscular function and avoiding additional costs related to residual NMB and associated postoperative pulmonary complications.