Unrestricted and Restricted Access to Sugammadex and Side Effect Profile in a Teaching Hospital Centre for Year 2014- Database Audit Study

Background: Sugammadex is used for the rapid reversal of neuro muscular block. It was used on an unrestricted basis in our facility prior to July 2014 but has subsequently been restricted due to the removal of cost subsidies. Our aim is to determine the impact of restricting the use of Sugammadex on clinical outcomes. Methods: A retrospective audit was conducted for the period January 1st to December 31st 2014. Sugammadex use was unrestricted during the first 6 months of this period and restricted over the following period. Patients who had endotracheal intubation for any surgery were included in the audit. Non- intubated patients, patients with incomplete data and patients who were intubated and transferred to the intensive care unit were excluded. The Operating Room Information System and medical records were used to obtain information on the operating theatre time, post-anesthesia care unit time and side effects such as postoperative nausea and vomiting, oxygen-de-saturation during recovery and anaphylaxis; Sugammadex usage and cost data obtained from the hospital pharmacy. Results: 1347 and 1302 patients were included for the unrestricted and restricted periods, respectively. There were no significant differences between the time periods with respect to patient characteristics (Age, ASA) or side effects (oxygen de-saturation, nausea). While mean time in theatre was similar across the time periods, mean recovery time was significantly longer during the restricted period (P < 0.0001). One case of anaphylaxis was reported during the restricted period while no cases occurred during the unrestricted period. Median Sugammadex dose was 200 mg and its usage dropped by 54% in the restricted time. The cost of sugammadex was $180 AUD and Neostigmine $1.80 AUD. Conclusions: Though unrestricting Sugammadex reduced recovery time but has had minimal impact on other clinical outcomes. Neostigmine represents a cheaper alternative and its use remains standard practice in our facility.