Sugammadex: Appropriate Use in the Context of Budgetary Constraints

Guy Cammu, Guy Cammu

Abstract

Purpose of review: The purpose of this review is to assess how sugammadex impacts postoperative residual curarization using appropriate doses based on neuromuscular transmission monitoring and whether the advantages of sugammadex versus neostigmine outweigh its higher cost.

Recent findings: An accurate assessment of neuromuscular blockade with monitoring is necessary before selecting neostigmine versus sugammadex for reversal at the end of surgery to overcome incomplete neuromuscular recovery. The main advantages of sugammadex over neostigmine are its predictability and its ability to extend the range of blockade reversal. The cost of sugammadex is greater when higher doses of sugammadex are required for antagonism of deep block. Sugammadex probably has the potential to be cost-effective compared with neostigmine if its time savings are put to productive use in clinical practice. However, to date, the economic benefits of the drug are unknown.

Summary: With sugammadex, almost any degree of neuromuscular block can be antagonized within 2-3 min; neostigmine is the only reversal agent effective against benzylisoquinolines and can ideally be used for reversal of lower levels of residual paralysis. The performance of the more expensive sugammadex on improving patient outcomes may depend on several elements of clinical strategy.

Keywords: Neostigmine; Neuromuscular block; Pharmacoeconomics; Postoperative complications; Sugammadex.

Conflict of interest statement

Compliance with Ethical StandardsGuy Cammu received honoraria from MSD Company for lectures at scientific meetings on the use of neuromuscular blocking agents and reversal agents. He previously performed funded research on sugammadex and received research grants from MSD, which were paid into a research account of his employer, the Department of Anesthesia and Critical Care Medicine of the Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium. He has served on the national advisory board on the introduction of sugammadex into clinical practice in Belgium. The author has no financial relationship with any organization or company that may have an interest in the submitted work. MSD had no role in this submitted work whatsoever.All reported studies/experiments with human or animal subjects performed by the author have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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