(1030) Evaluation of Sugammadex Use for Reversal of Neuromuscular Blockade in the ED and ICU

Introduction: Sugammadex has seen increasing use outside of the perioperative areas for reversal of post-RSI paralysis and prolonged paralysis due to organ dysfunction. This medication use evaluation aimed to describe the use of sugammadex at a single institution, outside of the perioperative arena, to describe dosing, timing of reversal from NMBA administration, indication for reversal, and if any adverse effects were observed.

Methods: Retrospective chart review at an academic tertiary care medical center of adult patients who received sugammadex in either the emergency department or one of 3 intensive care units, between January 2020 to July 2024. Patients who received sugammadex in the operating room or post-anesthesia care unit were excluded. Outcomes analyzed include sugammadex dose, time from sugammadex and NMBA administration, indication for neuromuscular blocker reversal, and if any adverse effects were observed.

Results: 29 patients were included in the final analysis. The most frequently administered sugammadex dose was 4-10 mg/kg (52%). The time from sugammadex administration after long-acting neuromuscular blocker was < 1 hour (38%) and 1-6 hours (38%). The most common indication for sugammadex use was to obtain a neurologic assessment (69%), followed by reversal of prolonged paralytic effect (31%). The majority of sugammadex was used after RSI (50%) or post-operatively after returning to the ICU (46%). The trauma and neurosurgical ICU were the most frequent services utilizing sugammadex, 45% and 27%, respectively. Renal and hepatic dysfunction, 38% and 25% respectively, was common which likely contributed to prolonged paralysis necessitating reversal with sugammadex. No adverse effects were reported such as anaphylaxis or bradycardia.

Conclusions: Sugammadex use is still infrequent outside of the perioperative areas at this single institution. Utilization is mostly driven by surgical and neurosurgical services to obtain neurological examination after RSI or in those who have prolonged paralysis, possibly due to reduced elimination from underlying organ dysfunction. The majority of patients received sugammadex doses of 4-10 mg/kg and given < 6 hours from long-acting neuromuscular blocker administration.