(937) Exploration of Sugammedex Dosing and Redosing Factors at an Academic Medical Center

Introduction: Non-depolarizing neuromuscular blockers (NMB) (e.g., rocuronium [ROC], vecuronium [VEC]) are used to induce paralysis. Sugammadex (SUG) is a modified gamma cyclodextrin indicated for reversal of ROC and VEC. Recommended dosing varies between 2-16 mg/kg based on NMB dose and timing with minimal guidance on redosing. The objective of this study was to evaluate how SUG is being utilized at an academic medical center to optimize dosing guidance.

Methods: A single center retrospective chart review was conducted from December 1, 2023 to May 31, 2024 and included patients ≥ 18 years who received at least one dose of SUG following administration of an NMB. Data collection focused on SUG/NMB initial doses, repeat doses and administration times. Outcomes included SUG dose, time between first and last SUG dose, cumulative NMB dose, time between first and last NMB dose, and time between last dose of NMB and first dose of SUG

Results: This study evaluated 6,136 patients over 6,947 encounters and 7,328 SUG administrations. Patients had a median age of 57 years and 51.6% were female. The majority of SUG administrations (97.4%) were performed by anesthesia. Number of SUG administrations per encounter ranged from 1 (n=6,597), 2 (n = 337), 3 (n=21), to 4 (n=5). Total median SUG dose was 200 mg (IQR 200, 200) for single administrations and 400 mg (IQR 400, 400) for 2+ administrations with a median time between first and last doses of SUG of 5 min (IQR 3, 11). Patients with repeat SUG dosing did not have a higher median cumulative dose of NMB compared to single dose SUG patients. Patients who required 3+ doses of SUG had a time between first and last dose of NMB of 58 min (IQR 37, 81) and a time between last dose of NMB and first dose of SUG of 56.5 min (IQR 27.25, 94).

Conclusions: Consideration should be given on whether SUG dosing should continue to be weight based per package labeling or if there is the opportunity for fixed dose, which could help with ease of administration and cost. Repeat dosing of SUG is rare, however, timing of repeat NMB administration within 60 minutes may prompt redosing of SUG.