Date of Award
Doctor of Nursing Practice (DNP)
Karen Kapanke, DNP, CRNA
Mark Deshur, MD
rior to the introduction of sugammadex, the only option to reverse rocuronium-induced neuromuscular blockade (NMB) were cholinesterase inhibitors (i.e. neostigmine) and anticholinergics (i.e. glycopyrrolate). Sugammadex administration has been shown to provide a more effective and complete reversal of rocuronium. However, the higher cost of sugammadex has been cited as a limiting factor to its use. The medication costs of sugammadex and neostigmine with glycopyrrolate have been studied in the operating room setting. There is a lack of information regarding the usage and medication costs of sugammadex and neostigmine with glycopyrrolate for non-operating room anesthesia care (NORA). A retrospective chart review was conducted over a 12-month period, from January 1, 2017, to December 31, 2017 aimed at examining the cost associated with the administration of neostigmine with glycopyrrolate versus sugammadex for anesthesia in NORA locations. The following information was collected on patients who met the inclusion criteria: type and dose of NMB reversal agent, age, weight, body mass index (BMI), American Society of Anesthesiologist physical status (ASA PS) classification, NORA locations such as cardiac catheterization laboratory (Cath lab), gastrointestinal laboratory (GI lab), magnetic resonance imaging room (MRI), computed tomography room (CT), interventional radiology (IR), obstetrics (OB) unit, and electrophysiology laboratory (EP lab). This study consisted of 526 patient charts that fulfilled inclusion criteria. Correlational data analysis revealed that there was a weak positive correlation between ASA score and use of sugammadex. There was also a statistically significant difference in the administration between NORA departments, notably in the EP lab. Due to fluctuating costs of sugammadex, neostigmine, and glycopyrrolate, cost analysis did not reveal sugammadex as a cost-effective option for NMB reversal in NORA locations.
Kilsdonk, Lindsey Marie and Ruan, Mindy, "Cost Differences Between Sugammadex and Neostigmine Use in Non-Operating Room Anesthesia Care" (2019). College of Science and Health Theses and Dissertations. 345.