Evolving Methods and Practices to Improve Reversal of Anesthesia-Induced Paralysis

The purpose of this project was to improve patient outcomes and safety by replacing reversal of anesthesia-induced paralysis from current methods to a safer more reliable technique with emphasis on neuromuscular monitoring. Supporting literature was reviewed from American, European, Asian, and Australian sources. Using a recently approved drug, sugammadex, the goal of this project was to demonstrate that sugammadex is more effective than conventional methods in eliminating the undesirable side effects associated with the conventional practice of a combination of an anticholinesterase, neostigmine, and an anticholinergic glycopynolate. Additionally, to provide an alternative to the procedure of rapid-sequence­induction to avoid the use of succinylcholine as a means to decrease the adverse reactions associated with the depolarizing agent. Finally, reinforcing strong evidenced-based practices such as neuromuscular monitoring is worth undertaking to augment the adoption of sugammadex as the new standard of care for reversing anesthesia-induced paralysis. Methods to achieve these ends included a retrospective chart review going back four years in a community hospital. The review noted surgeries in which paralysis was induced by the agents rocuronium or vecuronium and compare reversals achieved with neostigmine and glycopyrrolate versus sugammadex. Unexpectedly, this did not demonstrate shorter time periods when use of sugammadex was juxtaposed against the standard neostigmine and glycopyrrolate. In addition, no direct benefit was noted when comparing post-operative complications at this clinical site. Further, a more comprehensive investigation of the benefits of Sugammadex is warranted.