Quantitative Monitoring Maximizes Cost-Saving Strategies When Antagonizing Neuromuscular Block With Sugammadex

Area of Science:

• Anesthesiology
• Pharmacoeconomics
• Quality Improvement

Background:

• Pediatric anesthesia often involves significant medication waste due to weight-based dosing and single-use vials.
• High-cost medications like sugammadex are particularly affected by this waste.
• Current sugammadex dosing relies on quantitative monitoring, which is not routinely used.

Purpose of the Study:

• To demonstrate cost savings by aliquoting sugammadex from large vials.
• To utilize quantitative neuromuscular monitoring for accurate and appropriate sugammadex dosing.
• To reduce medication waste and associated expenses in pediatric anesthesia.

Main Methods:

• Sugammadex aliquots were prepared aseptically in the operating room pharmacy.
• Quantitative neuromuscular monitoring (electromyography-based) guided sugammadex administration.
• Cost analysis compared savings from aliquots versus single-use vials and avoided administrations.

Main Results:

• A total of 200 patients were analyzed.
• Sugammadex was administered from aliquots in 86 patients.
• 41 patients did not require sugammadex due to spontaneous recovery (TOF ratio ≥90%).

Conclusions:

• Administering sugammadex from aliquots, guided by quantitative monitoring, resulted in net cost savings of ~$46 per case.
• Projected annual savings for the institution reached nearly $370,000.
• Quantitative monitoring contributed 40% of savings by identifying patients not needing sugammadex.