Utility of Readily Available Sugammadex for Emergent Neuromuscular Blockade Reversal

Anesthesia providers are often called upon to assist with other providers during can't intubate, can't ventilate (CICV) scenarios. The current availability of doses of sugammadex sufficient to provide emergent reversal of neuromuscular blockade in an operating room environment requires visits to multiple operating rooms at our institution. The Anesthesiology Department at OhioHealth Doctors Hospital sought to evaluate the practicality of administering a rescue dose of sugammadex (16 mg/kg) in a CICV scenario. The current storage of sugammadex is six 200 mg vials maximum per operating room, which would provide insufficient dosing for emergent reversal dosing for most adult patients. Furthermore, an audit of our operating room environment found that the average available during a given workday is four vials of sugammadex (800 mg total) per operating room. A simulation-based quality improvement project was devised to test the feasibility of the creation of an emergent reversal kit with six 500 mg vials and a 30 mL syringe in an easily accessible location equidistant from all operating rooms to provide emergent reversal in a CICV scenario.

The study involved anesthesia trainees (residents and student registered nurse anesthetists (SRNAs), n = 6) participating in a simulated CICV scenario at OhioHealth Doctors Hospital in Columbus, OH, where they were instructed to obtain an emergent reversal dose of sugammadex while others completed the ASA difficult airway algorithm. Each participant completed three iterations of the current arrangement in which they visited multiple operating rooms to obtain the appropriate dose. Participants then completed two iterations in which they utilized an emergent reversal kit. The time from request for sugammadex to the administration of a complete reversal dose was recorded. The data collected were evaluated to determine if a statistically significant improvement in the utilization of the emergent reversal kit was present. A one-tailed paired t-test was used to evaluate if the use of an emergent reversal kit resulted in a statistically significant reduction in the time to administration (p < 0.001).

Our study found a statistically significant decrease in the time to reversal when an emergent reversal kit of six 500 mg vials is placed in an easily accessible location. The mean time for anesthesia residents to successfully reverse neuromuscular blockade was 7.7 minutes on their first attempt without the emergent reversal kit and decreased to 2.9 minutes after practice (on the third attempt). However, implementation of an emergent reversal kit resulted in further time reduction to a mean time of 2.1 minutes on their first attempt and 1.4 minutes on their second attempt when using the emergency reversal kit. These findings reinforce the importance of medication accessibility in high-stakes scenarios and provide a novel method for improving emergency preparedness in anesthesia practice.