Percentage of adult and pediatric (>3yrs) cases with sugammadex administration where cumulative sugammadex dose is ≤ 200mg OR ≤ 3mg/kg.

Sugammadex was FDA approved in 2015. It works by irreversibly binding to and thereby reducing the amount of neuromuscular blocking agent available to bind to nicotinic cholinergic receptors in the neuromuscular junction.⁶ This results in the reversal of the paralytic effects of rocuronium and vecuronium.  Sugammadex has a rapid onset and can fully reverse patients that have deep neuromuscular blockade. ⁶  In a multicenter observational study of noncardiac surgeries, sugammadex administration was associated with a 30% reduced risk of pulmonary complications, 47% reduced risk of pneumonia and 55% reduced risk of respiratory failure.³  The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade endorse sugammadex over neostigmine for reversal of deep, moderate and shallow blockade.⁵

In addition, many centers are interested in cost-containment strategies given the current expense of sugammadex.^1,4  Some  are implementing formulary restrictions and investigating lower dosing options (0.5 or 1 mg/kg) or using ‘adjusted’ body weight instead of actual body weight for dosing.¹ This measure considers the fixed cost of the 200mg vial and acknowledges dose rounding given small injection volumes.²  This measure also encourages judicious use of neuromuscular blockade (NMB) agents, encouraging train-of-four values of at least 2 before reversing NMB with sugammadex. The measure threshold is adjusted to account for cases where sugammadex use above 200 mg or 3mg/kg may be required:  cannot intubate, cannot ventilate (CICV), unexpected discontinuation of surgery, and unique circumstances that may require special dosing parameters.¹

Anesthesia Start to Earliest Extubation

All cases in which sugammadex was administered AND patients were extubated.

• Age ≤ 2yrs
• ASA 5 and 6 cases including Organ Procurement (CPT: 01990)
• Cases <30 min
• Patients that were not extubated in the immediate postoperative period (as defined by the LMA Removal Times and Extubation Times phenotypes).
  • Will look for the earliest value resulted before Anesthesia End.

Cases where cumulative sugammadex dose was < 200 mg or < 3mg/kg.

• If neostigmine and sugammadex were administered during the measure time period, include case. If neostigmine was administered without sugammadex, exclude the case.
• Cases where weight is not documented will be excluded.
• Average dose of sugammadex in mg/kg will be added as column in Measure Case Report

*This measure will include valid  MPOG cases defined by the Is Valid Case phenotype.

Not applicable

 Provider signed into case at time of last sugammadex administration.

1. Anders MG, Albrecht JS, Gibbons M, Rock P, Implementation of a clinical practice measure to promote cost-conscious use of sugammadex, IARS Virtual Annual Meeting. 2021  
2. Bowdle, T. Andrew, Kishanee J. Haththotuwegama, Srdjan Jelacic, Sharon T. Nguyen, Kei Togashi, and Kelly E. Michaelsen. 2023. “A Dose-Finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis.” Anesthesiology 139 (1): 6–15.
3. Kheterpal S, et al. Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis. Anesthesiology. 2020
4. Pregnall AM, Gupta RK, Clifton JC, Wanderer JP. Use of provider education, intraoperative decision support, and an email-feedback system in improving compliance with sugammadex dosage guidelines and reducing drug expenditures. J Clin Anesth. 2022;77:110627. doi:10.1016/j.jclinane.2021.110627
5. Thilen, Stephan R., Wade A. Weigel, Michael M. Todd, Richard P. Dutton, Cynthia A. Lien, Stuart A. Grant, Joseph W. Szokol, et al. 2023. “2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade.” Anesthesiology 138 (1): 13–41.
6. Yost, S. Clinical Review, n.d. https://www.fda.gov/media/152066/download