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.
Cases where cumulative sugammadex dose was < 200 mg or < 3mg/kg.
*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.
Measure Author | Institution |
Megan Anders, MD |
University of Maryland |
Nicole Barrios, MHA, BSN |
University of Michigan |
Nirav Shah, MD |
University of Michigan |
Brad Taicher, DO, MBA |
Duke Uniersity |
Published Date: 10/2023 |
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Date |
Criteria |
Revision |
12/6/2023 |
Measure Time Period |
Added time check for LMA removal |
10/23/2023 |
Initial Spec |