Changes in Intraoperative Rocuronium Dosing after the Introduction of Sugammadex and Association with Postoperative Respiratory Complications: A Retrospective Cohort Study
Authors' conclusion
Sugammadex introduction was followed by a 45.1% increase in rocuronium doses. While sugammadex attenuated the risk of postoperative respiratory complications, it was completely abolished only with quantitative neuromuscular monitoring.
Study context
- Population
- Adults under GA receiving exclusively rocuronium at an academic medical center, 2010–2024
- Participants
- 163,402 adult patient cases
- Exposure
- Rocuronium dosing before vs after sugammadex introduction (September 2016); dose-response with PPCs by sugammadex use and NMB monitoring
- Outcome
- Change in cumulative intraoperative rocuronium dose (mg/kg) after sugammadex introduction
Methodological detailsinterrupted time series analysis, single-centre (academic medical center)
- Interrupted time series analysis
- Single-centre (academic medical center)
Main finding
As reported in the abstract
Baseline trend Jan 2010–Aug 2016
−0.01 mg/kg
per year; 95% CI −0.05 to 0.03 mg/kgP = 0.58
Annual increase after sugammadex introduction
0.05 mg/kg
95% CI 0.03 to 0.07 mg/kgP < 0.001
Mean ± SD dose, August 2016
0.83 ± 0.49 mg/kg
Mean ± SD dose, January 2024
1.20 ± 0.65 mg/kg
Observational data: associations, not effects.
Further findings
| Outcome | aOR (95% CI) | P value | |
|---|---|---|---|
| Rocuronium dose-response for PPCs, neither sugammadex nor NMB monitoring (subgroup) | 1.99 (1.82–2.18) | P < 0.001 | |
| Rocuronium dose-response for PPCs, sugammadex administered (subgroup) | 1.08 (1.01–1.16) | P = 0.023 | |
| Rocuronium dose-response for PPCs, qualitative NMB monitoring (subgroup)n = 49,045 | 1.10 (1.02–1.18) | P = 0.017 | |
| 0.512Adjusted odds ratio (log scale) |
| Outcome | aOR (95% CI) | P value |
|---|---|---|
| Rocuronium dose-response for PPCs, quantitative NMB monitoring (subgroup)n = 25,564 | 10.94 (0.85–1.03) | P = 0.19 |
- Rocuronium dose-response for PPCs, sugammadex administered (subgroup): n = 42,141; median sugammadex dose 200 mg (IQR 200 to 300 mg)
- Rocuronium dose-response for PPCs, sugammadex administered (subgroup): P for interaction < 0.001
- Rocuronium dose-response for PPCs, quantitative NMB monitoring (subgroup): P for interaction < 0.001
- Rocuronium dose-response for PPCs, qualitative NMB monitoring (subgroup): P for interaction < 0.001
Postoperative respiratory complications (desaturation <90% postextubation, 7-day reintubation or emergency NIV)
- Incidence (9,101 of 108,317 patient cases)
- 8.4%
Original publication
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