SUGAMMADEX IN GENERAL ANAESTHESIA

Sugammadex for reversal of muscle relaxation in general anaesthesia: a systematic review and cost-effectiveness analysis

Background

Neuromuscular blocking agents (NMBA) are muscle relaxants used in anaesthesia that enable relaxation of the vocal cords for the passage of a tracheal tube and adequate relaxation of the muscles of the abdomen and diaphragm for surgical access. There are two main categories of NMBA: depolarising (e.g. suxamethonium ) which are rapid in onset and short acting but associated with a number of significant adverse side effects; and non-depolarising (e.g. rocuronium, vecuronium) which have a longer time to onset and a longer duration of action. It is estimated that there are about 0.8 million procedures currently use rocuronium or vecuronium for muscle relaxation and an estimated 66% of these will require reversal (currently 528,000 procedures).

Sugammadex is a selective non-depolarising muscle relaxant binding agent that is in phase III clinical trials to reverse the neuromuscular blockade induced by rocuronium or vecuronium. The potential benefit of the new combination is faster recovery from anaesthetic, which could free up resources within the operating department recovery area.

The aim of this review was to determine the efficacy and safety of sugammadex for the reversal of muscle relaxation during standard intubation and emergency intubation. The review also investigated, through the use of an economic model, whether this treatment would be cost effective in UK practice.

Findings

There are potential benefits of sugammadex in terms of increased patient safety, increased predictability of recovery from neuromuscular block, more efficient use of theatre time and staff, but these have yet to be explored in clinical practice. New practices in anaesthesia may have to be adopted before the full benefits of sugammadex can be realised.

Conducted by: D Chambers1, M Paulden2, F Paton1, M Heirs1, S Duffy1, D Craig1, J Hunter3, J Wilson4, M Sculpher2, N Woolacott1

1. Centre for Reviews and Dissemination; 2. Centre for Health Economics, University of York; 3. University Department of Anaesthesia, University of Liverpool; 4. York NHS Trust

Further details

Project page on NIHR HTA Programme website

Publications

Chambers D, Paulden M, Paton F, Heirs M, Duffy S, Craig D. Sugammadex for the reversal of muscle relaxation in general anaesthesia: a systematic review and economic assessment. Health Technol Assess. 2010;14(39):1-211

Chambers D, Paulden M, Paton F, Heirs M, Duffy S, Hunter JM, Sculpher M, Woolacott N. Sugammadex for reversal of neuromuscular block after rapid sequence intubation: a systematic review and economic assessment. Br J Anaesthesia. 2010; 105(5):568-75

Paton F, Paulden M, Chambers D, Heirs M, Duffy S, Hunter JM, Sculpher M, Woolacott N. Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation. Br J Anaesthesia. 2010;105(5):558-67

Posters

Chambers D, Paton F, Hunter J, Heirs M, Duffy S, Woolacott N. Is there a role for sugammadex in the reversal of neuromuscular blockade? A systematic review. HTAi 2010. Dublin, Ireland, 6 - 9 June 2010

Funding

Commissioned by the NIHR HTA Programme as part of the Technology Assessment Report (TAR) process