Sugammadex introduction is associated with increased dosing of neuromuscular blocking drugs

Casey W. Drubin, Rachel C. Wolfe, Troy S. Wildes

Research output: Contribution to journalArticlepeer-review


Background: The introduction of sugammadex, a relatively new medication that can quickly and effectively reverse deeper states of neuromuscular blockade, may cause anesthesiology clinicians to change dosing patterns of neuromuscular blocking agents. Methods: We retrospectively examined intraoperative aminosteroid neuromuscular blocking agent (NMBA) usage at a large tertiary care hospital from 15 months before until 39 months after the introduction of sugammadex. For each surgical case using commonly used aminosteroid NMBAs, we normalized the observed dose to a predicted dose of NMBA calculated using case duration and patient weight. An observed-to-predicted aminosteroid NMBA dose ratio was calculated for all surgical cases in the QI project and this metric was used to compare NMBA dosage in the pre-sugammadex epoch with that in the post-sugammadex epoch. Results: The observed-to-predicted dose ratio increased from 0.509 ± 0.007 (n = 25,132) in the pre-sugammadex epoch to 0.524 ± 0.007 (n = 51,801) in the post-sugammadex epoch (p= 0.007). Using segmented regression with co-variate analysis, the regression slope representing daily change in aminosteroid NMBA observed-to-predicted dosage ratio increased from -1.06×10−4± 4.4 × 10−5 (n= 24,779) in the pre-sugammadex epoch to 9.01×10−5± 1.8 × 10−5 in the post-sugammadex epoch (n= 51,218) (p < 0.001). Conclusion: Aminosteroid NMBA dosage increased after the introduction of sugammadex. Potential explanations for this increased dosage include risk compensation, which is the tendency to engage in higher risk activities after a new safety measure is available.

Original languageEnglish (US)
Article number100242
JournalPerioperative Care and Operating Room Management
StatePublished - Mar 2022
Externally publishedYes


  • Clinical economics
  • Neuromuscular blocking agents
  • Rocuronium
  • Sugammadex
  • Surgical duration
  • Vecuronium

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine
  • Medical–Surgical
  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Sugammadex introduction is associated with increased dosing of neuromuscular blocking drugs'. Together they form a unique fingerprint.

Cite this