Sugammadex: Enhancing Efficiency and Safety in Neuromuscular Blockade Reversal — Clinical and Economic Perspectives

Sugammadex: Clinical and Economic Perspectives

Authors

  • Andrew Barnthson

Abstract

Introduction
Efficient reversal of neuromuscular blockade (NMB) is critical for patient safety, recovery, and operating room (OR) efficiency. Traditional reversal with neostigmine and glycopyrrolate relies on competitive physiologic mechanisms, often resulting in variable recovery and residual blockade. Sugammadex, a γ-cyclodextrin compound approved in 2015, directly encapsulates steroidal neuromuscular blocking agents and provides rapid, predictable reversal. Despite clinical advantages, high drug costs have limited its unrestricted use. This review evaluates the efficacy, safety, and economic impact of sugammadex compared to conventional methods.

Methods
A literature review was conducted using Google Scholar, Anesthesia & Analgesia, and UpToDate. Keywords included “sugammadex cost,” “sugammadex financial impact,” and “sugammadex adverse effects.” Over 30 articles were screened; 16 peer-reviewed studies met inclusion criteria, focusing on clinical efficacy, cost analyses, and postoperative outcomes. Extracted data included recovery times, incidence of residual blockade, length of stay, complications, drug acquisition costs, and OR efficiency metrics.

Results
Sugammadex demonstrated significantly faster reversal than neostigmine, reducing mean recovery by ~1.8 minutes and lowering rates of postoperative residual paralysis. Randomized trials confirmed improved recovery profiles and more predictable extubation. Clinical studies showed shortened induction, emergence, and turnover times, with higher surgeon satisfaction. Safety analyses revealed no overall increase in postoperative delirium, though one large cohort found slightly higher odds of early delirium within 24 hours. Economic models consistently showed higher direct drug costs but potential net savings when factoring reductions in pulmonary complications, PACU stay, and OR time. In cost simulations, sugammadex became favorable when OR time was valued at $8.60 per minute or higher—well within real-world hospital estimates. Surveys indicated variable adoption, with inconsistent use of quantitative neuromuscular monitoring despite its role in optimizing outcomes.

Conclusion
Sugammadex provides faster, more reliable neuromuscular blockade reversal than neostigmine, with benefits for OR efficiency and potential reductions in complications. Although drug acquisition costs remain a barrier, economic evidence supports its value in high-volume surgical settings. The anticipated arrival of generic formulations will likely improve affordability and accessibility. Selective use of sugammadex, combined with standardized neuromuscular monitoring, may offer the greatest balance between clinical efficacy and cost-effectiveness.

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Published

2025-12-10

Issue

Vol. 9 No. 5 (2025): Articles

Section

Healthcare Administration

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