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Sugammadex for the Reversal of Neuromuscular Blockade in Surgical Patients: A Review of Clinical Effectiveness and Cost-Effectiveness

Last updated: August 6, 2019
Project Number: RC1161-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of rocuronium with sugammadex versus succinylcholine in patients undergoing surgery?
  2. What is the cost-effectiveness of sugammadex in patients undergoing surgery

Key Message

Three randomized controlled trials were identified regarding the clinical effectiveness of rocuronium with sugammadex compared with succinylcholine in patients requiring rapid sequence induction. The evidence consisted of low- to moderate-quality studies conducted in adult patients undergoing three different procedures (i.e., outpatient surgery, bronchoscopy, and electroconvulsive therapy) using different dose combinations for rocuronium, sugammadex, and succinylcholine. For deep neuromuscular block, moderate-quality evidence from one study suggested that rocuronium with sugammadex had a shorter time to spontaneous respiration and eye-opening as compared with succinylcholine. In contrast, moderate-quality evidence from another study suggested that patients treated with low-dose rocuronium and low-dose sugammadex had longer times to first eye opening compared to patients treated with low-dose succinylcholine for very short procedures. There was limited low- to moderate-quality evidence that the use of rocuronium with sugammadex was associated with less myalgia, fewer headaches and sore throats, fewer fasciculations, and less myalgia, as compared to succinylcholine.There was also limited low- to moderate-quality evidence to suggest that rocuronium with sugammadex made no difference compared to succinylcholine with regards to patient satisfaction, extubation time, residual neuromuscular block, post-operative nausea or vomiting, discharge from the operating room or the post-anesthesia care unit, overall adverse events, and serious adverse events. Evidence from one moderate-quality study suggested that low-dose succinylcholine resulted in better intubation conditions and a shorter time to intubate compared to low-dose rocuronium and sugammadex. For the most part, the small quantity of heterogenous evidence suggests that the clinical effectiveness of rocuronium with sugammadex in patients requiring rapid sequence induction was better or no different compared with succinylcholine. However, there were three outcomes that favoured low-dose succinylcholine compared to low-dose rocuronium and sugammadex. One cost-effectiveness evaluation was identified for sugammadex and the evidence was summarized in a previous CADTH report on sugammadex. Sugammadex may lead to economic savings in the hospital setting, however, the certainty of the findings is unclear.