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Anesthesiology Research and Practice
Volume 2015 (2015), Article ID 367937, 4 pages
Research Article

Neuromuscular Monitoring, Muscle Relaxant Use, and Reversal at a Tertiary Teaching Hospital 2.5 Years after Introduction of Sugammadex: Changes in Opinions and Clinical Practice

1Department of Anaesthesia, Royal Perth Hospital, Perth, WA 6000, Australia
2University of Western Australia, Perth, WA 6009, Australia
3Royal Perth Hospital, Perth, WA 6000, Australia
4Department of Intensive Care, The Alfred Hospital, Melbourne, VIC 3000, Australia

Received 5 September 2014; Revised 18 December 2014; Accepted 24 December 2014

Academic Editor: Yukio Hayashi

Copyright © 2015 Thomas Ledowski et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Sugammadex was introduced to Royal Perth Hospital in early 2011 without access restriction. Two departmental audits (26-page online survey and 1-week in-theatre snapshot audit) were undertaken to investigate the change of beliefs and clinical practice related to the use of neuromuscular blocking agents at the Royal Perth Hospital since this introduction. Results were compared with data from 2011. We found that, in the 2.5 years since introduction of Sugammadex, more anesthetists (69.5 versus 38%) utilized neuromuscular monitoring, and aminosteroidal neuromuscular blocking agents were used in 94.3% of cases (versus 77% in 2011). Furthermore, 53% of anesthetists identified with a practice of “deeper and longer” intraoperative paralysis of patients. All 71 patients observed during the 5-day in-theatre audit were reversed with Sugammadex. Since the introduction of Sugammadex, 69% of respondents felt it provided “faster turnover,” less postoperative residual neuromuscular blockade ; 79%), and higher anesthetist satisfaction ; 59%). 45% of colleagues reported that they would feel professionally impaired without the unrestricted availability of Sugammadex, and 1 colleague would refuse to work in a hospital without this drug being freely available. In clinical practice Sugammadex was frequently (57%) mildly overdosed, with 200 mg being the most commonly administered dose.