People are more likely to administer a poison when the antidote is immediately available. Anaesthetists are more likely to provide rocuronium muscle relaxation to their patients when Sugammadex is immediately available.
‘No longer should Sugammadex be kept hidden away centrally in some locked cupboard, but available immediately to hand in the anaesthetic/operating room.’
Immediate (in theatre drug trolley) Sugammadex will benefit rapid reversal where a patient’s deteriorating airway can just be ventilated:
‘We found that costly time was lost because sugammadex was not directly available in the operating theatre. This decision was made at a managerial level because sugammadex is an expensive drug.’ (See Anaesthesia Sept 2010)
Understandably hospital administrators have warmed to those anaesthetists proclaiming immediate access to Sugammadex is unnecessary – it takes the pressure off them and their budget – this is very short sighted as there are numerous hidden cost benefits to Sugammadex (see here). This in turn leads to stress on front line staff members who understand immediate access is in the interest of optimal patient management.
There are several reports of successful Sugammadex use in airway rescue: (see here) However it’s vital we educate its use is unreliable in airway emergency. It is unlikely appropriate in a CICO situation. For those pre-emptively considering its use when managing a difficult airway perhaps understand that an alternative approach will be more suitable.
It’s intuitive, that in rare cases of airway rescue if rapid reversal may benefit, a sufficient dose of Sugammadex needs to be immediately available in the theatre drug trolley.
A box of 10 vials of 200mg Sugammadex ensures a 16mg/kg dose for patients weighing up to 125kg.
The cost of Sugammadex restricts availability. From our understanding the cost of a 200mg vial in Australia varies from A$45 to 195 depending on contract agreements.
There are institutions who do not purchase it, and others who only make it available from a centrally located locked cupboard.
We present a tiered approach to Sugammadex restriction which limits use but ensures immediate availability in sufficient dose:
We hope that healthcare institutions adopt this approach enabling optimal patient safety while allowing for current cost constraints.
How you can help:
1. Ensure your institution has immediate access (in theatre drug trolley) to sugammadex so it may be rapidly drawn up to reverse a large induction dose of rocuronium (1.2mg/kg).
2. Offer to perform an audit of Sugammadex usage.
4. Forward any interesting anecdotal cases where the presence or absence of Sugammadex may have had a significant impact (avoid any identifiers).
5. For those colleagues still undecided about the benefits of unrestricted access to Sugammadex provide a link to the following article:
While Merck did not develop Sugammadex, through a series of acquisitions they now control the price.
Sugammadex is overpriced.
This is detrimental to patient care and places unnecessary stress on hospital staff. We should encourage Merck to reduce the price so we may all benefit from unrestricted access. This is after all their company mantra:
We ask that Merck do the right thing – the healthcare community won’t forget their decisions – we can only hope that Merck remember ‘medicine is for the people‘.
Please note that patientsafe has no financial interest with Merck (MSD) or Sugammadex.