Reversal of Neuromuscular Blockade: A Discrete Event Simulation Model of Clinical and Operating Room Efficiency Outcomes of Sugammadex Versus Neostigmine In Canada.

• Neuromuscular blocking agents (NMBAs) are often administered during surgical procedures to provide muscle relaxation and prevent patient movement, which may increase the risk of surgical complications • When neuromuscular block no longer needs to be maintained, patients may either be allowed to spontaneously recover neuromuscular function or be administered a reversal agent for more rapid recovery • Sugammadex is a reversal agent licensed in the European Union, but not yet available in Canada, to reverse neuromuscular blockade induced by the NMBAs rocuronium and vecuronium • In clinical trials, sugammadex produced much more rapid and predictable reversal of neuromuscular block than comparator reversal agent neostigmine and, when quantitative neuromuscular monitoring was not required, a steep reduction in the incidence of residual neuromuscular blockade1-5 • In addition, sugammadex is effi cacious in rapidly reversing deep levels of neuromuscular blockade,6-8 whereas neostigmine is not8,9 • Prior models of sugammadex10,11 have explored potential impacts on operating room (OR) effi ciency and/or clinical outcomes modeling a single procedure – Or via a simple summation of identical procedures • To better understand sugammadex’s impact within the OR overall, a discrete event simulation (DES) model was developed to simulate an entire OR day over a 1-month period