Do The Benefits Of Sugammadex Outweigh Its Higher Cost Compared To Neostigmine?

Neuromuscular blocking agents (NMBAs) are frequently utilized in anesthetic practice to relax the vocal cords in preparation for endotracheal intubation and to facilitate optimal operating conditions for various surgical procedures. Residual muscle paralysis in the postoperative period is a serious consequence of NMBAs that can lead to severe consequences including airway obstruction, hypoxia, reintubation, aspiration, and pneumonia. Neuromuscular blockade (NMB) is overcome either by spontaneous recovery or, in most cases, with the use of a reversal agent. Two of the most common reversal agents are neostigmine, a cholinesterase inhibitor, and sugammadex, a modified gamma-cyclodextrin. Of the two medications, sugammadex is a significantly more expensive option per dose, which creates budgetary concerns and leads to restrictions on its usage. However, sugammadex provides a markedly faster, more reliable, and more effective reversal of neuromuscular blockade compared to neostigmine with fewer side effects. By accelerating recovery from NMB with fewer adverse effects, patients spend less time in the operating room (OR) and post-anesthesia care unit (PACU) with fewer respiratory complications. Taking these factors into consideration, the higher medication cost of sugammadex can potentially be justified and/or offset by its superior safety profile and savings in OR and PACU time