Analysis of Clinical Outcomes and Cost-Effectiveness of Neuromuscular Blocking Drug Reversal in Patients with Obstructive Sleep Apnea

Non-depolarizing neuromuscular blockers are used during many surgical procedures to induce muscle relaxation for tracheal intubation and improve surgical conditions for surgeons. The use of these medications requires an agent to be given to fully reverse the effects of the neuromuscular blocking drug. Historically, neostigmine has widely been used as the primary reversal agent. However, sugammadex, a recently FDA approved drug, is also available for the reversal of common neuromuscular blocking drugs, rocuronium and vecuronium. In the literature, sugammadex is widely regarded as a clinically superior reversal agent. But its use is commonly limited to emergent situations due to the high price associated with the drug. A risk associated with reversal agents is incomplete recovery from the neuromuscular blockade that can lead to postoperative pulmonary complications. Patients with certain comorbidities are at higher risk for postoperative pulmonary complications (PPCs). Patients with obstructive sleep apnea already struggle with airway obstruction and may be at higher risk for adverse outcomes after the use of neuromuscular blocking agents (NMBAs). Therefore, this project seeks to provide evidence-based recommendations for NMBA reversal in patients diagnosed with or identified as at risk for OSA through a literature search and synthesis. Therefore, the project developed evidence-based practice recommendations utilizing the John Hopkins Nursing Evidence-Based Practice Model by asking a practice question, evaluating, and translating findings into practice. The project will also outline a plan for implementation and evaluation of outcomes such as cost effectiveness and clinical outcomes