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$9 per 200mg vial? My shop is getting robbed then. We are paying $20/200mg vial apparently.
Sugammadex Usage / Cost versus Benefit
Started by YadaYadaNext
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yes- confrimed
We’re paying $9 as opposed to $2 for N&G
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One of the best bargains in anesthesia.
I'd pay for that myself.
Always slippery rope cost/benefit ratio over anything
In high pace ent room. They always want crnas who can wake up and get the patient out of the room faster. They even did analysis average wake up up time 4 min faster with one crna over the others from end time to out of the or time. 6 cases on average each day. That 24 min of savings in the or for the day. Of course the or drags their feet with slower turnover time near 3pm and ruins any efficiency.
So why you we pay the crna 24 min of or time they save over the course of a day.
I’m old school. I can use either neostigme or bridion.
There are more inefficient road blocks in the operating room than one superior drug.
In high pace ent room. They always want crnas who can wake up and get the patient out of the room faster. They even did analysis average wake up up time 4 min faster with one crna over the others from end time to out of the or time. 6 cases on average each day. That 24 min of savings in the or for the day. Of course the or drags their feet with slower turnover time near 3pm and ruins any efficiency.
So why you we pay the crna 24 min of or time they save over the course of a day.
I’m old school. I can use either neostigme or bridion.
There are more inefficient road blocks in the operating room than one superior drug.
You literally make no sense in the post
We are talking about Bridion cost/ benefit
You can apply cost/benefit to any situation when it involves time savings in the or
The biggest road block to cost benefit in terms of or savings is due to humans. Not some magic drug waking up a patient
Rarely is Bridion needed for routine cases and most cases are routine these days.
I am well aware of what the discussion is about. Your rambling was incoherent. Go back a read what you actually wrote.
Yea thats why i blocked his posts awhile ago.
Its generally a jumbled word salad of incoherent statements.
I wouldn't be surprised if he somehow blamed the ACA for it
I think (because this is what I’ve seen in my ORs too) what he’s saying is that room turnover time is driven by techs mopping and the circulators and scrubs opening pans, which when they drag their feet can take several times longer than the improvement in time spent on reversal using sugammadex, so the fact that it’s faster doesn’t facilitate faster OR throughput.
Not certain, but I believe the money that suggamadex supposedly saves is not by slightly faster emergences, but fewer post op pneumonias, ICU admissions, reintubations, etc.
Yup.
Glyco and neostig are just a bad options.
Suga is faster onset, more reliable, less side effects, more predictable
Really no reason not to use it
right, but if I'm sitting in the OR waiting for the neostigmine to work, a) the techs can't start mopping, and b) I'm not in the lounge chilling while the techs are mopping. I get it, tho; I was a neostigmine officianado for a long time and I don't tend to hop onto things with hype, but I use sugammadex every chance I get.
Those same people are going to still drag their feet if using neo/glyco. But now you’ll also have to keep everyone around for an extra 1+ hour because the ORs ran longer.
What is the hourly labor cost for RNs + tech + EVS + sterile processing?
That is not an either-or argument that stands up to even basic scrutiny.
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“
Yes, there is significant legitimate skepticism around bias in the sugammadex literature, sharing many parallels with landmark industry-sponsored trials like the 2010 Darouiche NEJM ChloraPrep study.
In perioperative research, commercial sponsorship, design choices, and observational confounders frequently amplify the perceived superiority and cost savings of high-margin drugs over cheap generics.
Parallels to the "ChloraPrep" Model of Bias
The famous ChloraPrep trials faced criticism for comparing a proprietary combination (chlorhexidine + alcohol) against aqueous povidone-iodine (iodine without alcohol) rather than an equal alcoholic iodine solution—essentially testing alcohol vs. water rather than chlorhexidine vs. iodine.
A similar dynamic often appears in sugammadex research:
Unfair Comparator Protocols: Early trials often compared sugammadex (which acts in 2–3 minutes) against neostigmine administered at suboptimal times or without waiting the requisite 10–15 minutes before extubation, guaranteeing higher measured rates of "residual weakness" in the neostigmine arm.
Industry Sponsorship & Modeling Assumptions: Pharmacoeconomic models showing massive cost savings were frequently funded by Merck (the manufacturer of Bridion/sugammadex). Health-economic models are notoriously sensitive to input assumptions; by pricing OR time at maximum theoretical rates ($50–$100/min) and assuming every minute saved directly converts into billable revenue, cost models heavily tilt in favor of expensive drugs.
Key Methodological Biases in Sugammadex Research
Observational Confounding (Selection Bias): Much of the large-scale pulmonary complication data (such as the STRONGER study) comes from retrospective electronic health records rather than double-blind RCTs. Anesthesiologists often choose reversal agents based on subtle clinical intuitions that database propensity-matching cannot fully capture.
Conflating the Drug with the Monitor: Neostigmine fails primarily when given blindly without objective Train-of-Four (TOF) monitoring or when given during deep block. When neostigmine is dosed strictly under quantitative quantitative neuromuscular monitoring at moderate twitch recovery, the difference in clinical pulmonary complications between sugammadex and neostigmine shrinks dramatically.
Non-Realizable "OR Time" Savings: Saving 4 minutes in emergence does not actually save hospital money unless it allows an entire additional surgical case to be scheduled before staff shift changes. In practice, saving a few minutes between cases often just creates slight idle time, meaning the projected financial ROI is never realized in cash.”
The gylco/neo dinosaurs are also the ones who tend not to check twitches, dose neo/gluco arbitrarily based on "its been awhile since i gave roc" and have the most patients with resodual paralysis in pacu. Not 100% but certainly not 0.
I used to get called to evaluate others patients in pacu for that very reason..
I have yet to meet a single practitioner you actually believes that new/glyco is superior to suggamadex. Met a few that challenge it on a selective cost/benefit ratio. Do you actually know anybody that feels that way?
Less and less so these days. Most have converted..only holdouts were due to cost
Apparently aneftp based on last post
I think all of this is irrelevant, especially when we now have generic sugammadex available. The reality is, sugammadex is a targeted drug that allows the removal of roc from the neuromuscular junction. Neostigmine is a dirty drug that has so many negative side effects that we have to give glyco to prevent them. Not to mention the dependence on out-competing roc at the NMJ.
20 years from now, stories about the use of neostigmine will be shared around the campfire when sharing spooky stories. Just like the idea of not using ultrasound for art lines and central lines.
Saving OR time is probably the least important aspect of sugammadex. Even if sugammadex was slower than neo/glyco, its still better in terms of efficacy, reliability, predictability and side effect profile.
So yes, entirely irrelevant
have you use Rapacuronium Or mivacuriun in your career?
Drugs come and go.
We will see in the future.
cittykat
Full Member
Everyone knew mivacurium was a BS drug after using it a few times. Sugammadex is very different.
I wouldn't be surprised if within the next decade, residents wont even be trained in using neostigmine as a reversal anymore
have you use Neostigmine Or glycopyrrolate in your career?
Drugs come and go.
We will see in the future.
There are many programs where a typical resident will use sugammadex <5 times in their 3 years. I worked at a hospital where they rotated and we would have to teach them how to dose neo/glyco.
I will continue to use Neo/glyco for young females unless the birth control risk is disproven.
We found no evidence of a change in hormone levels that might threaten contraceptive efficacy in women on hormonal contraception receiving sugammadex.
Unfortunately the recommendation make take awhile to be removed, but appears that there is minimal evidence for the recommendation
Decent study. Hopefully they remove it, but even if I wonder if you could still find an expert witness to blame an unwanted pregnancy on sugammadex.
We used to call it MAYBE-curium…
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Would be a hard case to prove.
OCPs arent 100%..no proof that patient was taking OCPs regularly.
What would the damages be?
Hopefully they do more studies. Especially since the recommendation was only based on a theory
Or just tell them to keep it in their pants for a week. Usually not that big a deal after surgery of any kind.
But you could also put them at greater risk of a terrible and dangerous anesthetic experience. That's also a good option to mitigate the incredibly small chance of unintended pregnancy, for which you would never be held responsible any way if you told them to not have intercourse for a week.
Thank you, anefchatgpt
I quote it to signify I’m copy and pasting it.
It’s pretty clearly what I’m doing.
And I don’t just use chatgpt. I pay for Claude ai ($17 a month) wit my biz card and use my Google Gemini pro (included with Chase sapphire business sapphire Google workspace $200 annual perk)
Kinda funny too. His own post actually identifies some of the main issues with neostigmine.
You have to give it 10-15 mins before extubating..which few people do, because then they start coughing while they are still closing. So most people wait until a few mins before..not 15.
And you have to strictly monitor and assess TOF. Many dont. Otherwise you risk incomplete reversal
You cant maintain a deep block without risking resid paralysis.
So in the end, he acknowledged that neostigmine is more difficult to use, requires precise timing and precise monitoring that many anes dont do, and even then, at best, can only hope to matches the relative efficacy of sugam.
I do a lot of healthy peds, patients with essentially zero chance of pulmonary complications and who don’t follow directions well. Are you routinely counseling 15 year old girls on using backup contraception in the PACU?
No, because I’m not worried about a patient getting pregnant because she had sex within a week of having surgery, then subsequently blaming me for it somehow and suing me for….what exactly? Having unprotected sex a week after surgery, becoming pregnant, and then finding a rationalization for why her birth control failed that is unsubstantiated?
I practice defensively, but this fear of sugammadex is “penicillin allergy = no ancef” levels of bad medicine.
💯
Not to mention she would somehow have to prove that she maintained 100% OCP compliance before and after surgery.
All to mitigate a risk that was never shown to actually exist in the first place
I give sugammadex even if I have 4 twitches. If I give roc/vec, then theyre getting reversed.
Hospitals wont have my back for any adverse events, so screw them.
Sugamma momma every time, every case.
Hospitals wont have my back for any adverse events, so screw them.
Sugamma momma every time, every case.
Idk. I’ve never been burned by glyco and neostigmine…. Thankfully not my cases but have gone to help when suga was an issue…. One scary bradycardia and one full on code kounis reaction.
I for sure use it most of the time. It is a faster wake up… but well timed glyco/neo, gas titration and adjuvants can be almost as fast in a healthy patient… and too often I’m not the limiting factor and am waiting on everyone else anyways
