| Summary: | 碩士 === 義守大學 === 管理碩博士班 === 107 === Background. Neuromuscular blocking agents such as rocuronium are widely used to maintain patient immobilization and facilitate mechanical ventilation support during general anesthesia. Therefore, the recovery of voluntary muscle power is essential during the emergence and recovery phases of anesthesia for the return of adequate spontaneous respiration, cough reflex and motor function. Development of respiratory failure due to residual muscle relaxation effect increases risk of re-intubation of endotracheal tube and requires prolonged ventilatory support, leading to serious post-anesthesia complications, even death. Sugammedex is a modified cyclodextrin that encapsulates rocuronium molecules, and thus rapidly inactivates the neuromuscular blockade effect of rocuronium. Unlike the classic reversal agents, sugammedex is associated with less systemic adverse reaction due to the lack of the antimuscarinic and anticholinergic effect. This research project aimed to analyze the cost-benefit of sugammedex in perioperative care.
Methods. This study retrospectively analyzed the medical records of patients received endotracheal tube intubation general anesthesia (ETGA) from August 2016 to August 2018. Patients who admitted to intensive care unit (ICU) after operation or extubated of the endotracheal tube outside the operation room (OR) were excluded. The development of acute respiratory failure after removal of endotracheal tube in the OR and required re-intubation in OR or at postanesthetisa care unit (PACU) were recorded for the agents used for reversing neuromuscular blockade and the clinical outcomes of individual patient. The increased length of hospital-stay and extraneous medical expense due to failure of extubation was calculated according the xxx model.
Results. A total of 44328 patients were included in this analysis, including 2951 (6.6%) of these patients received sugammedex for reversal of neuromuscular blockade at the end of operation. There were 19 cases developed acute respiratory distress who required re-intubation during the study period. Compared with sugammedex treatment group, the incidence of re-intubation was higher in the conventional reversal group (0% vs 0.045%, respectively; P=0.633 Fisher Exact test), as all the acute respiratory failure cases did not receive sugammedex for muscle relaxant reversal. The relative risk of reintubation for conventional reversal use was 2.78 (95% CI 0.17-46.09; P=0.475). All the cases required re-intubation was transferred to ICU for postoperative care and 2 patients (10.53%) eventually expired after the event. The average per person medical care expense in the ICU and labor productivity loss was NT$ 11334 and NT$1570.2, respectively, resulting in an overall social cost of NT$ 2902.3 for a newly developed case of acute respiratory failure after extubation. However, the increase in social costs caused by not using Sugammadex is 2902.3 yuan per person, but Sugammadex is 6,000 yuan at its own expense, so it is not cost-effective for the patient to use Sugammaderx for money, but the feeling of satisfaction is cost-effective. The net benefit of the cost-benefit analysis is 1,560,906.60, and the cost-to-book ratio is 1.08, which is cost-effective.
Conclusion. Based on the holistic health care principle, use of sugammedex as the reversal agent for neuromuscular blockade during recovery of anesthesia provides high cost-effectiven -ess in prevention of acute respiratory failure after extubation, reduction of extra medical expe -nse and labor productivity loss for unplanned intensive care, and enhancement of medical car -e quality. Furthermore, the avoidance of postoperative complications may potentially prohibit the unnecessary medical dispute between the health providers and the patients.
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