Association of Clinico-demographic Characteristics in the Use of Muscle Relaxant Reversal Agents in a Tertiary Hospital in the Philippines

Abstract

This retrospective observational study investigated the factors influencing neuromuscular blocking agent (NMBA) reversal agent use at Amang Rodriguez Memorial Medical Center (ARMMC) from June to December 2023. NMBAs facilitate endotracheal intubation, but reversal agents like Sugammadex and Neostigmine are used to prevent complications such as residual neuromuscular blockade. Objectives. This study aimed to determine the prevalence of reversal agent use and identify clinico-demographic characteristics affecting Sugammadex and Neostigmine administration. Data was collected via total enumeration sampling and chart review of 294 patients who underwent general anesthesia. The study examined variables including age, sex, BMI, comorbidities, ASA classification, and the specific muscle relaxant and reversal agent used. Statistical analysis involved descriptive statistics, Chi-square tests, and multivariate logistic regression. Results showed that Sugammadex was used in 69.4% of reversals. Significant associations were found between age and reversal agent choice, with Sugammadex favored in children (p<0.001) and Neostigmine in middle-aged and older patients. Obese patients were more likely to receive Neostigmine (p=0.039). Patients with ASA II or III classifications and comorbidities were more likely to be reversed with Sugammadex (p=0.038). Notably, bronchial asthma was associated with a decreased likelihood of Sugammadex use (OR = 0.12, p = 0.05). This study highlights the influence of patient characteristics on reversal agent selection at ARMMC. The findings can inform the development of local guidelines to optimize NMBA reversal practices and improve patient safety.