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Thought Leader Session

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Aging Adult Track

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Research Snapshot Theater: Quality and Patient Safety, Adult and Pediatric III

Rationalizing the Use of Sugammadex in Postoperative Patients of Cardiothoracic Surgery in the ICU

Sunday, March 22, 2026

12:15 PM - 1:15 PM Central Time

Location: Connections Central - RST 10

SG

Saptarshi Ghosh, MBBS

Disclosure(s): No relevant financial relationship(s) to disclose.
KH

Katelyn Henninger, BSN, RN

Program Manager - Cardiovascular Disease
Mayo Clinic Florida

Disclosure information not submitted.
CA

Cristina Amendola, MD, PhD

Specialist in Intensive Care Medicine
Barretos Cancer Hospital (Hospital de Amor), Sao Paulo, Brazil

Disclosure information not submitted.
JL

Jesse LaMotta, RN

Registered Nurse, Critical Care
Mayo Clinic Florida

Disclosure information not submitted.
CR

Carolina Robles de Brady, RN

Registered Nurse, Critical Care
Mayo Clinic Florida

Disclosure information not submitted.
SD

Sandy Deniz, RN

Registered Nurse, ICU
Mayo Clinic Florida

Disclosure information not submitted.
AS

Amanda Santoro, RN

Registered Nurse
Mayo Clinic Florida

Disclosure information not submitted.
SB

Sara Budhwani, RN

Registered Nurse, ICU
Mayo Clinic Florida

Disclosure information not submitted.
MC

Michael Crouch, RN

Registered Nurse, Critical Care
Mayo Clinic Florida

Disclosure information not submitted.
RR

Roshani Rana, RN

Registered Nurse, ICU
Mayo Clinic Florida

Disclosure information not submitted.
PB

Paris Bumgardner, RN

Registered Nurse, ICU
Mayo Clinic Florida

Disclosure information not submitted.
SB

Shivang Bhakta, MD

Internal Medicine Physician
Clinical Research at Montefiore Medical Center

Disclosure information not submitted.
JS

Jenny Shapiro, RN

Registered Nurse - Manager of Surgical ICU at Mayo Clinic Florida
Mayo Clinic Florida

Disclosure information not submitted.
SB

Stephen Brim, RN

Registered Nurse, ICU
Mayo Clinic Florida

Disclosure information not submitted.
SC

Sanjay Chaudhary, MD

Consultant, Critical Care Medicine
Mayo Clinic Hospital in Florida

Disclosure information not submitted.
TM

Terri Menser, PhD, MBA

Senior Associate Consultant in Healthcare Delivery Research
Mayo Clinic Florida

Disclosure information not submitted.
KT

Klaus Torp, MD

Consultant, Anesthesiology
Mayo Clinic Hospital in Florida

Disclosure information not submitted.
PM

Pablo Moreno Franco, MD

Chair, Critical Care Medicine
Mayo Foundation for Medical Education

Disclosure information not submitted.
RR

Ross Renew, MD

Consultant, Anesthesiology
Mayo Clinic Florida

Disclosure information not submitted.
AS

Anna Shapiro, MD

Consultant, Anesthesiology and Critical Care
Mayo Clinic Florida

Disclosure information not submitted.

Introduction: Sugammadex is a recently approved reversal agent of neuromuscular blockade. Adequate reversal in the ICU is important to prevent sequelae of residual paralysis like prolonged hospital stays and increased reintubation rates. Also, excessive use of sugammadex can increase adverse effects like anaphylactoid reactions, bradycardia or headache. A quality improvement (QI) protocol for proper dosing of sugammadex in ICU patients post-cardiothoracic surgery was studied.

Methods: A QI training was done with nurses, physicians, nurse practitioners and physician assistants in the cardiothoracic surgical ICU of Mayo Clinic Florida, from October 2024 to February 2025, to implement quantitative monitoring of train-of-four (TOF) ratio in postoperative patients for appropriate dosing of sugammadex for reversal. The TOF ratio was monitored using acceleromyography. The following protocol was used - on arrival of paralyzed patient to the ICU, if spontaneous recovery had reached ≥2 twitches, then 2 mg/kg sugammadex was given. If recovery had reached < 2 twitches but had reached 1 to 2 post tetanic contractions (PTCs), 4mg/kg sugammadex was given. When all 4 twitches were present, the quantitative monitor was used to check the TOF ratio (magnitude of 4th twitch divided by 1st twitch). If ratio < 0.9, then 2mg/kg was administered, and if >0.9, patient was considered fully reversed with no dose given. The dose used per patient after the training was compared to the empiric dosing practiced previously. A total of 72 patients (33 before and 39 after training) were analyzed. The doses were summarized as median with interquartile range (IQR), and compared by the Wilcoxon rank-sum test. IBM SPSS Statistics ver. 31.0 was used for analysis.

Results: The median sugammadex dose (mg) administered per patient before the training was 200 [200,200]. After the training it increased to 285 [200,400]. The difference between the dose before and after training was significant, p=0.004. Correcting for body weight, the median dose administered (mg per kg body wt) before training was 2.36 [2.14, 2.66]. After training, it increased to 3.93 [2.03, 4.00]. The difference was significant, p=0.014.

Conclusions: The QI study highlighted a need for more precise sugammadex dosing by quantitative TOF ratio monitoring post-cardiothoracic surgery.