Characterization of Sugammadex Use in the Intensive Care Unit and Emergency Department

Introduction: Sugammadex is a selective relaxant binding agent used to reverse the paralytic effects of non-depolarizing neuromuscular-blocking agents such as rocuronium. Dosing of this medication varies by weight, timing of paralytic, and train-of-four (TOF) stimulation. Providers can order 2 mg/kg, 4 mg/kg, or 16 mg/kg of sugammadex with the emergency department (ED), intensive care unit (ICU), and operating room (OR) at our institution. This medication use evaluation aimed to describe the use of sugammadex within critically ill patients in the ED and ICU at an academic medical center.


Methods: This was a single-center retrospective cohort study. Doses of sugammadex administered in the ED or ICU from December 1, 2024, to May 31, 2025, were reviewed. Doses of sugammadex that were duplicate or administered in the OR were excluded. Appropriate dosing was defined as a composite of receiving a dose of 2-4 mg/kg, a dose rounded to the nearest 200 mg or 400 mg increment, and a dose administered within 1 hour (+/- 5 minutes) of receiving a paralytic. Data was collected using Slicer Dicer within EPIC®. Descriptive statistics were used for evaluation.


Results: During the study period, there were 106 administrations of sugammadex identified across seven ICUs and two ED’s. Seven administrations were excluded as duplicates, and 69 due to administration in the OR. Thirty doses were included in the final review. The percentage of administrations with appropriate dosing was 67%. The median age was 60.8 years (48.25-74), and weight was 84.4 kg (73-96.9). The most common and median dose of sugammadex administered was 200 mg. Eight patients (27%) received sugammadex after rocuronium administration for rapid sequence intubation, 5 patients (17%) after tracheostomy, and 4 patients (13%) after a bronchoscopy. There were 3 (10%) administrations with TOF documented. The highest percentage of administrations was in the cardiothoracic ICU.


Conclusions: Sugammadex was dosed appropriately in the majority of administrations in critically ill patients; however, documentation of TOF was lacking. Future directions include optimization of documentation and establishing appropriate indications for use in critically ill patients.