DOI

10.21007/con.dnp.2025.0127

Faculty Advisor

Tracy McClinton, DNP, APRN, AGACNP-BC, HGET-C, EBP-C

Subject Matter Expert

Dwayne Accardo, DNP, CRNA, FAANA

Clinical Site

Methodist University Hospital

Document Type

Poster

Publication Date

Spring 5-7-2025

Disciplines

Anesthesiology | Health and Medical Administration | Investigative Techniques | Medical Pharmacology | Medicine and Health Sciences | Nursing | Nursing Administration | Perioperative, Operating Room and Surgical Nursing | Quality Improvement

Abstract

Purpose/Background

Sugammadex and neostigmine are two common drugs used to reverse neuromuscular blockade in anesthesia, but they differ in mechanism of action, side effects, and cost.

Sugammadex provides rapid reversal, has fewer side effects, and has a lower risk of bradycardia than neostigmine. This scoping review examines the frequency of bradycardia in adult surgical patients receiving sugammadex versus neostigmine.

Methods

A scoping review was completed of peer-reviewed articles comparing the incidence of bradycardia in adult surgical patients after the administration of sugammadex and neostigmine for neuromuscular blockade reversal. Findings indicate that sugammadex resulted in fewer adverse events, including bradycardia, than neostigmine. Articles were critically appraised for quality and relevance, and results were synthesized to evaluate clinical outcomes and complications.

Results

The scoping review included ten articles assessing the safety profiles of sugammadex and neostigmine for neuromuscular blockade reversal, focusing on the incidence of bradycardia. High-quality evidence from randomized controlled trials and meta-analyses consistently demonstrated that sugammadex was associated with a lower incidence of bradycardia and adverse effects than neostigmine. Sugammadex showed particularly favorable outcomes in patients at high cardiovascular risk, such as those undergoing cardiac surgery. While some Level IV studies reported mixed results, including occasional increases in bradycardia with sugammadex, the majority of evidence highlighted its superior safety and efficacy. These findings support the administration of sugammadex as a safer alternative to neostigmine, though patient-specific considerations remain essential.

Implications for Nursing Practice

The findings of this scoping review suggest that using sugammadex for neuromuscular blockade reversal reduces the incidence of bradycardia compared to neostigmine, enhancing patient safety. Effective implementation of sugammadex in clinical practice requires standardized protocols and ongoing evaluation to ensure optimal patient outcomes. Further studies are necessary to explore long-term safety, cost-effectiveness, and broader clinical applications of sugammadex.

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