Sugammadex to Facilitate Neurologic Assessment in Severely Brain-Injured Patients: A Retrospective Analysis and Practical Guidance.

Background Widely used in anesthetic management, sugammadex is increasingly employed in the reversal of neuromuscular blocking agents (NMBAs) in the emergency department and critical care arena, where little evaluative data currently exists. This study explored the utility and safety of using sugammadex to facilitate neurologic assessments in critically ill, NMBA-exposed patients. Methods We pursued a retrospective case series and single-arm cohort analysis of all brain-injured patients receiving sugammadex to facilitate neurologic evaluation during one year at a high-volume Level 1 trauma center. The primary outcome was the qualitative impact of sugammadex administration on neurosurgeon decision-making. Secondary outcomes included the change to Glasgow Coma Scale (GCS) and hemodynamic parameters compared before and after sugammadex administration. Sugammadex dosing was also assessed across various weight scalars to explore dose-response trends and generate preliminary guidance for use in this setting. Results Our study criteria yielded 12 sugammadex administrations across 11 patients, the majority of whom had sustained a traumatic brain injury. All sugammadex administrations were adjudicated as beneficial to neurosurgeon decision-making and 50% were associated with a change to prognosis and plan. Sugammadex was associated with an increase in the GCS of 1-8 points among the 67% of patients who responded. Mean arterial pressure decreased significantly after sugammadex administration (median 94 vs. 104 mmHg,