Anesthesia in the News
  • Contraception Awareness and Anesthesia

    Although anesthesia providers may be aware of the interactions between the agent sugammadex and hormonal contraception, they may not always convey this information to patients, one recently published clinical survey has found.

    Reversal agent and MOA

    Sugammadex (Bridion) is a first-in-class selective relaxant binding agent for reversal of neuromuscular blockade in adults. It was approved by the FDA for use in the United States in 2015. Hailed as a “game-changer” upon its approval, sugammadex is now considered the antagonist of choice among anesthesia providers. Sugammadex binds progesterone with high affinity and may interfere with hormonal contraceptive effectiveness. The manufacturer recommends using alternative contraception (nonhormonal and barrier methods) for seven days following sugammadex administration due to the possibility of contraceptive failure.

    Survey participants

    Researchers in the Department of Anesthesiology at Vanderbilt University Medical Center in Nashville, Tennessee, conducted the survey among their coworkers in 2019-2020.

    For this study, 259 surveys were distributed. One hundred fifty-five were fully completed and 10 were partially completed. Overall response rate was 60% (among residents, 85%; student nurse anesthetists, 53%; certified registered nurse anesthetists, 58%; and attendings, 48%).

    Awareness, mostly

    Knowledge about the potential for sugammadex interference with oral hormonal contraception was widespread, with all but one respondent aware of this phenomenon. Far fewer respondents were aware of the potential for interference with hormonal intrauterine devices (44%). Fifty-five percent were aware of the potential for interference with hormonal contraceptive implants.

    The manufacturer’s recommended 7-day period of alternative contraception use was correctly identified by 72% of respondents; others (22%) were under the impression that the recommendation was for a longer duration (range 10–30 days).

    The patient counseling gap

    Most of the respondents (78%) agreed or strongly agreed that potential interference with contraceptive effectiveness should be discussed with patients preoperatively. Despite the majority (86%) who, in theory, supported communicating openly with patients about the possibility, many respondents reported rarely or never having discussed it with patients in actual clinical practice, either preoperatively (67%) or postoperatively (80%).

    Further, most respondents (79%) reported rarely or never turning to an alternative agent (neostigmine) to avoid this interaction.

    The authors noted that their findings “highlight the need for education regarding residual neuromuscular block versus adverse drug interactions, collaboration among providers involved in patient counseling, and intentional mindfulness of reproductive justice when caring for women of childbearing potential.”

    Dive deeper into the investigators’ findings and their practice implications, Dwan RL, Raymond BL, Richardson MG. Unanticipated consequences of switching to Sugammadex: anesthesia provider survey on the hormone contraceptive drug interaction. Anesth Analg. 2021 Mar 8., at https://pubmed.ncbi.nlm.nih.gov/33684087/