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The authors assessed the effect of a cognitive aid on reducing the use of sugammadex and its associated costs using an inter rupted time ser ies analysis.
We are fortunate to work in a department that provides quantitative neuromuscular blockade monitor ing in every anesthesia workstation.
In fact, we have been faced with cases of prolonged neuromuscular blockade and reversal with rocuronium and sugammadex that would have been overlooked without monitor ing.
We would like to under stand why quantitative monitorswere not selected for acquisition if you had a budget and operational per ipheral nerve stimulatorswere available in every station before the month of intervention.
Our concernis that the reduction in use of sugammadex, der ived from the intervention, was aided by better monitor ing equipment, not previously available.
In fact, the authorsfound that the decrease in costs was due to a decreased use of sugammadex but also from neuromuscular blocking drugs and rever sal agents.
The ar ticle does not present the number of neostigmine administrations pre or postcognitive aid, but one should expect an increase in use and costs postintervention.
Regarding sugammadex administrations, the ar ticle states that the postintervention monthly rate of sugammadex administration was per, general anesthetics with a nonsignificant P.
We do not under stand the meaning of this statement as that information contradicts the information presented in the figures.
Concer ning the adver se respiratory events, the authorscautiously state that significant changes were not observed.
Although that can be a statistically sound statement, the reg ression of the interrupted time ser ies analysis seems to be less fitted when evaluating the adver se respiratory events.
One can notice that the highest value of adver se respiratory events was, in fact, recorded in the postintervention per iod.
Despite all of our considerations, we find the published article of very high quality.
Unauthorized reproduction of this article is prohibited.
for their interest and comments related to our ar ticle.
In their letter, the authorsstate that the reduction in sugammadex use could have been the result of better monitoring equipment andor a reduction in general anesthetics with neuromuscular blockade.
While data on use of monitor ing equipment was not collected, the number of general anesthetics and administrations of neuromuscular blocking drugs was presented in table of the or ig inal ar ticle.
The authors also ask why quantitative monitors were not selected for acquisition.
In fact, our anesthesiolog ists did request the purchase of quantitative monitors, but this request was not approved.
The authors also note that the number of neostigmine administrations was not presented and that increased use of neostigmine might increase costs postintervention.
In fact, the costs associated with neostigmine were part of the secondary outcome, total acquisition costs of neuromuscular blocking drugs and reversal agents, which decreased postintervention.
The authors go on to suggest that the finding of the postintervention monthly rate of sugammadex administrations contradicts the figures.
In figure in the or ig inal article, upper left panel showing sugammadex, the solid trend line to theright of the vertical gray area appears flat.
A nonsignificant P value for the postintervention slope indicates that the slope is in fact flat, or not different from zero.
Only a nonzero value for this postintervention slope would indicate that sugammadex use was increasing after the intervention.
Finally, the authors note that the regression of the interrupted time ser ies analysis seems to be less fitted when evaluating adverse respiratory events.
While this is true, we did not find the parameter coefficients to be statistically significant.
In summary, because time ser ies analyses are not used very commonly in the scientific literature, it may be challeng ing for many clinicians to interpret the results.
Ultimately, the purpose of this statistical analysis is to demonstrate whether the slope and level of an outcome have changed over time.
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