Date of Award

Spring 4-19-2024

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Brian Garrett, CRNA, DNP

First Committee Member

Brian Garrett, CRNA, DNP

Second Committee Member

Amy Bishop, DNP, AGCNS-BC

Third Committee Member

Danielle Winch, CRNA, DNP


Neuromuscular Blocking Agents, Rocuronium, Neuromuscular Reversal Agents, Sugammadex, Neostigmine, Postoperative Pulmonary Complications

Subject Categories

Anesthesiology | Medicine and Health Sciences


Neuromuscular blocking agents play a vital role in the safe delivery of modern anesthetic practice. These medications provide patient paralysis for anesthesia staff to perform tracheal intubation and for surgeons to have a motionless surgical field. At the end of surgery, the effects of these paralytic agents must be fully reversed by reversal agents. Incomplete reversal impairs the patient’s ability to maintain an airway, which can lead to various postoperative pulmonary complications such as respiratory failure, pneumonia, and atelectasis. Patients undergoing thoracic surgery are at high risk for this incomplete reversal due to deep levels of paralysis required to keep the diaphragm motionless for surgical manipulation. Therefore, optimal paralytic reversal strategies must be analyzed and incorporated into clinical practice to decrease residual paralysis and subsequent complications. Neostigmine has traditionally been the primary agent used for paralytic reversal. However, a newer alternative is available with the relatively recent introduction of Sugammadex. Literature has shown that in patients undergoing thoracic surgery, utilizing Sugammadex for reversal of neuromuscular blockade, compared to Neostigmine, improves patient outcomes by reducing postoperative pulmonary complications. This evidence-based practice project evaluates the most up-to-date literature to identify, plan, and implement recommendations for an optimal paralytic reversal strategy in patients undergoing thoracic surgery at a level-one trauma center in the Midwest United States.

Acknowledgement 1


Acknowledgement 2


Licensing Permission

Copyright, all rights reserved. Fair Use



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