Women are rarely informed of contraceptive failure after the usual use of anesthetics

Women undergoing surgery are not routinely informed that traditional anesthesia can make their birth control less effective and put them at risk of an unplanned pregnancy, new research will be presented at Euroanaesthetic, the annual meeting of the European Society of Anaesthesiology and Intensive Care (ESAIC) presented. in Milan, Italy (June 4-6), proposes.

The active ingredient sugammadex is widely used in anesthesia. Given towards the end of the surgery, before the patient wakes up, it reverses the effects of medications given earlier in the procedure to relax the patient’s muscles.

It is known that sugammadex interacts with the hormone progesterone and therefore may reduce the effectiveness of hormonal contraceptives, including the progesterone-only pill (minipill), combined pills, vaginal rings, implants and intrauterine devices.

The current policy is to inform women of childbearing potential (WCBA) that they have received the drug and, due to the increased risk of contraceptive failure, to advise those taking hormonal oral contraceptives to follow the missed pill instructions in the package leaflet of their contraceptives and advise people using other types of hormonal contraceptives to use an additional non-hormonal contraceptive for seven days.

However, in the authors’ experience, robust methods for identifying at-risk patients and educating them about the associated risk of contraceptive failure are not common practice in anesthesia departments within the UK and probably beyond.

To learn more, Dr. Neha Passi, Dr. Matt Oliver and colleagues from the Department of Anaesthesiology at University College London Hospitals NHS Foundation Trust, London, UK, interviewed anesthetics in their hospital trust about the use of sugammadex and conducted a retrospective review of the use of sugammadex in the trust.

A seven-question survey was sent to all anesthesiologists at the Trust. Including specialists, assistant doctors and medical assistants, there were almost 150 employees.

94% of the 82 responding anesthesiologists reported being aware of the risk of contraceptive failure. 70% of respondents said they do not routinely discuss sugammadex with the patients who have received the drug.

234 patients were administered sugammadex during the six weeks of the audit.

Sixty-five (28%) of the patients given sugammadex were WCBA and 48 of them would have needed counseling about the risks of contraceptive failure. However, none of the 48 women reported anything in their medical records. (The medical histories of the other 17 meant they were not at risk of pregnancy and therefore ineligible for counseling.)

It is worrying that we so rarely inform patients about the risk of contraceptive failure after using sugammadex. The use of sugammadex is expected to increase as it becomes cheaper in the future and making sure women receiving this drug are aware that it may increase their risk of an unwanted pregnancy must be a priority.”

dr Neha Passi, Department of Anaesthesiology, University College London

dr Oliver adds: “We have only studied one hospital trust but we expect the results will be similar elsewhere in the UK.”

dr Passi adds, “However, it is important to note that most patients receiving an anesthetic do not require a muscle relaxant and that sugammadex is one of several drugs available to reverse muscle relaxation.”

In response to their findings, the study authors produced patient information brochures and letters, and programmed the Trust’s electronic medical record system to identify “at-risk” patients and send electronic prompts to their anesthetic care provider during the perioperative period.

Sugammadex is the only anesthetic known to have this effect.


The European Society of Anaesthesiology and Intensive Care Medicine (ESAIC)

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