Abstract

Healthcare systems today face the dual challenge of escalating costs and shrinking budgets, forcing administrators to scrutinize every investment in technology and medication. Even as innovations continue to advance patient safety, financial sustainability demands that hospitals allocate resources strategically to achieve the greatest impact. In the case examined, a 67-year-old man with extensive comorbidities including paraplegia, coronary artery disease, and obstructive sleep apnea, underwent sacral flap reconstruction requiring deep neuromuscular blockade. Quantitative electromyography monitoring (qNMM) with a TetraGraph device was applied concurrently with a traditional qualitative peripheral nerve stimulator (PNS). Discrepancies were observed between devices throughout the case, with the qualitative monitor suggesting 1 twitch while the quantitative monitor confirmed deeper block. At emergence, sugammadex 200 mg was administered with recovery confirmed at a train of four ratio (TOFR) > 0.9. Although the outcome was uneventful, the case revealed potential overuse of sugammadex and underscored the question of whether universal quantitative monitoring could improve both safety and cost efficiency through objective reversal guidance. Further, it spurred the debate of whether such an investment might ultimately pay for itself.

Author Details

Logan E. Young, DNP(c), BSN, CCRN, SRNA. 3.5 years of nursing experience in the pediatric cardiac intensive care unit. Currently completing my final semester of CRNA school to obtain my Doctorate in Nursing Practice.

David Sanford, DNP, CRNA, EMT-P - David Sanford began his healthcare career as a paramedic/firefighter, gaining valuable experience in EMS before pursuing nursing and spending several years in the emergency department. Sanford was honored to be part of the second cohort in Samford University's nurse anesthesia program. 

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Neuromuscular Blockade, Surgery, Sugammadex, Quantitative Monitoring, Qualitative Monitoring

Advisor

David Sanford

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-02-03

Full Text of Presentation

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Additional Files

Abstract.pdf (106 kB)

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