Women undergoing NHS operations are not being routinely informed that a drug commonly used in anaesthesia may make their contraception less effective, putting them at risk of an unplanned pregnancy, doctors have warned.
Administered at the end of surgery before patients wake up, sugammadex reverses the action of drugs that are given earlier in the procedure to relax the patient’s muscles. The drug is known to interact with the hormone progesterone and may reduce the effectiveness of hormonal contraceptives, including the progesterone-only pill, combined pill, vaginal rings, implants and intra-uterine devices.
However, new research suggests that robust methods for identifying at-risk patients and informing them of the associated risk of contraceptive failures is not common practice across anaesthetic departments in the UK.
The findings are being presented this weekend at Euroanaesthesia in Milan, the annual meeting of the European Society of Anaesthesiology and Intensive Care.
Current guidance says doctors must inform women of child-bearing age about the drug. Women taking oral hormonal contraceptives should be advised to follow the missed pill advice in the leaflet that comes with their contraceptives, and those using other types of hormonal contraceptive should be advised to use an additional non-hormonal means of contraception for seven days.
But doctors at a major London hospital trust found no record within the medical notes of relevant patients that they had been given advice on the risks of contraceptive failure due to sugammadex.
Doctors at the department of anaesthesiology at University College London (UCL) hospitals NHS foundation trust surveyed anaesthetists at their hospital trust on their use of sugammadex.
Of the 48 women of childbearing age who they deemed should have been given advice on the risks, not a single one had any record of such a conversation in their medical notes, the researchers said. In addition, 70% of 82 anaesthetists surveyed said they did not routinely discuss sugammadex with patients who received the drug.
“We only studied one hospital trust but we expect the results to be similar elsewhere in the UK,” said Dr Matt Oliver, one of the leaders of the study.
Another of the researchers, Dr Neha Passi, added: “It is concerning that we are so seldom informing patients of the risk of contraceptive failure following sugammadex use. Use of sugammadex is expected to rise as it becomes cheaper in the future and ensuring that women receiving this medicine are aware it may increase their risk of unwanted pregnancy must be a priority.”
Researchers said sugammadex was the only such drug known to have such an effect. Doctors at UCL have now compiled patient information leaflets and letters and also programmed their trust’s electronic patient record system to identify at-risk patients and deliver electronic prompts to the anaesthetists caring for them.
Separately, new research also being presented at the Euroanaesthesia conference reveals that preoperative body mass index (BMI) and weight play an important role in outcomes after bariatric surgery.
The study by Dr Michael Margarson from St Richard’s Hospital in Chichester confirms the long-suspected view that admission to ICU or death after bariatric surgery is much more likely in patients with the highest weight and BMI.
