Dexamethasone does not diminish sugammadex reversal of neuromuscular block - clinical study in surgical patients undergoing general anesthesia

• Published in: BMC anesthesiology 2016-10, Vol.16 (1), p.101-101, Article 101
• Main Authors: Rezonja, Katja, Mars, Tomaz, Jerin, Ales, Kozelj, Gordana, Pozar-Lukanovic, Neva, Sostaric, Maja
• Format: Article
• Language: English
• Subjects: Aged; Androstanols - administration & dosage; Anesthesia, General - methods; Antiemetics - administration & dosage; Antiemetics - pharmacokinetics; Complications and side effects; Dexamethasone; Dexamethasone - administration & dosage; Dexamethasone - pharmacokinetics; Dosage and administration; Dose-Response Relationship, Drug; Drug interactions; Elective Surgical Procedures - methods; Female; gamma-Cyclodextrins - administration & dosage; Granisetron - administration & dosage; Humans; Male; Middle Aged; Neuromuscular Blockade - methods; Neuromuscular Monitoring; Neuromuscular Nondepolarizing Agents - administration & dosage; Physiological aspects; Prospective Studies; Single-Blind Method; Time Factors
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-016-0254-6

Sugammadex reverses neuromuscular block (NMB) through binding aminosteroid neuromuscular blocking agents. Although sugammadex appears to be highly selective, it can interact with other drugs, like corticosteroids. A prospective single-blinded randomized clinical trial was designed to explore the significance of interactions between dexamethasone and sugammadex. Sixty-five patients who were anesthetized for elective abdominal or urological surgery were included. NMB was assessed using train-of-four stimulation (TOF), with rocuronium used to maintain the desired NMB depth. NMB reversal at the end of anaesthesia was achieved using sugammadex. According to their received antiemetics, the patients were randomized to either the granisetron or dexamethasone group. Blood samples were taken before and after NMB reversal, for plasma dexamethasone and rocuronium determination. Primary endpoint was time from sugammadex administration to NMB reversal. Secondary endpoints included the ratios of the dexamethasone and rocuronium concentrations after NMB reversal versus before sugammadex administration. There were no differences for time to NMB reversal between the control (mean 121 ± 61 s) and the dexamethasone group (mean 125 ± 57 s; P = 0.760). Time to NMB reversal to a TOF ratio ≥0.9 was significantly longer in patients with lower TOF prior to sugammadex administration (Beta = -0.268; P = 0.038). The ratio between the rocuronium concentrations after NMB reversal versus before sugammadex administration was significantly affected by sugammadex dose (Beta = -0.375; P = 0.004), as was rocuronium dose per hour of operation (Beta = -0.366; p = 0.007), while it was not affected by NMB depth before administration of sugammadex (Beta = -0.089; p = 0.483) and dexamethasone (Beta = -0.186; p = 0.131). There was significant drop in plasma dexamethasone after sugammadex administration and NMB reversal (p