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

Abstract

BackgroundSugammadex 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.MethodsSixty-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.ResultsThere 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 < 0.001).ConclusionsAdministration of dexamethasone to anesthetized patients did not delay NMB reversal by sugammadex.Trial registrationThe trial was retrospectively registered with The Australian New Zealand Clinical Trials Registry (ANZCTR) on February 28th 2012 (enrollment of the first patient on February 2nd 2012) and was given a trial ID number ACTRN12612000245897 and universal trial number U1111-1128-5104.

Sugammadex Always Fast? Probably Yes, but in Liver Transplantation

“…In the literature, experimental studies investigated possible interactions between sugammadex and other drugs, and found that flucloxacillin, fusidic acid and tormifene had the potential for a displacement interaction with sugammadex 27 . An in vitro study showed possible interferences of corticosteroids in the action of sugammadex 28 but, on the contrary, Rezonja et al published an in vivo randomized controlled trial where they demonstrated that dexamethasone did not alter sugammadex recovery time 29 . In our study all patients received high intraoperative dose (3.5-5 mg/kg) of methylprednisolone hemisuccinate as immunosuppressant just before hepatic vascular unclamping.…”

Sugammadex versus neostigmine after rocuronium continuous infusion in patients undergoing liver transplantation.

“…In the literature, an experimental study has investigated the possibility of interactions occurring between sugammadex and other drugs, and indeed it has been found that flucloxacillin, fusidic acid and tormifene have the potential to exert a displacement interaction with sugammadex. 28 An in vitro study has also demonstrated possible interferences between corticosteroids and sugammadex action, 29 whereas, Rezonja and colleagues, published an in vivo randomized controlled trial in which they demonstrated that dexamethasone does not alter sugammadex recovery time 30 . The opposite was later concluded by Saleh and colleagues, who, evaluating dexamethasone use for the prevention of post-operative nausea and vomiting in children undergoing strabismus surgery, demonstrated a delayed reversal of rocuronium-induced NMB by sugammadex.…”

SUGAMMADEX versus neostigmine after ROCURONIUM continuous infusion in patients undergoing liver transplantation

“…In the literature, an experimental study has investigated the possibility of interactions occurring between sugammadex and other drugs, and indeed it has been found that flucloxacillin, fusidic acid and tormifene have the potential to exert a displacement interaction with sugammadex [28]. An in vitro study has also demonstrated possible interferences between corticosteroids and sugammadex action [29], whereas, Rezonja and colleagues, published an in vivo randomized controlled trial in which they demonstrated that dexamethasone does not alter sugammadex recovery time [30]. The opposite was later concluded by Saleh and colleagues, who, evaluating dexamethasone use for the prevention of postoperative nausea and vomiting in children undergoing strabismus surgery, demonstrated a delayed reversal of rocuronium-induced NMB by sugammadex [31].…”