Dexamethasone Does Not Inhibit Sugammadex Reversal After Rocuronium-Induced Neuromuscular Block

Buonanno, Pasquale; Laiola, Anna; Palumbo, Chiara; Spinelli, Gianmario; Servillo, Giuseppe; Minno, R. M. Di; Cafiero, T; Iorio, Carlo Di

doi:10.1213/ane.0000000000001294

Cited by 18 publications

(29 citation statements)

References 22 publications

(16 reference statements)

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“…We first quantified the possible binding of dexamethasone to sugammadex by measuring the time to TOF ratio ≥0.9. Our results show, that the time to TOF ratio ≥0.9 is not delayed by the administration of dexamethasone before sugammadex reversal of rocuronium-induced NMB, which is in accordance with recent clinical studies by Buonanno et al [ 24 ] and Gulec et al [ 23 ]. In both of these studies dexamethasone was used for prevention of postoperative nausea and vomiting.…”

Section: Discussionsupporting

confidence: 93%

“…Among the corticosteroids, dexamethasone is the most commonly used for the treatment of oedema and analgesia, and for the prevention of postoperative nausea and vomiting. Structurally, dexamethasone closely resembles the aminosteroid neuromuscular blocking agents, and therefore concerns have been raised about possible interference of such corticosteroids in the action of sugammadex [ 21 – 24 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…Dexamethasone is a commonly utilized drug, as it has many applications: the treatment of edema, use in multimodal analgesia and prophylactic treatment of postoperative nausea and vomiting. 8,9 As dexamethasone is so widely utilized, its potential impact on sugammadex reversal is also quite broad. Dexamethasone is very similar in size and shape to rocuronium, having the same cyclopentanoperhydrophenanthrene structure and very similar dimensions, per Buonanno et al, 9 indicating that it is likely to interact with sugammadex.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 As dexamethasone is so widely utilized, its potential impact on sugammadex reversal is also quite broad. Dexamethasone is very similar in size and shape to rocuronium, having the same cyclopentanoperhydrophenanthrene structure and very similar dimensions, per Buonanno et al, 9 indicating that it is likely to interact with sugammadex. 8 The impact of preferential binding of dexamethasone by sugammadex could result in several negative outcomes such as prolonged reversal times leading to extended time in the recovery room, or even re-intubation due to persistent neuromuscular blockade.…”

Section: Introductionmentioning

confidence: 99%

“…Several research studies have been conducted to analyze the effects of dexamethasone on sugammadex. One such study, published by Buonanno et al, 9 indicates that dexamethasone has no effect on sugammadex reversal times. Another study, performed in the pediatric population by Gulec et al 10 , also demonstrates that dexamethasone appears to have no effect on the efficacy of sugammadex to reverse the paralytic effects of rocuronium, nor does it impact time to extubation.…”

Section: Introductionmentioning

confidence: 99%

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Effects of dexamethasone on sugammadex reversal times of rocuronium: a systematic review protocol

Held¹,

Sullivan²

2017

JBI Database of Systematic Reviews and Implementation Reports

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The objective of the review is to identify the effect of dexamethasone on reversal times of rocuronium when utilizing sugammadex as the reversal agent. The incidence of the prolonged time to extubation in patients who have received concurrent dexamethasone and sugammadex therapies as opposed to those who have not received dexamethasone will also be examined.The proposed PICO question is as follows: In patients undergoing reversal of aminosteroidal neuromuscular blockade with rocuronium, does dexamethasone administration affect sugammadex reversal times, as compared to patients who have not received dexamethasone?

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Muskelrelaxanzien und ihre Antagonisten

Blobner¹,

Lewald²,

Busley³

2017

Springer Reference Medizin

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Dexamethasone Does Not Inhibit Sugammadex Reversal After Rocuronium-Induced Neuromuscular Block

Cited by 18 publications

References 22 publications

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

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

Effects of dexamethasone on sugammadex reversal times of rocuronium: a systematic review protocol

Muskelrelaxanzien und ihre Antagonisten

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