Effect of dexamethasone on the onset time and recovery profiles of cisatracurium

Abstract

BackgroundThe effect of dexamethasone injection on cisatracurium-induced neuromuscular block was compared according to different injection time points.MethodsOne hundred seventeen patients were randomly assigned to three groups: 8 mg of dexamethasone injected intravenously 2–3 h before anesthesia (group A), just before anesthesia induction (group B), and at the end of surgery (control group). Three minutes after anesthesia induction, intubation was performed without neuromuscular blockers, and acceleromyography was initiated. All patients received 0.05 mg/kg cisatracurium; the onset time and recovery profiles were recorded.ResultsEighty patients were finally enrolled. The onset time (median [interquartile range], seconds) was significantly hastened in group A (520.0 [500.0–560.0], n = 30) compared to that in group B (562.5 [514.0–589.0], n = 22) (P = 0.008) and control group (586.5 [575.0–642.5], n = 28) (P < 0.001). The onset time in group B was faster than the control group (P = 0.015). The recovery time [mean (95% CI) minutes] was significantly hastened in group A [28.5 (27.3–29.6)] compared to that in group B [32.3 (31.0–33.6)] (P < 0.001) and control group [30.9 (29.9–31.8)] (P = 0.015). The total recovery time was significantly hastened more in group A [47.1 (45.5–48.6)] than group B [52.8 (51.6–54.0) minutes] (P < 0.001) and control group [50.5 (48.7–52.3) minutes] (P = 0.008).ConclusionsA single dose of 8 mg of dexamethasone hastened the onset and total recovery times of cisatracurium-induced block by approximately 15 and 9%, respectively if administered 2–3 h prior to surgery.

Impact of intravenous dexamethasone on the initiation and recovery of atracurium in children: A double‐blinded randomized controlled trial

“…Soltész et al 14 were the first to demonstrate that a single dose of intravenous dexamethasone can attenuate the duration of action of rocuronium. Another study reported a similar result with cisatracurium 15 . In both these trials, clinically relevant changes in the duration of action of neuromuscular blockers have only been seen when the dose was administered at least 2–3 h before induction.…”

“…Another study reported a similar result with cisatracurium. 15 In both these trials, clinically relevant changes in the duration of action of neuromuscular blockers have only been seen when the dose was administered at least 2-3 h before induction. However, in clinical practice, dexamethasone is commonly given only at induction.…”

Searching for the ideal neuromuscular blocking agent: literature review

“…Corticosteroizii au un mecanism direct de acțiune asupra axonilor nervilor motori, crescând sinteza de ACh și eliberarea spontană precum și stimulată de ACh, îmbunătățind astfel performanța musculară dar și prevenind blocul neuromuscular. Recuperarea blocului neuromuscular a fost accelerată când s-au administrat 8 mg dexametazonă cu 2-3 ore înainte de operație [22] sau chiar intraoperator [23].…”