Is there an interaction between dexamethasone and sugammadex in real clinical conditions? A randomized controlled trial in patients undergoing laparoscopic cholecystectomy

Abstract

Background and Aims: There is evidence that sugammadex can encapsulate other substances except rocuronium, such as dexamethasone. The aim of this study was to investigate the possible clinical interaction between dexamethasone and sugammadex, in patients undergoing laparoscopic cholecystectomy. Material and Methods: This was a randomized, double-blind controlled trial, performed in patients aged 18–75 years, American Society of Anesthesiologists (ASA) I–III, who underwent a laparoscopic cholecystectomy under deep neuromuscular blockade with rocuronium. Patients received 5 mg of dexamethasone or placebo (N/S 0.9%) during induction of anesthesia. Sugammadex 4 mg/kg was administered at the end of surgery at post-tetanic count 1–2. The outcome measures assessed were the time from sugammadex administration until train-of-four (TOF) 0.9, and until patient's extubation, postoperative pain (measured by numeric rating scale 0–10), nausea and vomiting, as well as rescue analgesics and antiemetics required during the first 24 hours postoperatively. The total dose of rocuronium required in both groups was also recorded. Results: Overall, 44 patients were studied. No difference was detected regarding the demographic and surgical characteristics of patients. The time from sugammadex administration until TOF 0.9 and until patients' extubation did not differ significantly between the groups ( P = 0.21 and 0.17). Operating conditions, pain scores, nausea/vomiting, and rescue analgesics and antiemetics during the first 24 hours postoperatively, did not differ between the groups. The total dose of rocuronium, however, was significantly more in patients who received dexamethasone ( P = 0.01). Conclusion: No significant clinical interaction was revealed between dexamethasone and sugammadex during reversal of deep neuromuscular blockade in patients undergoing laparoscopic cholecystectomy.

The effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia

“…One study was conducted in an African country, [ 14 ] and 5 studies were conducted in European countries. [ 9 – 13 ] The patients usually underwent surgeries that required anti-edema or antiemetic prophylaxis or deep NMB application such as laparoscopic cholecystectomy (n = 1), adenoidectomy or tonsillectomy (n = 1), direct laryngoscopy and biopsy (n = 1), abdominal or urological surgery (n = 1), strabismus surgery (n = 1), and others (n = 1). Two studies included pediatric patients aged 1 to 8 years.…”

“…[ 11 , 14 ] Two studies included adult patients, except for elderly patients aged above 65 years, [ 10 , 13 ] and 2 studies included adult patients with elderly patients up to 75 years of age. [ 9 , 12 ] The selected studies generally excluded patients with American Society of Anesthesiology (ASA) physical status classification IV and those with a history of difficult intubation, current treatment with steroids or hormones, drugs interacting with neuromuscular blockers (e.g., magnesium and anticonvulsants), or allergy to NMBAs.…”

“…In 5 studies, general anesthesia was maintained with sevoflurane, and in the other study, general anesthesia was maintained with desflurane. [ 9 ] All studies used rocuronium as an NMBA and performed the following neuromuscular monitoring method to assess the NMB state during surgery, at the end of surgery, and to accurately measure the recovery times from the NMB after sugammadex administration. Neuromuscular monitoring was initiated with an acceleromyograph (TOF-Watch S or SX; Organon Ireland Ltd., Dublin, Ireland), which measures the function of the adductor pollicis muscle after the induction of anesthesia.…”

“…Thus, the dose of sugammadex administered was 2 mg kg −1 in the studies, [ 10 , 11 , 13 , 14 ] and in 1 study, the NMB degree was deep (TOF count 0, post-tetanic count [PTC] 1–2), thus, the dose of sugammadex was 4 mg kg −1 . [ 9 ] One study administered 200 mg of sugammadex in the range of TOF count 0–2 (median TOF count 0; deep NMB). [ 12 ]…”

“…In contrast, some clinical studies have reported conflicting results regarding in vivo clinical dexamethasone-sugammadex interactions in adults or pediatric patients undergoing surgeries under general anesthesia. Some clinical reports suggest that dexamethasone does not significantly affect NMB antagonism of sugammadex, [ 9 – 12 ] while some suggest that dexamethasone significantly extends or shortens sugammadex action times. [ 13 , 14 ] However, a meta-analysis of the topic has not yet been reported.…”