The effect of rocuronium, sugammadex, and their combination on cardiac muscle and diaphragmatic skeletal muscle cells.
OBJECTIVE
Rocuronium has been associated with muscle weakness when administered in prolonged infusions. The effect of sugammadex and rocuronium together on muscle is unknown. In this study, we examined the effects of rocuronium and sugammadex, and the complex formed by these agents, on cardiac and diaphragmatic muscle cells.


METHODS
Forty-two Sprague-Dawley male rats were divided into six groups. Group I received only rocuronium at a dose of 1 mg/kg and groups II and III received sugammadex alone at doses of 16 and 96 mg/kg, respectively. Groups IV and V received 1 mg/kg rocuronium plus 16 mg/kg sugammadex and 1 mg/kg rocuronium plus 96 mg/kg sugammadex, respectively. Group six was the control group and received only 0.9 % NaCl without any drug.


RESULTS
Histopathological examination demonstrated that rocuronium and high doses of sugammadex accumulated in both cardiac and diaphragm muscle tissues. We also observed intense edema and degeneration in diaphragmatic and myocardial cells when the rocuronium-sugammadex complex was used. Rocuronium and sugammadex remain in the circulation for a long time and they may cause skeletal muscle myopathy, vacuolization, pyknotic nuclear clumps, and hypertrophy, and weaken the muscle fibers.


CONCLUSIONS
Rocuronium, sugammadex, and rocuronium-sugammadex complexes cause histopathological changes and immunoreactivity to calcineurin in muscle cells.
Department of Histology and Embryology, Medical Faculty, Rize University, Rize, Turkey. yildiray.kalkan@rize.edu.tr
Yildiray
Y
Kalkan
Habib
H
Bostan
Levent
L
Tumkaya
Yakup
Y
Tomak
Mehmet
M
Bostan
Adnan
A
Yilmaz
Hasan
H
Turut
Ahmet
A
Temiz
Alper
A
Yalçin
Alparslan
A
Turan
D000732:Androstanols / Q000037:antagonists & inhibitors / Q000494:pharmacology*; D000818:Animals; D019703:Calcineurin / Q000378:metabolism; D003964:Diaphragm / Q000166:cytology / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004573:Electrolytes / Q000378:metabolism; D007150:Immunohistochemistry; D066298:In Vitro Techniques; D008297:Male; D018485:Muscle Fibers, Skeletal / Q000187:drug effects*; D018482:Muscle, Skeletal / Q000187:drug effects*; D032383:Myocytes, Cardiac / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors / Q000494:pharmacology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000494:pharmacology*
D000732:Androstanols; D004573:Electrolytes; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D019703:Calcineurin; D000077123:Rocuronium