title: Dexamethasone does not diminish sugammadex reversal of neuromuscular block - clinical study in surgical patients undergoing general anesthesia.
abstract: Sugammadex 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.
  
  
  
  Sixty-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.
  
  
  
  There 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).
  
  
  
  Administration of dexamethasone to anesthetized patients did not delay NMB reversal by sugammadex.
  
  
  
  The 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.
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, 1000, Slovenia.
authors.forename: Katja
authors.initials: K
authors.lastname: Rezonja
authors.affiliation: Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Tomaz
authors.initials: T
authors.lastname: Mars
authors.affiliation: Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Ales
authors.initials: A
authors.lastname: Jerin
authors.affiliation: Institute of Forensic Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Gordana
authors.initials: G
authors.lastname: Kozelj
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, 1000, Slovenia.
authors.forename: Neva
authors.initials: N
authors.lastname: Pozar-Lukanovic
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, 1000, Slovenia. maja.sos@siol.net.
authors.forename: Maja
authors.identifier: 0000-0002-7114-8155
authors.initials: M
authors.lastname: Sostaric
mesh_terms: D000368:Aged; D000732:Androstanols / Q000008:administration & dosage*; D000768:Anesthesia, General / Q000379:methods; D000932:Antiemetics / Q000008:administration & dosage / Q000493:pharmacokinetics; D003907:Dexamethasone / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D017829:Granisetron / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods*; D061886:Neuromuscular Monitoring; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D011446:Prospective Studies; D000077123:Rocuronium; D016037:Single-Blind Method; D000077122:Sugammadex; D013997:Time Factors; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
chemical_list: D000732:Androstanols; D000932:Antiemetics; D003907:Dexamethasone; D017829:Granisetron; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins
keywords: Dexamethasone; Neuromuscular block; Rocuronium; Sugammadex