Abstract
Sugammadex reverses the rocuronium-induced neuromuscular block by trapping the cyclopentanoperhydrophenanthrene ring of rocuronium. Dexamethasone shares the same steroidal structure with rocuronium. The purpose of this study was to evaluate the influence of dexamethasone on neuromuscular reversal of sugammadex after general anesthesia. Electronic databases were searched to identify all trials investigating the effect of dexamethasone on neuromuscular reversal of sugammadex after general anesthesia. The primary outcome was time for neuromuscular reversal, defined as the time to reach a Train-of-Four (TOF) ratio of 0.9 after sugammadex administration. The secondary outcome was the time to extubation after sugammadex administration. The mean difference (MD) and 95% CI were used for these continuous variables. Six trials were identified; a total of 329 patients were included. The analyses indicated that dexamethasone did not influence the time for neuromuscular reversal of sugammadex (MD −3.28, 95% CI −36.56 to 29.99, p = 0.847) and time to extubation (MD 25.99, 95% CI −4.32 to 56.31, p = 0.093) after general anesthesia. The results indicate that dexamethasone did not influence the neuromuscular reversal of sugammadex in patients after general anesthesia. Therefore, the dexamethasone does not appear to interfere with reversal of neuromuscular blockade with sugammadex in patients undergoing general anesthesia for elective surgery.
Highlights
The prevention of residual neuromuscular blockade (NMB) after general anesthesia is important in decreasing the risk of critical respiratory events [1]
Sugammadex, a selective neuromuscular blocking agent (NMBA)-binding drug, reverses NMB induced by an aminosteroid NMBA, such as rocuronium and vecuronium [2]
The aim of this meta-analysis was to explore whether the interaction of dexamethasone with sugammadex would lead to a clinical impact on the reversal of NMB
Summary
The prevention of residual neuromuscular blockade (NMB) after general anesthesia is important in decreasing the risk of critical respiratory events [1]. Sugammadex, a selective neuromuscular blocking agent (NMBA)-binding drug, reverses NMB induced by an aminosteroid NMBA, such as rocuronium and vecuronium [2]. Sugammadex is a modified γ-cyclodextrin designed to encapsulate the aminosteroid NMBA, forming a complex with aminosteroid NMBA [2]. This reduces the concentration of NMBA in the neuromuscular junction and results in a rapid and effective reversal of NMB of any level. The primary outcome was the difference in the time to recovery of Train-of-Four (TOF) ratio > 0.9 and the secondary outcome was the difference in the time to extubation in patients undergoing general anesthesia where sugammadex was used to reverse rocuronium-induced NMB
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