Influence of methylprednisolone on the reversal time of sugammadex: a randomized clinical trial

Abstract

Background and objectivesSugammadex is a modified gamma-cyclodextrin that reverses the effects of aminosteroidal neuromuscular blocking agents. Likewise, some steroid molecules, such as toremifene, fusidic acid, and flucloxacillin, can also be encapsulated by sugammadex. Methylprednisolone, which is a synthetic steroid used commonly for airway edema prophylaxis, can also be encapsulated by sugammadex. The objective of this study was to compare the recovery times of sugammadex for reversing rocuronium-induced moderate neuromuscular blockade in those who received intraoperative 1mgkg−1 methylprednisolone or saline. MethodThis single-centered, randomized, controlled, prospective study included 162 adult patients undergoing elective ear-nose-throat procedures (aged from 18 to 65, an ASA physical status I-II, a BMI less than 30kgm−2, and not taking steroid drug medication) with propofol, remifentanyl, rocuronium and sevoflurane. Neuromuscular monitoring was performed using calibrated acceleromyography. The Control Group (Group C) received 5mL of saline, while the Methylprednisolone Group (Group M) received 1mgkg−1 of methylprednisolone in 5mL of saline just after induction. After the completion of surgery, regarding the TOF count, two reappeared spontaneously and 2mgkg−1 sugammadex was administered to all patients. Recovery of the TOF ratio to 0.9 was recorded for both groups, and the estimated recovery time to reach a TOF ratio (TOFr) of 0.9 was the primary outcome of the study. ResultsMedian time to TOFr=0.9 was for 130.00s (range of 29–330) for Group C and 181.00s (100–420) for Group M (p<0.001). The differences between the two groups were statistically significant. ConclusionWhen using 2mgkg−1 of sugammadex to reverse rocuronium-induced neuromuscular blockade in patients who received 1mgkg−1 of intraoperative methylprednisolone, demonstrated delayed recovery times.