The effect of rocuronium, sugammadex, and their combination on cardiac muscle and diaphragmatic skeletal muscle cells

Abstract

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