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Dexamethasone concentration affecting rocuronium-induced neuromuscular blockade and sugammadex reversal in a rat phrenic nerve-hemidiaphragm model

An ex vivo study

In, Junyong; Bae, Hansu; Choi, Heyran; Kim, Yong Beom; Lee, Sangseok; Yang, Hong Seuk

European Journal of Anaesthesiology (EJA): November 2018 - Volume 35 - Issue 11 - p 856–862
doi: 10.1097/EJA.0000000000000866
Neuromuscular blocking agents
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BACKGROUND The concentration range of dexamethasone that inhibits neuromuscular blockade (NMB) and sugammadex reversal remains unclear.

OBJECTIVE To evaluate the effects of dexamethasone on rocuronium-induced NMB and sugammadex reversal.

DESIGN Ex vivo study.

SETTING Asan Institute for Life Sciences, Asan Medical Center, Korea, from July 2015 to November 2015.

ANIMALS One hundred sixty male Sprague–Dawley rats.

INTERVENTIONS We assessed the effect of four concentrations of dexamethasone [0, 0.5, 5 (clinical concentrations) and 50 μg ml−1 (experimental concentration)] on partial NMB on 40 phrenic nerve–hemidiaphragm preparations (n=10 per concentration). Once the first twitch of train-of-four (TOF) had been depressed by 50% with rocuronium, dexamethasone was administered. To assess the effect of dexamethasone on sugammadex reversal, 120 phrenic nerve–hemidiaphragm preparations were used in three subexperiments (n=40 per experiment), using three administration regimens of rocuronium–equimolar sugammadex: a single dose, a split-dose (split 1/2 and 1/2) and a reduced split-dose (split 1/2 and 1/4). After complete NMB was achieved, dexamethasone and sugammadex were administered.

MAIN OUTCOME MEASURES The change in the first twitch height, the recovery time to a TOF ratio at least 0.9, and the TOF ratio at 30 min were evaluated.

RESULTS There were no significant differences in the first twitch height among groups (P = 0.532). With a single dose of sugammadex, dexamethasone did not affect the recovery time to a TOF ratio at least 0.9 (P = 0.070). After using a split-dose of sugammadex, the recovery time to a TOF ratio at least 0.9 was delayed only at a concentration of 50 μg ml−1 of dexamethasone. With a reduced split-dose of sugammadex, the TOF ratio at 30 min was lowered only by a concentration of 50 μg ml−1 of dexamethasone (P < 0.010).

CONCLUSION Acute bolus administration of dexamethasone at clinical concentrations had no effect on NMB or on sugammadex reversal.

From the Department of Anaesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang (JI, HB), Department of Anaesthesiology and Pain Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul (HC), Department of Anaesthesiology and Pain Medicine, Gachon University Gil Hospital, Incheon (YBK), Department of Anaesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine (SL) and Department of Anaesthesiology and Pain Medicine, Asan Medical Center, Seoul, Republic of Korea (HSY)

Correspondence to Hong Seuk Yang, MD, PhD, Department of Anaesthesiology and Pain Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea Tel: +82 2 3010 3865; e-mail: hsyang@amc.seoul.kr

Published online 24 July 2018

© 2018 European Society of Anaesthesiology