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October 12, 2014
8:00 AM - 10:00 AM
Room Hall B1-Area C
Does Intraoperatively Administered Methylprednisolone Impact the Neuromuscular Blocade Reversal Effect of Sugammadex?
Merve H. Aral, M.D., Basak C. Meco, M.D., Menekse Ozcelik, M.D., Yesim Batislam, M.D.
Ankara University Faculty of Medicine, Ankara, Turkey
Background and Goal of Study: Sugammadex, a modified γ-cyclodextrin is a selective relaxant-binding agent that reverses the effects of steroidal neuromuscular blocking agents such as rocuronium and vecuronium. It demonstrates specific activity by encapsulating target drugs. Likewise, some other steroid hormones and drugs namely, flucloxacillin, toremifene and fusidic acid can also be encapsulated by sugammadex. Methylprednisolone, a synthetic corticosteroid is generally used for its anti-edematous and anti-inflammatory effects in nasal or endoscopic sinus surgery. Assuming that methylprednisolone would also be encapsulated by sugammadex; it can be hypothesized that the presence of methylprednisolone during a neuromuscular block induced by a steroidal muscle relaxant, might decrease the efficiency of reversal agent by decreasing the free component ready for encapsulation. In this study, we aimed to compare the time to recovery of rocuronium-induced muscle relaxation after reversal with sugammadex between patients who received intraoperative methylprednisolone or not.

Materials and Methods: After institutional review board (IRB) approval and informed consent, 100 adult patients undergoing elective ear-throat and nose procedures of 2-3 hours were enrolled in this prospective, single centered, controlled study. Patients were allocated into two groups (Group M, n: 53 and group C, n: 47, methylprednisolone administered group and control group respectively) according to the necessity of methylprednisolone administration. Patients who were enrolled into the study had no history of steroidal medicine intake. Anesthesia induction was performed with propofol (3mg/kg), 0.6 mg/kg rocuronium and neuromuscular monitoring was initiated with Train-of-Four (TOF-Carescape B 650 NMT, GE, Connecticut, USA). Patients were intubated as the TOFc: 0 was achieved and 1 mg/kg of methylprednisolone was administered intravenously in group M just after the intubation. Mean elimination half-life of methylprednisolone ranges from 2.4 to 3.5 hours in normal healthy adults and appears to be independent of the route of administration. As the neuromuscular blockade recovered spontaneously to TOFc: 2, all patients received 2.0 mg/kg of sugammadex. After sugammadex injection the time to recovery of TOF ratios to 0.7 and 0.9 were recorded in both groups. The statistical analyzes were performed using Student T Test and Mann-Whitney U test.

Results and Discussion: The data of 100 patients were analyzed. Demographic and surgical data were similar in both groups. Time to recovery of the TOF ratio to 0.7 and 0.9 after sugammadex were significantly longer in patients receiving intraoperative methylprednisolone (Table 1).

Conclusion: When using sugammadex as a reversal agent for rocuronium induced muscle relaxation, patients who received intraoperative methylprednisolone demonstrated delayed recovery times when compared to the patients who did not receive methylprednisolone. The results of this current study suggest a potential conflicting effect of methylprednisolone and sugammadex. This may be due to the action mechanism of the sugammadex. Further studies are needed to evaluate the exact mechanism of the current findings.
Figure 1

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