The Effect of Intravenous Dexamethasone on Sugammadex Reversal Time in Children Undergoing Adenotonsillectomy

Güleç, Ersel; Biricik, Ebru; Türktan, Mediha; Hatipoğlu, Zehra; Ünlügenç, H.

doi:10.1213/ane.0000000000001142

Cited by 19 publications

(24 citation statements)

References 30 publications

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“…We first quantified the possible binding of dexamethasone to sugammadex by measuring the time to TOF ratio ≥0.9. Our results show, that the time to TOF ratio ≥0.9 is not delayed by the administration of dexamethasone before sugammadex reversal of rocuronium-induced NMB, which is in accordance with recent clinical studies by Buonanno et al [ 24 ] and Gulec et al [ 23 ]. In both of these studies dexamethasone was used for prevention of postoperative nausea and vomiting.…”

Section: Discussionsupporting

confidence: 93%

“…In both of these studies dexamethasone was used for prevention of postoperative nausea and vomiting. Buonanno et al retrospectively compared the effect of 8 mg dexamethasone at the induction of anesthesia or just before sugammadex adminstration on reversal time in adults [ 24 ] while Gulec et al prospecitvely studied the reversal time of sugammadex on rocuronium induced NMB in children who received 0.5 mg/kg of dexamethasone at the induction of anesthesia [ 23 ]. In comparison to these studies, we used low-dose fixed dexamethasone concentration (0.15 mg/kg) just prior to sugammadex administration.…”

Section: Discussionmentioning

confidence: 99%

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Dexamethasone does not diminish sugammadex reversal of neuromuscular block – clinical study in surgical patients undergoing general anesthesia

et al. 2016

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BackgroundSugammadex reverses neuromuscular block (NMB) through binding aminosteroid neuromuscular blocking agents. Although sugammadex appears to be highly selective, it can interact with other drugs, like corticosteroids. A prospective single-blinded randomized clinical trial was designed to explore the significance of interactions between dexamethasone and sugammadex.MethodsSixty-five patients who were anesthetized for elective abdominal or urological surgery were included. NMB was assessed using train-of-four stimulation (TOF), with rocuronium used to maintain the desired NMB depth. NMB reversal at the end of anaesthesia was achieved using sugammadex. According to their received antiemetics, the patients were randomized to either the granisetron or dexamethasone group. Blood samples were taken before and after NMB reversal, for plasma dexamethasone and rocuronium determination. Primary endpoint was time from sugammadex administration to NMB reversal. Secondary endpoints included the ratios of the dexamethasone and rocuronium concentrations after NMB reversal versus before sugammadex administration.ResultsThere were no differences for time to NMB reversal between the control (mean 121 ± 61 s) and the dexamethasone group (mean 125 ± 57 s; P = 0.760). Time to NMB reversal to a TOF ratio ≥0.9 was significantly longer in patients with lower TOF prior to sugammadex administration (Beta = −0.268; P = 0.038). The ratio between the rocuronium concentrations after NMB reversal versus before sugammadex administration was significantly affected by sugammadex dose (Beta = −0.375; P = 0.004), as was rocuronium dose per hour of operation (Beta = −0.366; p = 0.007), while it was not affected by NMB depth before administration of sugammadex (Beta = −0.089; p = 0.483) and dexamethasone (Beta = −0.186; p = 0.131). There was significant drop in plasma dexamethasone after sugammadex administration and NMB reversal (p < 0.001).ConclusionsAdministration of dexamethasone to anesthetized patients did not delay NMB reversal by sugammadex.Trial registrationThe trial was retrospectively registered with The Australian New Zealand Clinical Trials Registry (ANZCTR) on February 28th 2012 (enrollment of the first patient on February 2nd 2012) and was given a trial ID number ACTRN12612000245897 and universal trial number U1111-1128-5104.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Dexamethasone does not diminish sugammadex reversal of neuromuscular block – clinical study in surgical patients undergoing general anesthesia

et al. 2016

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“…Nonetheless, a RCT including 24 patients did not encounter residual postoperative muscle relaxation with concomitant prescription of diclofenac or flucloxacillin [71]. Gulec et al [72] have recently conducted a randomized trial in 60 children undergoing adenotonsillectomy receiving saline or dexamethasone 0,5 mgkg -1 after induction. At the end of surgery, anesthesia was terminated, and when 2 twitches of the TOF reappeared, all patients were given 2 mgkg -1 sugammadex.…”

Section: Interactionsmentioning

confidence: 99%

“…At the end of surgery, anesthesia was terminated, and when 2 twitches of the TOF reappeared, all patients were given 2 mgkg -1 sugammadex. There was no significant difference between groups neither in the time to recover a TOF ratio of 0.9 nor in the time to meet the extubation criteria [72]. Dexamethasone seems to decrease the effectiveness of sugammadex to reverse rocuronium-induced NMB in a dose-dependent fashion [42].…”

Section: Interactionsmentioning

confidence: 99%

A Short Update on Sugammadex with a Special Focus on Economic Assessment of its Use in North America

Zaouter¹,

Mion²,

Palomba³

et al. 2017

J Anesth Clin Res

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Sugammadex offers significant advantages over the current anticholinesterase reversal drugs. Sugammadex used has been approved for the United Stated and for Canada since December 2015 and February 2016, respectively. The present article aims to provide a straightforward and concise review of the most recent literature describing its clinical advantages in routine use. A thorough and cost-effective evaluation has been conducted specifically for North America to determine if its price justifies its inclusion into regular patients' care. The search examined the relevant literature from January 2013 to October 2016. The present narrative review describes how sugammadex could play a crucial role in the modern conduct of anesthesia. The particular emphasis on sugammadex cost-effective analysis performed in this article suggests that this new reversal agent should be considered for a wider use in North America.

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“…One such study, published by Buonanno et al, 9 indicates that dexamethasone has no effect on sugammadex reversal times. Another study, performed in the pediatric population by Gulec et al 10 , also demonstrates that dexamethasone appears to have no effect on the efficacy of sugammadex to reverse the paralytic effects of rocuronium, nor does it impact time to extubation. However, other studies contradict these findings, such as the study by Zwiers et al, 7 indicating that there is the potential for dexamethasone to interact with sugammadex, allowing for the possibility of an inhibitory affect on sugammadex's reversal of rocuronium.…”

Section: Introductionmentioning

confidence: 98%

Effects of dexamethasone on sugammadex reversal times of rocuronium: a systematic review protocol

Held¹,

Sullivan²

2017

JBI Database of Systematic Reviews and Implementation Reports

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The objective of the review is to identify the effect of dexamethasone on reversal times of rocuronium when utilizing sugammadex as the reversal agent. The incidence of the prolonged time to extubation in patients who have received concurrent dexamethasone and sugammadex therapies as opposed to those who have not received dexamethasone will also be examined.The proposed PICO question is as follows: In patients undergoing reversal of aminosteroidal neuromuscular blockade with rocuronium, does dexamethasone administration affect sugammadex reversal times, as compared to patients who have not received dexamethasone?

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The Effect of Intravenous Dexamethasone on Sugammadex Reversal Time in Children Undergoing Adenotonsillectomy

Abstract: IV dexamethasone, given after induction of anesthesia, at a dose of 0.5 mg/kg, does not substantively affect the reversal time of sugammadex in pediatric patients undergoing adenoidectomy and/or tonsillectomy.

Cited by 19 publications

References 30 publications

Dexamethasone does not diminish sugammadex reversal of neuromuscular block – clinical study in surgical patients undergoing general anesthesia

Dexamethasone does not diminish sugammadex reversal of neuromuscular block – clinical study in surgical patients undergoing general anesthesia

A Short Update on Sugammadex with a Special Focus on Economic Assessment of its Use in North America

Effects of dexamethasone on sugammadex reversal times of rocuronium: a systematic review protocol

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