The Effects of Acute and Chronic Hydrocortisone Treatment on Neuromuscular Blockade in the Anesthetized Cat

Durant, N. N.; Briscoe, James R.; Katz, Ronald L.

doi:10.1097/00000542-198408000-00006

Cited by 16 publications

(7 citation statements)

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“…Monitoring of the affected limb will, therefore, underestimate the degree of neuromuscular 433 blockade (Graham 1980;Moorthy & Hilgenberg 1980). Short term administration of corticosteroids has been reported to enhance the neuromuscular blocking effect of pancuronium in animal models, whereas long term corticosteroid administration was without effect (Durant et al 1984b). This is consistent with the fact that exacerbations of myasthenia gravis may occur early during the course of corticosteroid therapy (Jenkins 1972).…”

Section: Resistancementioning

confidence: 73%

Adverse Effects of Nondepolarising Neuromuscular Blocking Agents

Abel

1994

Drug Safety

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Nondepolarising muscle relaxants block neuromuscular transmission, acting as antagonists of the nicotinic receptors at the neuromuscular junction. Their undesired effects are frequently caused by interaction with acetylcholine receptors outside this junction, and autonomic cardiovascular effects may result. Other adverse effects include anaphylactic or anaphylactoid reactions, and histamine release. Various disease states may present specific considerations in the use of nondepolarising muscle relaxants. Although many complications of these drugs (such as prolonged block or resistance) are easily treated, others may necessitate immediate intervention and vigorous therapy. Careful selection of an appropriate relaxant for a particular patient will usually prevent the occurrence of complications.

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Section: Resistancementioning

confidence: 73%

Adverse Effects of Nondepolarising Neuromuscular Blocking Agents

Abel

1994

Drug Safety

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“…Therefore, as demonstrated in this study, acute exposure did not cause resistance to the neuromuscular blockade even at high doses of dexamethasone and hydrocortisone. There is no previously published study about the effects of hydrocortisone on the rocuronium-induced neuromuscular blockade, but the effects of hydrocortisone on pancuronium and succinylcholine were evaluated by Durant et al [18]. In contrast to previous studies of the effects of steroids, they found no evidence of a facilitator action of hydrocortisone following acute or chronic exposure in cats.…”

Section: Discussionmentioning

confidence: 99%

“…However, in clinical studies, dexamethasone did not show an inhibitory effect on sugammadex reversal [15–17]. One explanation for this discrepancy is a dose difference between in vivo and in vitro studies [18]. Therefore, this interference effect, observed in vitro , requires further study at clinical doses.…”

Section: Introductionmentioning

confidence: 99%

“…Since dexamethasone and hydrocortisone are widely used during surgery, we explored the effects of these two steroids in vitro using a phrenic nerve-hemidiaphragm rat model. To account for steroidal resistance of neuromuscular blockade [10,18], we calculated the effective dose of rocuronium, that commonly used non-depolarizing neuromuscular blocking agent in various doses of these steroids. We also explored whether various clinical doses of steroids could affect the ability of sugammadex to reverse a rocuronium-induced neuromuscular blockade.…”

Section: Introductionmentioning

confidence: 99%

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Effects of dexamethasone and hydrocortisone on rocuroniuminduced neuromuscular blockade and reversal by sugammadex in phrenic nerve-hemidiaphragm rat model

Choi

Park

Kim

et al. 2019

Korean J Anesthesiol

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Background The facilitator effects of steroids on neuromuscular transmission may cause resistance to neuromuscular blocking agents. Additionally, steroids may hinder sugammadex reversal of neuromuscular blockade, but these findings remain controversial. Therefore, we explored the effect of dexamethasone and hydrocortisone on rocuronium-induced neuromuscular blockade and their inhibitory effect on sugammadex. Methods We explored the effects of steroids, dexamethasone and hydrocortisone, in vitro using a phrenic nerve-hemidiaphragm rat model. In the first phase, an effective dose of rocuronium was calculated, and in the second phase, following sugammadex administration, the recovery of the train-of-four (TOF) ratio and T1 was evaluated for 30 minutes, and the recovery index was calculated in dexamethasone 0, 0.5, 5, and 50 μg/ml, or hydrocortisone 0, 1, 10, or 100 μg/ml. Results No significant effect of steroids on the effective dose of rocuronium was observed. The TOF ratios at 30 minutes after sugammadex administration were decreased significantly only at high experimental concentrations of steroids: dexamethasone 50 μg/ml and hydrocortisone 100 μg/ml (P < 0.001 and P = 0.042, respectively). There were no statistical significances in other concentrations. No differences were observed in T1. Recovery index was significantly different only in 100 μg/ml of hydrocortisone (P = 0.03). Conclusions Acute exposure to steroids did not resist the neuromuscular blockade caused by rocuronium. And inhibition of sugammadex reversal on rocuronium-induced neuromuscular blockade is unlikely at typical clinical doses of dexamethasone and also hydrocortisone. Conclusively, we can expect proper effects of rocuronium and sugammadex when dexamethasone or hydrocortisone is used during general anesthesia.

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“…In the cat, hydrocortisone in 7–15 mg kg −1 doses significantly enhanced the 50% depression of the indirectly elicited twitch tension of the tibialis anterior muscle produced by an i.v. infusion of pancuronium [138]. It is uncertain as to the doses of corticosteroids that may affect neuromuscular function.…”

Section: Unknown Site Of Actionmentioning

confidence: 99%