Korean J Anesthesiol.  2019 Aug;72(4):366-374. 10.4097/kja.d.18.00238.

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

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea.
  • 2Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea. sunnypark97@schmc.ac.kr
  • 3Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea.
  • 4Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
  • 5Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 6Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
  • 7Department of Biostatistics, Soonchunhyang University College of Medicine, Asan, Korea.
  • 8Neuromuscular Physiology Research Team at the Laboratory of Animal Research, Asan Institute of Life Science, Seoul, Korea.

Abstract

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.

Keyword

Dexamethasone; Hydrocortisone; Neuromuscular monitoring; Rats; Rocuronium; Sugammadex

MeSH Terms

Anesthesia, General
Animals
Dexamethasone*
Hydrocortisone*
In Vitro Techniques
Models, Animal*
Neuromuscular Blockade*
Neuromuscular Blocking Agents
Neuromuscular Monitoring
Rats*
Steroids
Dexamethasone
Hydrocortisone
Neuromuscular Blocking Agents
Steroids

Cited by  1 articles

Effects of hydrocortisone-presensitized sugammadex on recovery from neuromuscular blockade induced by rocuronium: a rodent in vivo study
Hey-Ran Choi, Hong-Seuk Yang, Jae-Moon Choi, Chungon Park, Junyong In, Yong Beom Kim
Anesth Pain Med. 2022;17(2):182-190.    doi: 10.17085/apm.21076.

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