The effect of methylprednisolone on the reversal time of rocuronium by sugammadex in the paediatric patient group
European Journal of Anaesthesiology, cilt.42, sa.11, ss.1025-1033, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 42 Sayı: 11
- Basım Tarihi: 2025
- Doi Numarası: 10.1097/eja.0000000000002241
- Dergi Adı: European Journal of Anaesthesiology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE
- Sayfa Sayıları: ss.1025-1033
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
BACKGROUND – Sugammadex is an effective agent for reversing aminosteroid neuromuscular blocking agents, but its effectiveness can be influenced by interactions with steroid-based drugs. Previous studies suggest corticosteroids may affect sugammadex effectiveness, but data on methylprednisolone in paediatric patients is limited.OBJECTIVE – This study aimed to determine whether methylprednisolone administration at induction affects the reversal time of rocuronium by sugammadex.DESIGN – Single centre, double blinded, randomised controlled trial.SETTINGS – Turkish tertiary care centre from September 2024 to January 2025.STUDY POPULATION – Paediatric patients undergoing elective adenoidectomy and/or tonsillectomy.INTERVENTION(S) – Patients were randomly assigned to receive either methylprednisolone 1 mg kg−1 (group M) or a placebo (group C) with anaesthesia induction. Neuromuscular block was induced with rocuronium, monitored using acceleromyography and reversed with sugammadex 2 mg kg−1 at the end of surgery.MAIN OUTCOME MEAURES – The primary outcome was the reversal time of rocuronium by sugammadex: time from sugammadex administration at train of four (TOF) count = 2 to a TOF ratio of ≥0.9 of baseline. Secondary outcomes included extubation time (time from sugammadex administration at TOF count = 2 to extubation), postoperative pain, nausea and vomiting scores, and incidence of adverse events (stridor, hoarseness, severe cough and desaturation). RESULTS – At 89 ± 20.3 s, the reversal time of rocuronium by sugammadex was statistically significantly longer in group M compared with the 54.6 ± 9.3 s of group C (P < 0.001). The mean with 95% confidence interval (CI) of the difference was 34.5 (27.3 to 41.6) s. The extubation time was also significantly prolonged in group M compared with group C: 426.8 ± 134.4 vs. 331.3 ± 129.0 s (P = 0.002) with a difference of 95.5 (95% CI, 36.8 to 154.2) s. No significant differences were observed in postoperative pain, nausea and vomiting scores, or frequency of adverse events. CONCLUSION – Although methylprednisolone administration resulted in a significantly prolonged reversal of rocuronium-induced neuromuscular block by sugammadex and subsequent delayed extubation, the clinical importance of this interaction is minor.TRIAL REGISTRATION – ClinicalTrials.gov Identifier: NCT06623370