Influência da metilprednisolona no tempo de reversão do sugammadex: estudo clínico randomizado

Abstract

Background and objectives

Sugammadex is a modified gamma‐cyclodextrin that reverses the effects of aminosteroidal neuromuscular blocking agents. Likewise, some steroid molecules, such as toremifene, fusidic acid, and flucloxacillin, can also be encapsulated by sugammadex. Methylprednisolone, which is a synthetic steroid used commonly for airway oedema prophylaxis, can also be encapsulated by sugammadex. The objective of this study was to compare the recovery times of sugammadex for reversing rocuronium‐induced moderate neuromuscular blockade in those who received intraoperative 1 mg.kg^‐1 methylprednisolone or saline.

Method

This single‐centered, randomized, controlled, prospective study included 162 adult patients undergoing elective ear‐nose‐throat procedures (aged from 18‐65, an ASA physical status I‐II, a BMI less than 30 kg.m^‐2, and not taking steroid drug medication) with propofol, remifentanyl, rocuronium and sevoflurane. Neuromuscular monitoring was performed using calibrated acceleromyography. The Control Group (Group C) received 5 mL of saline, while the Methylprednisolone Group (Group M) received 1 mg.kg^‐1 of methylprednisolone in 5 mL of saline just after induction. After the completion of surgery, regarding the TOF count, two reappeared spontaneously and 2 mg.kg^‐1 sugammadex was administered to all patients. Recovery of the TOF ratio to 0.9 was recorded for both groups, and the estimated recovery time to reach a TOF ratio (TOFr) of 0.9 was the primary outcome of the study.

Results

Median time to TOFr = 0.9 was for 130.00 s (range of 29‐330) for Group C and 181.00 s (100‐420) for Group M (p < 0.001). The differences between the two groups were statistically significant.

Conclusion

When using 2 mg.kg^‐1 of sugammadex to reverse rocuronium‐induced neuromuscular blockade in patients who received 1 mg.kg^‐1 of intraoperative methylprednisolone, demonstrated delayed recovery times.