Rezonja Katja, Mars Tomaz, Jerin Ales, Kozelj Gordana, Pozar-Lukanovic Neva, Sostaric Maja
Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, 1000, Slovenia.
Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
BMC Anesthesiol. 2016 Oct 21;16(1):101. doi: 10.1186/s12871-016-0254-6.
Sugammadex 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.
Sixty-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.
There 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).
Administration of dexamethasone to anesthetized patients did not delay NMB reversal by sugammadex.
The 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.
舒更葡糖钠通过与氨基甾体类神经肌肉阻滞剂结合来逆转神经肌肉阻滞（NMB）。尽管舒更葡糖钠似乎具有高度选择性，但它可与其他药物相互作用，如皮质类固醇。一项前瞻性单盲随机临床试验旨在探讨地塞米松与舒更葡糖钠之间相互作用的意义。
纳入65例接受择期腹部或泌尿外科手术麻醉的患者。使用四个成串刺激（TOF）评估NMB，使用罗库溴铵维持所需的NMB深度。麻醉结束时使用舒更葡糖钠逆转NMB。根据患者接受的止吐药，将患者随机分为格拉司琼组或地塞米松组。在NMB逆转前后采集血样，用于测定血浆地塞米松和罗库溴铵。主要终点是从给予舒更葡糖钠到NMB逆转的时间。次要终点包括NMB逆转后与给予舒更葡糖钠前地塞米松和罗库溴铵浓度的比值。
对照组（平均121±61秒）和地塞米松组（平均125±57秒；P = 0.760）在NMB逆转时间上无差异。在给予舒更葡糖钠前TOF较低的患者中，NMB逆转至TOF比值≥0.9的时间明显更长（β = -0.268；P = 0.038）。NMB逆转后与给予舒更葡糖钠前罗库溴铵浓度的比值受舒更葡糖钠剂量（β = -0.375；P = 0.004）和每小时手术罗库溴铵剂量（β = -0.366；P = 0.007）的显著影响，而不受给予舒更葡糖钠前NMB深度（β = -0.089；P = 0.483）和地塞米松（β = -0.186；P = 0.131）的影响。给予舒更葡糖钠和NMB逆转后血浆地塞米松有显著下降（P < 0.001）。
对麻醉患者给予地塞米松不会延迟舒更葡糖钠逆转NMB。
该试验于2012年2月28日在澳大利亚新西兰临床试验注册中心（ANZCTR）进行回顾性注册（2012年2月2日纳入首例患者），并被赋予试验识别号ACTRN12612000245897和通用试验号U1111-1128-5104。
