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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.18.00238    [Epub ahead of print]
Published online March 19, 2019.
Effects of dexamethasone and hydrocortisone on rocuronium-induced neuromuscular blockade and reversal by sugammadex in a rat
Heyran Choi1,8, Sun Young Park2,8, Yong Beom Kim3,8, Junyong In4,8, Hong Seuk Yang5,8, Jeong-seok Lee6, Sanghyun Kim2, Suyeon Park7
1Department of Anaesthesiology and Pain Medicine, Inje University Seoul Paik hospital, Seoul, republic of Korea
2Department of Anaesthesiology and pain medicine, Soonchunhyang University Seoul Hospital, Seoul, republic of Korea
3Department of Anaesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
4Department of Anaesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Gyeonggido, republic of Korea
5Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, Seoul, republic of Korea
6Department of Anesthesiology and pain medicine, Soonchunhyang University Bucheon Hospital, Seoul, republic of Korea
7Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
8Neuromuscular Physiology Research Team at the Laboratory of Animal Research, Asan Institute of Life Science, Seoul, Korea
Corresponding author:  Sun Young Park, Tel: +82-10-8599-8432, 
Email: sunnypark97@schmc.ac.kr
Received: 14 August 2018   • Revised: 11 February 2019   • Accepted: 16 March 2019
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 in vitro using a phrenic nerve-hemidiaphragm rat model. In the first phase, effective dose of rocuronium were calculated and in the second phase, following sugammadex administration, the recovery of the train-of-four (TOF) ratio and T1 were evaluated for 30 minutes and the recovery index was calculated in dexamethasone 0, 0.5, 5, or 50 ug/ml; or hydrocortisone 0, 1, 10, or 100 ug/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 ug/ml and hydrocortisone 100 ug/ml. (p < 0.001 and p = 0.042, respectively). There were no significances in other concentrations.
Conclusion
Acute exposure to 0.5–50 ug/ml of dexamethasone or 1–100 ug/ml of hydrocortisone 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.
Key Words: Dexamethasone, Hydrocortisone, Neuromuscular monitoring, Rats, Rocuronium, Sugammadex


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