The effect of methylprednisolone on the reversal time of rocuronium by sugammadex in the paediatric patient group: A randomised controlled trial.

IF 6.8 2区 医学 Q1 ANESTHESIOLOGY
European Journal of Anaesthesiology Pub Date : 2025-11-01 Epub Date: 2025-07-16 DOI:10.1097/EJA.0000000000002241
Mustafa Büyükcavlak, Yasin Tire, Aydin Mermer, Muhammet S Yüce, Şerife N Yildirim, Betül Kozanhan
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引用次数: 0

Abstract

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.

Interventions: 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.

甲基强的松龙对儿科患者组糖马德治疗罗库溴铵逆转时间的影响:一项随机对照试验。
背景:Sugammadex是一种有效的逆转氨基类固醇神经肌肉阻滞剂的药物,但其有效性可能受到与类固醇类药物相互作用的影响。先前的研究表明,皮质类固醇可能会影响糖皮质酮的有效性,但甲基强的松龙在儿科患者中的数据有限。目的:探讨甲强的松龙诱导给药对罗库溴铵的逆转时间是否有影响。设计:单中心、双盲、随机对照试验。设置:土耳其三级保健中心,2024年9月至2025年1月。研究人群:接受选择性腺样体切除术和/或扁桃体切除术的儿科患者。干预措施:患者被随机分配接受甲基强的松龙1mg kg-1 (M组)或安慰剂(C组)麻醉诱导。用罗库溴铵诱导神经肌肉阻滞,用加速肌图监测,并在手术结束时用糖玛酮2mg kg-1逆转。主要观察指标:主要观察指标为舒玛德对罗库溴铵的逆转时间:舒玛德给药4次(TOF)计数= 2至TOF比≥0.9基线的时间。次要结局包括拔管时间(TOF计数为2时给药至拔管的时间)、术后疼痛、恶心和呕吐评分以及不良事件(喘鸣、声音嘶哑、严重咳嗽和去饱和)的发生率。结果:M组(89±20.3 s)与C组(54.6±9.3 s)相比,M组(89±20.3 s)对罗库溴铵的逆转时间有统计学意义(P)。结论:甲泼尼龙给药可显著延长罗库溴铵诱导的神经肌肉阻滞逆转时间,并可延迟拔管,但这种相互作用的临床重要性较小。试验注册:ClinicalTrials.gov标识符:NCT06623370。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.90
自引率
11.10%
发文量
351
审稿时长
6-12 weeks
期刊介绍: The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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