The effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia: A systematic review and meta-analysis
There have been conflicting results regarding clinical dexamethasone-sugammadex interactions in adults and pediatric patients under general anesthesia. This study used a systematic review with meta-analysis of randomized controlled trials and non-randomized studies based on the Cochrane Review Metho...
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| Veröffentlicht in: | Medicine (Baltimore) 2021-02, Vol.100 (5), p.e23992-e23992 |
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| creator | Lim, Byung Gun Won, Young Ju Kim, Heezoo |
| description | There have been conflicting results regarding clinical dexamethasone-sugammadex interactions in adults and pediatric patients under general anesthesia.
This study used a systematic review with meta-analysis of randomized controlled trials and non-randomized studies based on the Cochrane Review Methods. A comprehensive literature search was conducted to identify clinical trials that investigated the effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia.
Among the 314 patients in the 6 studies, 147 received intravenous dexamethasone (dexamethasone group), and 167 received intravenous saline or other antiemetics (control group). The primary outcome, the time to recovery after sugammadex administration (the time to recovery of the train-of-four ratio to 0.9 after sugammadex administration; s) was comparable between the 2 groups, the weighted mean difference (95% confidence interval [CI]) being -2.93 (-36.19, 30.33) (I2 = 94%). The time to extubation after sugammadex administration (s) and incidence of postoperative nausea and vomiting was not different between the 2 groups, the weighted mean difference (95% CI) being 23.31 (-2.26, 48.88) (I2 = 86%) and the pooled risk ratio (95% CI) being 0.25 (0.03, 2.11), respectively. The time to recovery after sugammadex administration might be different according to the study design or study region.
This meta-analysis showed that use of dexamethasone in the perioperative period neither delayed nor facilitated the reversal of rocuronium-induced neuromuscular blockade with sugammadex in patients undergoing elective surgery with general anesthesia. However, given that the results showed high heterogeneity, further randomized controlled trials are needed to confirm these findings. |
| doi_str_mv | 10.1097/MD.0000000000023992 |
| format | Article |
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This study used a systematic review with meta-analysis of randomized controlled trials and non-randomized studies based on the Cochrane Review Methods. A comprehensive literature search was conducted to identify clinical trials that investigated the effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia.
Among the 314 patients in the 6 studies, 147 received intravenous dexamethasone (dexamethasone group), and 167 received intravenous saline or other antiemetics (control group). The primary outcome, the time to recovery after sugammadex administration (the time to recovery of the train-of-four ratio to 0.9 after sugammadex administration; s) was comparable between the 2 groups, the weighted mean difference (95% confidence interval [CI]) being -2.93 (-36.19, 30.33) (I2 = 94%). The time to extubation after sugammadex administration (s) and incidence of postoperative nausea and vomiting was not different between the 2 groups, the weighted mean difference (95% CI) being 23.31 (-2.26, 48.88) (I2 = 86%) and the pooled risk ratio (95% CI) being 0.25 (0.03, 2.11), respectively. The time to recovery after sugammadex administration might be different according to the study design or study region.
This meta-analysis showed that use of dexamethasone in the perioperative period neither delayed nor facilitated the reversal of rocuronium-induced neuromuscular blockade with sugammadex in patients undergoing elective surgery with general anesthesia. However, given that the results showed high heterogeneity, further randomized controlled trials are needed to confirm these findings.</description><identifier>ISSN: 0025-7974</identifier><identifier>EISSN: 1536-5964</identifier><identifier>DOI: 10.1097/MD.0000000000023992</identifier><identifier>PMID: 33592855</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Anesthesia, General - methods ; Dexamethasone - pharmacology ; Drug Interactions ; Elective Surgical Procedures - methods ; Glucocorticoids - pharmacology ; Humans ; Neuromuscular Blockade - methods ; Neuromuscular Nondepolarizing Agents - pharmacology ; Perioperative Care - methods ; Rocuronium - pharmacology ; Sugammadex - pharmacology ; Systematic Review and Meta-Analysis</subject><ispartof>Medicine (Baltimore), 2021-02, Vol.100 (5), p.e23992-e23992</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.</rights><rights>Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3552-c61660994d4915016ef50c42583fc9b4ed62814ba8d7ff2ebbc34d5f36dcbc4e3</cites><orcidid>0000-0002-4754-9776 ; 0000-0002-3302-1831 ; 0000-0003-4046-0020</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870250/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870250/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33592855$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lim, Byung Gun</creatorcontrib><creatorcontrib>Won, Young Ju</creatorcontrib><creatorcontrib>Kim, Heezoo</creatorcontrib><title>The effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia: A systematic review and meta-analysis</title><title>Medicine (Baltimore)</title><addtitle>Medicine (Baltimore)</addtitle><description>There have been conflicting results regarding clinical dexamethasone-sugammadex interactions in adults and pediatric patients under general anesthesia.
This study used a systematic review with meta-analysis of randomized controlled trials and non-randomized studies based on the Cochrane Review Methods. A comprehensive literature search was conducted to identify clinical trials that investigated the effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia.
Among the 314 patients in the 6 studies, 147 received intravenous dexamethasone (dexamethasone group), and 167 received intravenous saline or other antiemetics (control group). The primary outcome, the time to recovery after sugammadex administration (the time to recovery of the train-of-four ratio to 0.9 after sugammadex administration; s) was comparable between the 2 groups, the weighted mean difference (95% confidence interval [CI]) being -2.93 (-36.19, 30.33) (I2 = 94%). The time to extubation after sugammadex administration (s) and incidence of postoperative nausea and vomiting was not different between the 2 groups, the weighted mean difference (95% CI) being 23.31 (-2.26, 48.88) (I2 = 86%) and the pooled risk ratio (95% CI) being 0.25 (0.03, 2.11), respectively. The time to recovery after sugammadex administration might be different according to the study design or study region.
This meta-analysis showed that use of dexamethasone in the perioperative period neither delayed nor facilitated the reversal of rocuronium-induced neuromuscular blockade with sugammadex in patients undergoing elective surgery with general anesthesia. However, given that the results showed high heterogeneity, further randomized controlled trials are needed to confirm these findings.</description><subject>Anesthesia, General - methods</subject><subject>Dexamethasone - pharmacology</subject><subject>Drug Interactions</subject><subject>Elective Surgical Procedures - methods</subject><subject>Glucocorticoids - pharmacology</subject><subject>Humans</subject><subject>Neuromuscular Blockade - methods</subject><subject>Neuromuscular Nondepolarizing Agents - pharmacology</subject><subject>Perioperative Care - methods</subject><subject>Rocuronium - pharmacology</subject><subject>Sugammadex - pharmacology</subject><subject>Systematic Review and Meta-Analysis</subject><issn>0025-7974</issn><issn>1536-5964</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUctu1DAUtRCIDoUvQEL-gRQ_k5gFUtXSgtSKTVlHjn2dmCb2yE46zKfxd3gYKA9vLJ3XvfZB6DUlZ5So5u3t5Rn5cxhXij1BGyp5XUlVi6doU1BZNaoRJ-hFzl8Jobxh4jk64Vwq1kq5Qd_vRsDgHJgFR4ctfNMzLKPOMQCOAed10POsC44TPEDKejroUjRrisGvc-WDXQ1YHKAg85rNOumE-yma-2LD_pCRBm-KcasXD2HJeA0W0hB9GPAAAVLhdIC8jJC9fofPcd7nBeYiN4exHnaFt7hspisd9LTPPr9Ez5yeMrz6dZ-iL1cf7i4-Vjefrz9dnN9UhkvJKlPTuiZKCSsUlYTW4CQxgsmWO6N6AbZmLRW9bm3jHIO-N1xY6XhtTW8E8FP0_pi7XfsZrCkPKPt22-RnnfZd1L77lwl-7Ib40DVtU_6flAB-DDAp5pzAPXop6Q5NdreX3f9NFtebv8c-en5XVwTiKNjFaSnF3E_rDlI3gp6W8WeebBSrGGGUMCJJVRDB-A_FZ7CK</recordid><startdate>20210205</startdate><enddate>20210205</enddate><creator>Lim, Byung Gun</creator><creator>Won, Young Ju</creator><creator>Kim, Heezoo</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4754-9776</orcidid><orcidid>https://orcid.org/0000-0002-3302-1831</orcidid><orcidid>https://orcid.org/0000-0003-4046-0020</orcidid></search><sort><creationdate>20210205</creationdate><title>The effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia: A systematic review and meta-analysis</title><author>Lim, Byung Gun ; Won, Young Ju ; Kim, Heezoo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3552-c61660994d4915016ef50c42583fc9b4ed62814ba8d7ff2ebbc34d5f36dcbc4e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anesthesia, General - methods</topic><topic>Dexamethasone - pharmacology</topic><topic>Drug Interactions</topic><topic>Elective Surgical Procedures - methods</topic><topic>Glucocorticoids - pharmacology</topic><topic>Humans</topic><topic>Neuromuscular Blockade - methods</topic><topic>Neuromuscular Nondepolarizing Agents - pharmacology</topic><topic>Perioperative Care - methods</topic><topic>Rocuronium - pharmacology</topic><topic>Sugammadex - pharmacology</topic><topic>Systematic Review and Meta-Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lim, Byung Gun</creatorcontrib><creatorcontrib>Won, Young Ju</creatorcontrib><creatorcontrib>Kim, Heezoo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Medicine (Baltimore)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lim, Byung Gun</au><au>Won, Young Ju</au><au>Kim, Heezoo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia: A systematic review and meta-analysis</atitle><jtitle>Medicine (Baltimore)</jtitle><addtitle>Medicine (Baltimore)</addtitle><date>2021-02-05</date><risdate>2021</risdate><volume>100</volume><issue>5</issue><spage>e23992</spage><epage>e23992</epage><pages>e23992-e23992</pages><issn>0025-7974</issn><eissn>1536-5964</eissn><abstract>There have been conflicting results regarding clinical dexamethasone-sugammadex interactions in adults and pediatric patients under general anesthesia.
This study used a systematic review with meta-analysis of randomized controlled trials and non-randomized studies based on the Cochrane Review Methods. A comprehensive literature search was conducted to identify clinical trials that investigated the effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia.
Among the 314 patients in the 6 studies, 147 received intravenous dexamethasone (dexamethasone group), and 167 received intravenous saline or other antiemetics (control group). The primary outcome, the time to recovery after sugammadex administration (the time to recovery of the train-of-four ratio to 0.9 after sugammadex administration; s) was comparable between the 2 groups, the weighted mean difference (95% confidence interval [CI]) being -2.93 (-36.19, 30.33) (I2 = 94%). The time to extubation after sugammadex administration (s) and incidence of postoperative nausea and vomiting was not different between the 2 groups, the weighted mean difference (95% CI) being 23.31 (-2.26, 48.88) (I2 = 86%) and the pooled risk ratio (95% CI) being 0.25 (0.03, 2.11), respectively. The time to recovery after sugammadex administration might be different according to the study design or study region.
This meta-analysis showed that use of dexamethasone in the perioperative period neither delayed nor facilitated the reversal of rocuronium-induced neuromuscular blockade with sugammadex in patients undergoing elective surgery with general anesthesia. However, given that the results showed high heterogeneity, further randomized controlled trials are needed to confirm these findings.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>33592855</pmid><doi>10.1097/MD.0000000000023992</doi><orcidid>https://orcid.org/0000-0002-4754-9776</orcidid><orcidid>https://orcid.org/0000-0002-3302-1831</orcidid><orcidid>https://orcid.org/0000-0003-4046-0020</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Anesthesia, General - methods Dexamethasone - pharmacology Drug Interactions Elective Surgical Procedures - methods Glucocorticoids - pharmacology Humans Neuromuscular Blockade - methods Neuromuscular Nondepolarizing Agents - pharmacology Perioperative Care - methods Rocuronium - pharmacology Sugammadex - pharmacology Systematic Review and Meta-Analysis |
| title | The effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia: A systematic review and meta-analysis |
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