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The effect of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular blockade in surgical patients undergoing general anesthesia A systematic review and meta-analysis

Authors
Lim, Byung GunWon, Young JuKim, Heezoo
Issue Date
5-2월-2021
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Keywords
adverse drug event; anesthesia recovery period; dexamethasone; general anesthesia; neuromuscular blockade; rocuronium; sugammadex; surgery; tracheal extubation
Citation
MEDICINE, v.100, no.5, pp.e23992
Indexed
SCIE
SCOPUS
Journal Title
MEDICINE
Volume
100
Number
5
Start Page
e23992
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/49607
DOI
10.1097/MD.0000000000023992
ISSN
0025-7974
Abstract
Background: There have been conflicting results regarding clinical dexamethasone-sugammadex interactions in adults and pediatric patients under general anesthesia. Methods: 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. Results: 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) (I-2 = 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) (I-2 = 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. Conclusion: 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.
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