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

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.