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. 2019 Oct;47(5):392-395.
doi: 10.5152/TJAR.2019.67760. Epub 2019 May 22.

Effect of Concurrent Lidocaine, Remifentanil and Methylprednisolone Use on the Clinical Effect of Sugammadex under General Anaesthesia in Rats

Tünay Kandemir  1 , Erbin Kandemir  1 , Tuğba Aşkın  1 , Selda Muslu  1 , Gonca Oğuz Tuncel  1 , Süheyla Ünver  1
Affiliations

Effect of Concurrent Lidocaine, Remifentanil and Methylprednisolone Use on the Clinical Effect of Sugammadex under General Anaesthesia in Rats

Tünay Kandemir et al. Turk J Anaesthesiol Reanim. 2019 Oct.

Abstract

Objective: In an in vitro study, lidocaine, remifentanil and methylprednisolone produced inclusion complexes with sugammadex, which lead to a decrease in free and active concentrations of sugammadex. When used concurrently with these drugs, it is likely that the time for sugammadex to reverse a neuromuscular blockade is going to be prolonged due to a synergistic pharmacokinetic or pharmacodynamic interaction. The aim of the present study was to investigate whether concurrent use of sugammadex with remifentanil, lidocaine and methylprednisolone led to a decrease in the neuromuscular blockade reversal effect of sugammadex produced with neuromuscular blockade agent (NMBA) rocuronium.

Methods: The present study included 42 male Wistar rats. They were randomised into 7 groups, with 6 rats per group. The first group was the control group, the second group received remifentanil and methylprednisolone, the third lidocaine and methylprednisolone, the fourth remifentanil, the fifth lidocaine, the sixth methylprednisolone and the seventh lidocaine and remifentanil. All groups were administered 3.2 mg kg-1 rocuronium for neuromuscular blockade after the administration of study drugs. When the train of four (TOF) value was 0, all groups were administered 16 mg kg-1 sugammadex for the reversal of neuromuscular blockade. With a TOF Watch SX device, the time to TOF ≥0.9 was recorded.

Results: When the control group was compared with Groups 3, 4, 5, 6 and 7, no statistically significant difference was found. However, in Group 2, time to TOF ≥0.9 was prolonged significantly when compared with the control group.

Conclusion: We suggest that remifentanil and methylprednisolone used concurrently with sugammadex lead to a decrease in sugammadex reversal effect by giving rise to decrease in its free and active concentrations probably via displacement in rats.

Keywords: Lidocaine; methylprednisolone; neuromuscular blockade; remifentanil; sugammadex.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

References

    1. Bom A, Hope F, Rutherford S, Thomson K. Preclinical pharmacology of sugammadex. J Crit Care. 2009;24:29–35. doi: 10.1016/j.jcrc.2008.10.010. - DOI - PubMed
    1. Plaud B, Meretoja O, Hofmockel R, Raft J, Stoddart PA, van Kuijk JH, et al. Reversal of rocuronium induced neuromuscular blockade with sugammadex in pediatric and adult surgical patients. Anesthesiology. 2009;110:284–94. doi: 10.1097/ALN.0b013e318194caaa. - DOI - PubMed
    1. Suy K, Morias K, Cammu G, Hans P, van Duijnhoven WG, Heeringa M, et al. Effective reversal of moderate rocuronium- or vecuronium-induced neuromuscular block with sugammadex, a selective relaxant binding agent. Anesthesiology. 2007;106:283–8. doi: 10.1097/00000542-200702000-00016. - DOI - PubMed
    1. Zwiers A, den Heuvel M, Smeets J, Rutherford S. Assessment of the potential for displacement interactions with sugammadex a pharmacokinetic-pharmacodynamic modelling approach. Clin Drug Investig. 2011;31:101–11. doi: 10.1007/BF03256937. - DOI - PubMed
    1. Booij LHDJ, De Boer HD, Van Egmond J. Reversal agents for nondepolarizing neuromuscular blockade: reasons for and development of a new concept. Semin Anesth Periop Med Pain. 2002;21:92–8. doi: 10.1053/sane.2002.34114. - DOI

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