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

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) (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.

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.

Figure 1

Flow diagram of included and excluded studies.

Figure 2

Time to recovery after sugammadex administration. SD = standard deviation, IV = inverse variance, CI = confidence interval.

Figure 3

Time to extubation after sugammadex administration SD = standard deviation, IV = inverse variance, CI = confidence interval.

Figure 4

Incidence of postoperative nausea and vomiting (PONV). M-H = Mantel–Haenszel, CI = confidence interval.

Figure 5

Subgroup analysis for the time to recovery after sugammadex administration according to age of study population. This figure shows the comparisons for the time to recovery within and between adult and pediatric subgroups. SD = standard deviation, IV = inverse variance, CI = confidence interval.

Figure 6

Sensitivity analysis for the time to recovery after sugammadex administration according to study design. This figure shows the comparisons for the time to recovery within and between RCT (randomized controlled trial) and non-randomized studies subgroups. SD = standard deviation, IV = inverse variance, CI = confidence interval.

Figure 7

Sensitivity analysis for the time to recovery after sugammadex administration according to study region. This figure shows the comparisons for the time to recovery within and between Europe and Africa subgroups. SD = standard deviation, IV = inverse variance, CI = confidence interval.

Figure 8

Quality assessment of the included studies. (A) Risk of bias summary of randomized controlled trials (RCTs): a review of authors judgments about each risk of bias item for each included RCT. Green circle: low risk of bias; yellow circle: unclear risk of bias; red circle: high risk of bias. (B) Risk of bias graph: review authors judgments about each risk of bias item presented as percentages across all included RCTs. Green color: low risk of bias; yellow color: unclear risk of bias; red color: high risk of bias.