Methylprednisolone vs Dexamethasone Interaction With Sugammadex in Pediatric Patients

Konya City Hospital

Status: Completed

Conditions: Pain Management; Postoperative Nausea; Neuromuscular Block, Residual

Treatments: Drug: Methyl Prednisolone (MP); Drug: Dexamethasone (0.2 mg/kg); Drug: Saline (0.9% NaCl)

Study type: Interventional

Funder types: Other

Identifiers

NCT07175623

12-5/2025

Details and patient eligibility

About

This randomized controlled trial aims to compare the interaction of methylprednisolone and dexamethasone with sugammadex in pediatric patients undergoing adenoidectomy and/or tonsillectomy. The primary objective is to evaluate the effect of these corticosteroids on the reversal time of rocuronium-induced neuromuscular block by sugammadex. Secondary outcomes include postoperative pain, nausea and vomiting, extubation time, and adverse events. Eligible participants are children aged 5 to 12 years, ASA I-II, scheduled for elective surgery under general anesthesia. The study is designed as a triple-blind, parallel-group trial with three arms: methylprednisolone, dexamethasone, and placebo.

Full description

Neuromuscular blocking agents (NMBAs) are widely used in pediatric anesthesia to facilitate tracheal intubation and optimize surgical conditions. However, residual neuromuscular block may increase the risk of postoperative respiratory complications, especially in children who have shorter safe apnea times due to their unique anatomical and physiological characteristics. Sugammadex, a modified γ-cyclodextrin, is a selective reversal agent for aminosteroid NMBAs such as rocuronium. Its mechanism of encapsulating steroidal neuromuscular blocking molecules raises concerns about potential interactions with other steroidal drugs, including perioperatively used corticosteroids.

Corticosteroids are commonly administered in the perioperative period for their antiemetic, analgesic, and anti-inflammatory effects. Dexamethasone is widely accepted for postoperative nausea and vomiting prophylaxis, while methylprednisolone is preferred for its rapid anti-inflammatory effect. Previous studies have suggested that the structural similarity of corticosteroids to rocuronium may interfere with sugammadex binding, but the available evidence is conflicting, and data on methylprednisolone remain limited. In a prior study, methylprednisolone was shown to prolong sugammadex reversal time slightly, but no direct comparison with another corticosteroid was performed.

This randomized controlled trial is designed to compare the effects of methylprednisolone and dexamethasone on sugammadex reversal time in pediatric patients undergoing adenoidectomy and/or tonsillectomy. The study will assess whether methylprednisolone has a stronger interaction with sugammadex compared with dexamethasone, leading to prolonged recovery from rocuronium block. Secondary outcomes will include postoperative pain, nausea and vomiting, extubation time, and adverse events. The results may provide clinically relevant evidence regarding the choice of corticosteroid in pediatric anesthesia when sugammadex is used for neuromuscular block reversal.

Enrollment: 60 patients

Sex: All

Ages: 5 to 12 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Children aged 5-12 years
• American Society of Anesthesiologists (ASA) physical status I-II

Exclusion criteria

• ASA physical status ≥ III
• Emergency surgery
• Known allergy or contraindication to neuromuscular blocking agents, sugammadex, or corticosteroids
• Chronic or recent systemic corticosteroid use (within the last 3 months)
• Neuromuscular disorders (e.g., muscular dystrophy, myasthenia gravis)
• Severe hepatic or renal dysfunction
• Significant respiratory or cardiac disease
• Anticipated difficult airway or history of difficult intubation
• Developmental delay or craniofacial anomalies affecting airway management
• Refusal of consent

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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60 participants in 3 patient groups, including a placebo group

Methylprednisolone

Experimental group

Description:

Patients will receive intravenous methylprednisolone 1 mg/kg at the induction of anesthesia.

Treatment:

Drug: Methyl Prednisolone (MP)

Dexamethasone

Experimental group

Description:

Patients will receive intravenous dexamethasone 0.2 mg/kg at the induction of anesthesia

Treatment:

Drug: Dexamethasone (0.2 mg/kg)

Control

Placebo Comparator group

Description:

Patients will receive 5 ml of intravenous normal saline at the induction of anesthesia

Treatment:

Drug: Saline (0.9% NaCl)