The effects of sugammadex on steroidal hormone levels

ABSTRACT The Effects of Sugammadex on Steroidal Hormone Levels In this study, the effect of sugammadex, a recently introduced alternative to traditional decurarization by cholinesterase inhibitors, on adrenal cortical hormones has been examined. After local ethics committee approval and written informed patient consent were obtained, a total of 50 male patients between 18 and 45 years of age with an ASA (American Anesthesiology Association) class of I or II undergoing elective lower extremity surgery with an expected surgery time of 1 to 3 hours were included in this study. Prior to surgery, patients were categorized into two groups (neostigmin group, Group N; and sugammadex group, Group S). In addition to standard monitorization, train-of-four (TOF) was also used to monitorize the level of neuromuscular blockade. Standard induction (propofol, rocuronium, remifentanyl) and maintenance (sevoflurane, O2) of anesthesia were performed. At the termination of surgery, neuromuscular blockade was antagonised using 0.05 mg/kg of neostigmine and 0.01 mg/kg of atropine in Group N and using 4 mg/kg sugammadex in Group S when spontaneous recovery of neuromuscular blockade occurred with the reappearance of T2. A total of three blood samples, just before and 15 minutes and 4 hours after antagonism, were obtained in each patient to determine serum aldosterone, cortisol, progesterone, and free testosterone levels. No significant differences were found in demographic characteristics, total surgery time, total rucuronium need, and perioperative hemodynamic parameters between the groups. While there were no differences in serum progesterone levels, patients in neostigmin group had significantly higher cortisol levels at 15 minutes as compared to baseline. Also, patients in sugammadex group had significantly higher serum aldosterone and testosterone levels 15 minutes after antagonism as compared to those in the neostigmine group. Our findings suggest that sugammadex is not associated with adverse effects on steroid hormones progesterone and cortisol, while it may lead to a temporary increase in aldosterone and testosterone. Keywords: Sugammadex, cortisol, progesterone, aldosterone, free testosterone