Methylprednisolone vs Dexamethasone: Effects on Sugammadex Reversal, Pain, and Nausea in Adults

Neuromuscular blockade with rocuronium is routinely reversed with sugammadex. Corticosteroids such as methylprednisolone and dexamethasone are frequently used perioperatively for their anti-inflammatory and antiemetic effects. However, possible pharmacological interactions between corticosteroids and sugammadex remain unclear and may affect reversal time.

This prospective, randomized, parallel-group clinical trial will enroll adult ASA I-II patients scheduled for elective septoplasty or rhinoplasty. Patients will be randomized to receive either methylprednisolone (1 mg/kg IV) or dexamethasone (0.2 mg/kg IV) at induction of anesthesia. Rocuronium will be administered for neuromuscular blockade, and sugammadex (2 mg/kg IV) will be given at the reappearance of the second twitch in TOF monitoring. Neuromuscular recovery will be continuously assessed with acceleromyography at the adductor pollicis muscle.

The primary outcome is the time interval from sugammadex injection to a TOF ratio of 0.9.

Secondary outcomes include extubation time, total rocuronium consumption, incidence and severity of PONV (assessed by VAS-B at 0, 30, 60, and 120 minutes in PACU), postoperative pain (VAS-A at the same time points), PACU complications (desaturation, stridor, severe cough), and intraoperative hemodynamic variables.

All anesthetic procedures will be standardized, and outcome assessors and statisticians will be blinded to group allocation. The results of this trial may guide perioperative steroid selection in patients receiving sugammadex reversal and help optimize postoperative recovery.

Inclusion criteria

• Adult patients aged 18-65 years
• American Society of Anesthesiologists (ASA) physical status I-II
• Scheduled for elective septoplasty or rhinoplasty under general anesthesia
• Written informed consent obtained

Exclusion criteria

• ASA physical status ≥ III
• Emergency surgery
• Known allergy or contraindication to rocuronium, sugammadex, or corticosteroids
• Chronic or recent (within 3 months) systemic corticosteroid therapy
• Concomitant use of drugs that may interact with sugammadex (e.g., toremifene, flucloxacillin, fusidic acid)
• Neuromuscular disorders (e.g., myasthenia gravis, muscular dystrophy)

• Significant hepatic, renal, respiratory, or cardiac dysfunction
• Anticipated difficult airway or history of difficult intubation
• Nasopharyngeal or oropharyngeal anomalies interfering with airway management
• Developmental or cognitive impairment interfering with informed consent or cooperation