Journal of Anesthesia

, Volume 26, Issue 6, pp 870–877 | Cite as

The effect of rocuronium, sugammadex, and their combination on cardiac muscle and diaphragmatic skeletal muscle cells

  • Yildiray Kalkan
  • Habib Bostan
  • Levent Tumkaya
  • Yakup Tomak
  • Mehmet Bostan
  • Adnan Yilmaz
  • Hasan Turut
  • Ahmet Temiz
  • Alper Yalçin
  • Alparslan Turan
Original Article



Rocuronium has been associated with muscle weakness when administered in prolonged infusions. The effect of sugammadex and rocuronium together on muscle is unknown. In this study, we examined the effects of rocuronium and sugammadex, and the complex formed by these agents, on cardiac and diaphragmatic muscle cells.


Forty-two Sprague–Dawley male rats were divided into six groups. Group I received only rocuronium at a dose of 1 mg/kg and groups II and III received sugammadex alone at doses of 16 and 96 mg/kg, respectively. Groups IV and V received 1 mg/kg rocuronium plus 16 mg/kg sugammadex and 1 mg/kg rocuronium plus 96 mg/kg sugammadex, respectively. Group six was the control group and received only 0.9 % NaCl without any drug.


Histopathological examination demonstrated that rocuronium and high doses of sugammadex accumulated in both cardiac and diaphragm muscle tissues. We also observed intense edema and degeneration in diaphragmatic and myocardial cells when the rocuronium-sugammadex complex was used. Rocuronium and sugammadex remain in the circulation for a long time and they may cause skeletal muscle myopathy, vacuolization, pyknotic nuclear clumps, and hypertrophy, and weaken the muscle fibers.


Rocuronium, sugammadex, and rocuronium–sugammadex complexes cause histopathological changes and immunoreactivity to calcineurin in muscle cells.


Sugammadex Muscle Diaphragmatic muscle cell Calcineurin Rat 


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Copyright information

© Japanese Society of Anesthesiologists 2012

Authors and Affiliations

  • Yildiray Kalkan
    • 1
  • Habib Bostan
    • 2
  • Levent Tumkaya
    • 1
  • Yakup Tomak
    • 3
  • Mehmet Bostan
    • 4
  • Adnan Yilmaz
    • 5
  • Hasan Turut
    • 6
  • Ahmet Temiz
    • 7
  • Alper Yalçin
    • 8
  • Alparslan Turan
    • 9
  1. 1.Department of Histology and Embryology, Medical FacultyRize UniversityRizeTurkey
  2. 2.The Ministry of JusticeInstitute of Forensic MedicineIstanbulTurkey
  3. 3.Department of Anesthesiology and Intensive Care, Medical FacultyRize UniversityRizeTurkey
  4. 4.Department of Cardiology, Medical FacultyRize UniversityRizeTurkey
  5. 5.Department of Biochemistry, Medical FacultyRize UniversityRizeTurkey
  6. 6.Department of Thoracic Surgery, Medical FacultyRize UniversityRizeTurkey
  7. 7.Department of Cardiology, Education and Research HospitalRize UniversityRizeTurkey
  8. 8.Provincial Coordination UnitAgriculture and Rural Development Support Institution (ARDSI)KahramanmaraşTurkey
  9. 9.Department of Outcomes ResearchCleveland ClinicClevelandUSA

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