Effects of Sugammadex and Neostigmine on Maternal Steroid and Lactation-Related Hormone Levels During Cesarean...

The effects of neuromuscular blockade reversal agents on maternal endocrine physiology during cesarean section remain poorly understood. Sugammadex, a selective γ-cyclodextrin that encapsulates aminosteroid neuromuscular blockers, may transiently interact with endogenous steroid hormones due to its structural affinity. This study compared the impact of sugammadex and neostigmine on maternal steroid and lactation-related hormones during cesarean delivery under general anesthesia.

In this randomized and controlled trial, 44 parturients (≥37 weeks) undergoing cesarean section under general anesthesia received either 2 mg/kg sugammadex or 0.03 mg/kg neostigmine for neuromuscular blockade reversal. Serum concentrations of progesterone, estradiol, aldosterone, cortisol, prolactin, and oxytocin were measured preoperatively, at the end of surgery, and at 15 minutes and 4 hours postoperatively.

Both groups showed significant decreases in progesterone and estradiol levels after surgery compared to preoperative values; however, the sugammadex group exhibited a greater decrease (p<0.05). Aldosterone levels reached their highest point at the end of surgery, but by 4 hours later they were lower than before surgery, especially in the sugammadex group (p<0.001). Cortisol showed a temporary postoperative elevation, whereas prolactin and oxytocin levels rose in both groups, with no significant intergroup variations.

Sugammadex induces a short-term suppression of maternal steroid hormones, particularly progesterone and estradiol, but does not affect lactation-related hormones. Measured hormone levels returned to near preoperative values within four hours, and no clinically significant adverse outcomes were associated with these temporary hormonal changes, supporting the safety of sugammadex use in obstetric anesthesia.