Efficacy of sugammadex for the reversal of moderate and deep rocuronium-induced neuromuscular block in patients pretreated with intravenous magnesium: a randomized controlled trial

Anesthesiology. 2014 Jul;121(1):59-67. doi: 10.1097/ALN.0000000000000204.

Abstract

Background: Magnesium enhances the effect of rocuronium. Sugammadex reverses rocuronium-induced neuromuscular block. The authors investigated whether magnesium decreased the efficacy of sugammadex for the reversal of rocuronium-induced neuromuscular block.

Methods: Thirty-two male patients were randomized in a double-blinded manner to receive magnesium sulfate (MgSO4) 60 mg/kg or placebo intravenously before induction of anesthesia with propofol, sufentanil, and rocuronium 0.6 mg/kg. Neuromuscular transmission was monitored using TOF-Watch SX acceleromyography (Organon Ltd., Dublin, Ireland). In 16 patients, sugammadex 2 mg/kg was administered intravenously at reappearance of the second twitch of the train-of-four (moderate block). In 16 further patients, sugammadex 4 mg/kg was administered intravenously at posttetanic count 1 to 2 (deep block). Primary endpoint was recovery time from injection of sugammadex to normalized train-of-four ratio 0.9. Secondary endpoint was recovery time to final T1.

Results: Average time for reversal of moderate block was 1.69 min (SD, 0.81) in patients pretreated with MgSO4 and 1.76 min (1.13) in those pretreated with placebo (P = 0.897). Average time for reversal of deep block was 1.77 min (0.83) in patients pretreated with MgSO4 and 1.98 min (0.58) in those pretreated with placebo (P = 0.572). Times to final T1 were longer compared with times to normalized train-of-four ratio 0.9, without any difference between patients pretreated with MgSO4 or placebo.

Conclusion: Pretreatment with a single intravenous dose of MgSO4 60 mg/kg does not decrease the efficacy of recommended doses of sugammadex for the reversal of a moderate and deep neuromuscular block induced by an intubation dose of rocuronium.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Androstanols / adverse effects
  • Androstanols / antagonists & inhibitors*
  • Anesthesia Recovery Period
  • Double-Blind Method
  • Endpoint Determination
  • Female
  • Humans
  • Injections, Intravenous
  • Magnesium Sulfate / administration & dosage
  • Magnesium Sulfate / adverse effects
  • Magnesium Sulfate / pharmacology*
  • Male
  • Middle Aged
  • Monitoring, Intraoperative
  • Neuromuscular Blockade* / adverse effects
  • Neuromuscular Nondepolarizing Agents / adverse effects
  • Neuromuscular Nondepolarizing Agents / antagonists & inhibitors*
  • Preanesthetic Medication
  • Rocuronium
  • Sugammadex
  • Young Adult
  • gamma-Cyclodextrins / adverse effects
  • gamma-Cyclodextrins / pharmacology*

Substances

  • Androstanols
  • Neuromuscular Nondepolarizing Agents
  • gamma-Cyclodextrins
  • Sugammadex
  • Magnesium Sulfate
  • Rocuronium