A single 60 mg/kg IV dose of magnesium sulphate does not impede rocuronium reversal by sugammadex.

pearl

• Christoph Czarnetzki, Edömér Tassonyi, Christopher Lysakowski, Nadia Elia, and Martin R Tramèr.
• From the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland (C.C., C.L., N.E., M.R.T.); Faculty of Medicine, University of Geneva, Geneva, Switzerland (M.R.T.); Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary (E.T.); and Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland (N.E.).
• Anesthesiology. 2014 Jul 1;121(1):59-67.

BackgroundMagnesium 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.MethodsThirty-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.ResultsAverage 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.ConclusionPretreatment 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.

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