Magnesium potentiates neuromuscular blockade with cisatracurium during cardiac surgery

Pinard, Anne Marie; Donati, François; Martineau, Raymond; Denault, André; Taillefer, Jean; Carrier, Michel

doi:10.1007/bf03017852

Cited by 44 publications

(37 citation statements)

References 31 publications

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“…An interaction between magnesium sulfate and the none-depolarizing neuromuscular blocking agents (NMBAs) has been documented for many years. This was also observed in patients undergoing cardiac surgery, where administration of magnesium sulfate results in a (30-35 min) prolongation of the neuromuscular blockade induced with intubating and maintenance doses of cisatracurium [14].…”

Section: Anesthetic Managementsmentioning

confidence: 63%

Effect of Magnesium Sulfate on the Total Anesthetic and Analgesic Requirements in Neurosurgery

Manaa¹

2013

J Neurol Neurophysiol

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Section: Anesthetic Managementsmentioning

confidence: 63%

Effect of Magnesium Sulfate on the Total Anesthetic and Analgesic Requirements in Neurosurgery

Manaa¹

2013

J Neurol Neurophysiol

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“…These findings are consis-tent with those published by Kussman et al, who demonstrated increased durations of NMB in patients given magnesium sulphate before rocuronium 9 and with those published by Pinard et al, who showed prolonged NMB in cardiac surgery patients given magnesium sulphate and cisatracurium. 10 Lastly, it is interesting to note that the patients' postoperative serum calcium levels were low. Since calcium has the potential to reverse the effect of magnesium at the nerve terminal, low serum calcium may be an additional contributory factor.…”

Section: Conclusion : Nous Devons éViter D'administrer De Fortes Dosementioning

confidence: 99%

Prolonged (more than ten hours) neuromuscular blockade after cardiac surgery: report of two cases

Olivieri

Plourde

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : We examine two cases of prolonged neuromuscular blockade (NMB) after cardiac surgery. To the best of our knowledge, these are the first reported cases of complete paralysis lasting more than ten hours after surgery.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : We attribute the extended durations of NMB (more than ten hours) to high doses of NMB drugs in combination with magnesium sulphate and moderate renal failure. Advanced age, hepatic disease, aminoglycoside exposure, hypocalcemia, and possible interaction between rocuronium and pancuronium may have played minor roles.C Co on nc cl lu us si io on n: : We should avoid administering large doses of NMB agents, even in the context of planned postoperative ventilation. If NMB is not monitored intraoperatively in patients who are at risk of prolonged NMB, then train-of-four response should be measured in the intensive care unit. Adequate sedation should be provided until proper recovery of neuromuscular function is documented. E examine two cases of prolonged neuromuscular blockade (NMB) after cardiac surgery. We attribute the extended durations of complete paralysis (more than ten hours) to high doses of NMB drugs in combination with magnesium sulphate and moderate renal failure. ObjectifC Ca as se e 1 1 A 67-yr-old woman was referred to the anesthesia service for prolonged NMB after mitral valve replacement.The patient had been transferred to our hospital for surgical treatment of bacterial endocarditis and critical mitral stenosis. The patient was treated initially for two weeks with ampicillin and gentamicin and one week of ampicillin alone. Her past medical history included rheumatic mitral valve stenosis (with previous commissurotomy), pulmonary hypertension and chronic atrial fibrillation. Height and weight were 165 cm and 63 kg. Laboratory investigations revealed anemia, hypokalemia, and mild pre-renal failure (Table I). Preoperative medications included furosemide, digoxin, ramipril, iv heparin, flurazepam, ampicillin, and potassium chloride.

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“…It is frequently used in anesthesia during repair surgery for patients with CHDs (Pinard et al, 2003;Mirinejad et al, 2007). However, the pharmacokinetics (PK) and pharmacodynamics (PD) of cisatracurium in patients with CHDs remain underexplored.…”

Section: Introductionmentioning

confidence: 99%

Altered Cisatracurium Pharmacokinetics and Pharmacodynamics in Patients with Congenital Heart Defects

Wang

Peng

et al. 2015

Drug Metabolism and Disposition

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The neuromuscular blocking agent cisatracurium is frequently used adjunctively in anesthesia to facilitate endotracheal intubation and to provide muscle relaxation during surgery. We aimed to determine the pharmacokinetics (PK)/pharmacodynamics (PD) of cisatracurium in patients with congenital heart defects (CHDs), such as ventricular septal defects and atrial septal defects, and to assess the effects of CHDs on the PK/PD profiles of cisatracurium. A modified two-compartment model with drug clearance from both compartments was best fitted to the PK data to determine the PK parameters. The model suggested that septal defects significantly lowered the rate of cisatracurium distribution from the central to peripheral compartment. The intercompartment rate constants k 12 and k 21 were significantly reduced (35%-60%, P < 0.05) in patients with ventricular septal defects and in patients with atrial septal defects compared with control patients. Consistently, septal defects caused a marked increase (160%-175%, P < 0.001) in the distribution half-life. Furthermore, significantly delayed pharmacodynamic responses to cisatracurium were observed in patients with septal defects. The onset time (i.e., the time to maximal neuromuscular block) was prolonged from 2.2 minutes to 5.0 minutes. PK/PD modeling suggested that reduced concentrations of cisatracurium in the effect compartment due to poorer distribution were the main cause of lagged pharmacodynamic responses. In conclusion, cisatracurium PK/PD were significantly altered in patients with septal defects. Our study should be of use in clinical practice for the administration of cisatracurium to patients with CHDs.

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Magnesium potentiates neuromuscular blockade with cisatracurium during cardiac surgery

Abstract: P Pu ur rp po os se e: : Magnesium potentiates the effect of nondepolarizing neuromuscular blocking agents. It is used in cardiac anesthesia to prevent hypertension and arrhythmias. This study was performed to measure the interaction between magnesium and cisatracurium in cardiac surgery.

Cited by 44 publications

References 31 publications

Effect of Magnesium Sulfate on the Total Anesthetic and Analgesic Requirements in Neurosurgery

Effect of Magnesium Sulfate on the Total Anesthetic and Analgesic Requirements in Neurosurgery

Prolonged (more than ten hours) neuromuscular blockade after cardiac surgery: report of two cases

Altered Cisatracurium Pharmacokinetics and Pharmacodynamics in Patients with Congenital Heart Defects

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