Magnesium sulfate accelerates the onset of low-dose rocuronium in patients undergoing laryngeal microsurgery

Choi, Eun Su; Jeong, Woo Jin; Ahn, Sang Hyun; Oh, Ah Young; Jeon, Young Tae; Hwan, Sang

doi:10.1016/j.jclinane.2016.10.020

Cited by 10 publications

(17 citation statements)

References 28 publications

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“…Magnesium sulfate has been shown to prolong the total time to recovery from a rocuronium-induced blockade by about 25% [11] and 60% [14] in non-pregnant patients. Magnesium sulfate 30 mg/kg accelerated the onset and improved operating conditions of low-dose rocuronium without prolongation of action [4]. Pre-treatment with magnesium sulfate 40 mg/kg did not significantly affect the recovery time of moderate neuromuscular blockade facilitated by sugammadex [6].…”

Section: Discussionmentioning

confidence: 85%

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Prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in cesarean section under general anesthesia: a case report

Moriwaki

Kayashima

2019

JA Clin Rep

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Background: We present a rare case of prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in a pregnant patient being treated with magnesium sulfate and nifedipine undergoing cesarean section under general anesthesia. Case presentation: A 37-year-old woman at 34 weeks gestation, weighing 42.5 kg, and receiving magnesium sulfate 94 mg/kg for preeclampsia and nifedipine 20 mg, underwent cesarean section under general anesthesia for abruptio placentae. Her trachea was intubated after administering rocuronium 0.94 mg/kg. Postoperatively, sugammadex 4.7 mg/kg was administered at post-tetanic count 2, 163 min after rocuronium administration. However, 9 min after sugammadex administration, the train-of-four ratio only reached 0.7. Fifteen min after sugammadex administration, extubation was successfully performed when the train-of-four ratio reached 0.9 after administration of atropine 0.5 mg and neostigmine 1.0 mg. Conclusions: Caution is required in pregnant women on high-dose magnesium sulfate with nifedipine, which may cause prolongation of neuromuscular blockade and insufficient reversal.

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Section: Discussionmentioning

confidence: 85%

“…In the experimental setting, administration of a high dose of magnesium 87 mg/kg caused the twitch height to decrease to 33% of the baseline value [3]. Data on onset of rocuronium action with magnesium are available in non-pregnant [4], but not in pregnant patients.…”

Section: Introductionmentioning

confidence: 99%

Prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in cesarean section under general anesthesia: a case report

Moriwaki

Kayashima

2019

JA Clin Rep

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“…Magnesium reduces muscle contraction in proportion to its concentration in the blood and accelerates the effects of NMBDs [ 68 69 ]. In contrast, calcium increases ACh release while maintaining action potential at the neuromuscular junction [ 70 ].…”

Section: Factors That Affect Muscle Contractilitymentioning

confidence: 99%

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

Kim

Sung

Yang

2017

Korean J Anesthesiol

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Neuromuscular blockade plays an important role in the safe management of patient airways, surgical field improvement, and respiratory care. Rapid-sequence induction of anesthesia is indispensable to emergency surgery and obstetric anesthesia, and its purpose is to obtain a stable airway, adequate depth of anesthesia, and appropriate respiration within a short period of time without causing irritation or damage to the patient. There has been a continued search for new neuromuscular blocking drugs (NMBDs) with a rapid onset of action. Factors that affect the onset time include the potency of the NMBDs, the rate of NMBDs reaching the effect site, the onset time by dose control, metabolism and elimination of NMBDs, buffered diffusion to the effect site, nicotinic acetylcholine receptor subunit affinity, drugs that affect acetylcholine (ACh) production and release at the neuromuscular junction, drugs that inhibit plasma cholinesterase, presynaptic receptors responsible for ACh release at the neuromuscular junction, anesthetics or drugs that affect muscle contractility, site and methods for monitoring neuromuscular function, individual variability, and coexisting disease. NMBDs with rapid onset without major adverse events are expected in the next few years, and the development of lower potency NMBDs will continue. Anesthesiologists should be aware of the use of NMBDs in the management of anesthesia. The choice of NMBD and determination of the appropriate dosage to modulate neuromuscular blockade characteristics such as onset time and duration of neuromuscular blockade should be considered along with factors that affect the effects of the NMBDs. In this review, we discuss the factors that affect the onset time of NMBDs.

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“…The primary outcomes for the current study were the effects of adjuvant magnesium on the pharmacodynamics of rocuronium in terms of onset time, clinical duration, and recovery index. Based on previous studies, [16][17][18][19][21][22][23][24][25][26][27] the time from injection of rocuronium to 80% to 100% depression of the single twitch, 95% to 100% depression of the first twitch, or when the train-of-four (TOF) count reached 0 as defined in the eligible studies were all accepted as the onset time. Clinical duration was defined as the time from injection of rocuronium to 25% recovery of first twitch of TOF stimulation or TOF count recovered to 2.…”

Section: Data Extraction and Outcomes Assessedmentioning

confidence: 99%

“…Eleven studies [16][17][18][19][21][22][23][24][25][26][27] involving 460 participants (!18 years old) were included in the meta-analysis. The characteristics of the included trials are presented in Tables 1 and 2.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

Efficacy of magnesium sulfate as an adjuvant to rocuronium in general anaesthesia: a meta-analysis

Sun

Jin

et al. 2021

J Int Med Res

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Objective Magnesium sulfate is considered to be an effective adjuvant to rocuronium in general anaesthesia. We conducted a meta-analysis to clarify its efficacy. Methods We searched the PubMed, Embase, Web of Science, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) of magnesium sulfate as an adjuvant to rocuronium from the start of the database establishment until May 2020. Results Eleven RCTs were analysed. The pooled meta-analysis showed that using magnesium sulfate as an adjuvant significantly shortened the onset time and prolonged the clinical duration of neuromuscular blockade by rocuronium compared with the control group without magnesium sulfate. However, there was no significant difference in recovery index of neuromuscular block between the magnesium and control groups. Furthermore, magnesium sulfate significantly increased the rates of excellent and clinically acceptable intubation conditions. Conclusion Adding magnesium sulfate to rocuronium during general anaesthesia can alter the neuromuscular parameters, including shortening the anaesthesia-onset time and prolonging the clinical duration, without significantly increasing the recovery time. Pretreatment with magnesium sulfate may also improve intubation conditions during general anaesthesia.

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Magnesium sulfate accelerates the onset of low-dose rocuronium in patients undergoing laryngeal microsurgery

Cited by 10 publications

References 28 publications

Prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in cesarean section under general anesthesia: a case report

Prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in cesarean section under general anesthesia: a case report

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

Efficacy of magnesium sulfate as an adjuvant to rocuronium in general anaesthesia: a meta-analysis

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