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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.A

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.

Authors+Show Affiliations

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.).No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

24608361

Citation

Czarnetzki, Christoph, et al. "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, vol. 121, no. 1, 2014, pp. 59-67.
Czarnetzki C, Tassonyi E, Lysakowski C, et al. 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;121(1):59-67.
Czarnetzki, C., Tassonyi, E., Lysakowski, C., Elia, N., & Tramèr, M. R. (2014). 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, 121(1), 59-67. https://doi.org/10.1097/ALN.0000000000000204
Czarnetzki C, et al. 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;121(1):59-67. PubMed PMID: 24608361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of sugammadex for the reversal of moderate and deep rocuronium-induced neuromuscular block in patients pretreated with intravenous magnesium: a randomized controlled trial. AU - Czarnetzki,Christoph, AU - Tassonyi,Edömér, AU - Lysakowski,Christopher, AU - Elia,Nadia, AU - Tramèr,Martin R, PY - 2014/3/11/entrez PY - 2014/3/13/pubmed PY - 2014/8/13/medline SP - 59 EP - 67 JF - Anesthesiology JO - Anesthesiology VL - 121 IS - 1 N2 - 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. SN - 1528-1175 UR - https://www.unboundmedicine.com/medline/citation/24608361/Efficacy_of_sugammadex_for_the_reversal_of_moderate_and_deep_rocuronium_induced_neuromuscular_block_in_patients_pretreated_with_intravenous_magnesium:_a_randomized_controlled_trial_ L2 - https://pubs.asahq.org/anesthesiology/article-lookup/doi/10.1097/ALN.0000000000000204 DB - PRIME DP - Unbound Medicine ER -