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Magnesium-induced recurarisation after reversal of rocuronium-induced neuromuscular block with sugammadex.
Acta Anaesthesiol Scand. 2015 Apr; 59(4):536-40.AA

Abstract

A 61-year-old woman (57 kg, 171 cm) underwent surgery under general anaesthesia with desflurane 5.8-6.1 vol. % end-tidal, remifentanil 0.2-0.4 μg/kg/min and rocuronium 35 mg (0.61 mg/kg). On return of the second twitch in the train-of-four (TOF) stimulation measured by acceleromyography, sugammadex 120 mg (2.1 mg/kg) was given. After complete neuromuscular recovery, magnesium sulphate 3600 mg (60 mg/kg) was injected intravenously over 5 min to treat atrial fibrillation. This was associated with recurarisation with a nadir [first twitch=25%, TOF ratio (TOFR)=67%] 7 min after the start of the magnesium sulphate infusion (magnesium plasma level: 2.67 mM). A spontaneous twitch value and a TOFR of >90% were observed 45 min after the beginning of the magnesium sulphate infusion under general anaesthesia. Rapid infusion of magnesium sulphate may re-establish a sugammadex-reversed, rocuronium-induced neuromuscular block during general anaesthesia, probably because of the high plasma level of magnesium (2.67 mM). Desflurane and a small fraction of unbound rocuronium may amplify the known muscle relaxing effects of magnesium. Intravenous injection of magnesium sulphate is not recommended in patients after general anaesthesia with neuromuscular relaxants, particularly after sugammadex reversal. Quantitative neuromuscular monitoring should be used for reversing aminosteroid muscle relaxants with sugammadex--particularly in combination with magnesium injection--to prevent post-operative residual curarisation.

Authors+Show Affiliations

Department of Anaesthesiology, University Medical Centre Regensburg, Regensburg, Germany.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25582520

Citation

Unterbuchner, C, et al. "Magnesium-induced Recurarisation After Reversal of Rocuronium-induced Neuromuscular Block With Sugammadex." Acta Anaesthesiologica Scandinavica, vol. 59, no. 4, 2015, pp. 536-40.
Unterbuchner C, Ziegleder R, Graf B, et al. Magnesium-induced recurarisation after reversal of rocuronium-induced neuromuscular block with sugammadex. Acta Anaesthesiol Scand. 2015;59(4):536-40.
Unterbuchner, C., Ziegleder, R., Graf, B., & Metterlein, T. (2015). Magnesium-induced recurarisation after reversal of rocuronium-induced neuromuscular block with sugammadex. Acta Anaesthesiologica Scandinavica, 59(4), 536-40. https://doi.org/10.1111/aas.12461
Unterbuchner C, et al. Magnesium-induced Recurarisation After Reversal of Rocuronium-induced Neuromuscular Block With Sugammadex. Acta Anaesthesiol Scand. 2015;59(4):536-40. PubMed PMID: 25582520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Magnesium-induced recurarisation after reversal of rocuronium-induced neuromuscular block with sugammadex. AU - Unterbuchner,C, AU - Ziegleder,R, AU - Graf,B, AU - Metterlein,T, Y1 - 2015/01/13/ PY - 2014/12/02/received PY - 2014/12/04/accepted PY - 2015/1/14/entrez PY - 2015/1/15/pubmed PY - 2015/12/15/medline SP - 536 EP - 40 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 59 IS - 4 N2 - A 61-year-old woman (57 kg, 171 cm) underwent surgery under general anaesthesia with desflurane 5.8-6.1 vol. % end-tidal, remifentanil 0.2-0.4 μg/kg/min and rocuronium 35 mg (0.61 mg/kg). On return of the second twitch in the train-of-four (TOF) stimulation measured by acceleromyography, sugammadex 120 mg (2.1 mg/kg) was given. After complete neuromuscular recovery, magnesium sulphate 3600 mg (60 mg/kg) was injected intravenously over 5 min to treat atrial fibrillation. This was associated with recurarisation with a nadir [first twitch=25%, TOF ratio (TOFR)=67%] 7 min after the start of the magnesium sulphate infusion (magnesium plasma level: 2.67 mM). A spontaneous twitch value and a TOFR of >90% were observed 45 min after the beginning of the magnesium sulphate infusion under general anaesthesia. Rapid infusion of magnesium sulphate may re-establish a sugammadex-reversed, rocuronium-induced neuromuscular block during general anaesthesia, probably because of the high plasma level of magnesium (2.67 mM). Desflurane and a small fraction of unbound rocuronium may amplify the known muscle relaxing effects of magnesium. Intravenous injection of magnesium sulphate is not recommended in patients after general anaesthesia with neuromuscular relaxants, particularly after sugammadex reversal. Quantitative neuromuscular monitoring should be used for reversing aminosteroid muscle relaxants with sugammadex--particularly in combination with magnesium injection--to prevent post-operative residual curarisation. SN - 1399-6576 UR - https://www.unboundmedicine.com/medline/citation/25582520/Magnesium_induced_recurarisation_after_reversal_of_rocuronium_induced_neuromuscular_block_with_sugammadex_ L2 - https://doi.org/10.1111/aas.12461 DB - PRIME DP - Unbound Medicine ER -