title: Effects of valproic acid and magnesium sulphate on rocuronium requirement in patients undergoing craniotomy for cerebrovascular surgery.
abstract: BACKGROUND
  Many anti-epileptics cause resistance to non-depolarizing neuromuscular blocking agents, but this has not been reported for valproic acid (VPA). We hypothesized that VPA would increase the rocuronium requirement and that magnesium sulphate (MgSO(4)) may reduce this increase.
  
  
  METHODS
  Fifty-five patients undergoing cerebrovascular surgeries were studied. Subjects were allocated into three groups at a 1:1:1 ratio: Groups VM, VC, and C. Groups VM and VC were given VPA premedication; Group C was not. A rocuronium injection (0.6 mg kg(-1) i.v.) was administered to Group VM, followed by MgSO(4) as a 50 mg kg(-1) i.v. bolus and 15 mg kg(-1) h(-1) infusion. The same volume of 0.9% saline was administered to the other groups. Supplementary rocuronium (0.15 mg kg(-1)) was given whenever the train-of-four count reached 2. Rocuronium requirements (primary outcome), mean arterial pressure (MAP), heart rate (HR), nausea, vomiting, shivering, and use of anti-emetics and nicardipine were compared.
  
  
  RESULTS
  Group VC showed the highest rocuronium requirement [mg kg(-1) h(-1): 0.47 (0.08) vs 0.33 (0.12) (Group C), 0.31 (0.07) (Group VM); P<0.001]. MAP, intraoperative HR, nausea, vomiting, shivering, and use of anti-emetics and nicardipine were not significantly different among the groups. Postoperative HR was lower in Group VM than in Group VC.
  
  
  CONCLUSIONS
  VPA increased the rocuronium requirement, and MgSO(4) infusion attenuated this increase.
authors: Department of Anesthesiology and Pain Medicine,  Seoul National University Bundang Hospital, 166, Gumi-ro, Seongnam-si, Gyeonggi-do,  Republic of Korea.
authors: M-H
authors: MH
authors: Kim
authors: J-W
authors: JW
authors: Hwang
authors: Y-T
authors: YT
authors: Jeon
authors: S-H
authors: SH
authors: Do
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000732:Androstanols / Q000008:administration & dosage*; D000927:Anticonvulsants / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D002561:Cerebrovascular Disorders / Q000601:surgery*; D003399:Craniotomy; D004311:Double-Blind Method; D004347:Drug Interactions; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008278:Magnesium Sulfate / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D000077123:Rocuronium; D014635:Valproic Acid / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D000927:Anticonvulsants; D003473:Neuromuscular Nondepolarizing Agents; D014635:Valproic Acid; D008278:Magnesium Sulfate; D000077123:Rocuronium