title: Efficacy of sugammadex for the reversal of moderate and deep rocuronium-induced neuromuscular block in patients pretreated with intravenous magnesium: a randomized controlled trial.
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.
  
  
  CONCLUSIONS
  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.affiliation: 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.).
authors.forename: Christoph
authors.initials: C
authors.lastname: Czarnetzki
authors.forename: Edömér
authors.initials: E
authors.lastname: Tassonyi
authors.forename: Christopher
authors.initials: C
authors.lastname: Lysakowski
authors.forename: Nadia
authors.initials: N
authors.lastname: Elia
authors.forename: Martin R
authors.initials: MR
authors.lastname: Tramèr
mesh_terms: D000293:Adolescent; D000328:Adult; D000732:Androstanols / Q000009:adverse effects / Q000037:antagonists & inhibitors*; D000762:Anesthesia Recovery Period; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019148:Neuromuscular Blockade / Q000009:adverse effects; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects / Q000037:antagonists & inhibitors*; D011229:Preanesthetic Medication; D000077123:Rocuronium; D000077122:Sugammadex; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D008278:Magnesium Sulfate; D000077123:Rocuronium