A randomised controlled trial comparing rocuronium priming, magnesium pre-treatment and a combination of the two methods

Department of Anesthesiology and Pain Medicine, Seoul National University, South Korea.
Anaesthesia (Impact Factor: 3.38). 03/2012; 67(7):748-54. DOI: 10.1111/j.1365-2044.2012.07102.x
Source: PubMed


We investigated whether magnesium sulphate combined with rocuronium priming shortens the onset of neuromuscular blockade, compared with these methods used alone. Ninety-two patients scheduled for general anaesthesia were randomly allocated to one of four groups: controls were given 0.6 mg.kg(-1) rocuronium; patients in the prime group were given 0.06 mg.kg(-1) rocuronium three minutes before a further dose of 0.54 mg.kg(-1) rocuronium; patients in the magnesium group were given an infusion of 50 mg.kg(-1) magnesium sulphate before rocuronium and patients in the magnesium and prime group were given both the magnesium sulphate and the priming dose of rocuronium. Tracheal intubation was attempted 40 s after the rocuronium injection. The time to onset of neuromuscular blockade was the primary outcome; duration of blockade and tracheal intubating conditions were also measured. The group allocation and study drugs were coded and concealed until statistical analyses were completed. The magnesium and prime group had the shortest mean (SD) onset time (55 (16)s; p < 0.001), and best tracheal intubating conditions (p < 0.05). No statistical difference was found for the duration of blockade. As for adverse events, a burning or heat sensation was reported in eight (35%) and six (26%) patients in the magnesium and magnesium and prime groups, respectively. The combination of magnesium sulphate and rocuronium priming accelerated the onset or neuromuscular blockade and improved rapid-sequence intubating conditions, compared with either magnesium sulphate or priming used alone.

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Available from: Ah Young Oh, Nov 20, 2014
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    • "Until recently, when used during the induction of general anesthesia, magnesium has been highlighted on its efficacy to attenuate cardiovascular responses associated with tracheal intubation [44,45]. In addition, Kim et al. [46] reported that magnesium sulfate, when combined with rocuronium priming, improved rapid-sequence intubating conditions, compared with either magnesium sulfate or priming used alone. "
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    ABSTRACT: Magnesium sulfate has been used in preeclampsia patients in order to prevent seizure. It is also used for the treatment of arrhythmia and asthma and as an anesthetic adjunct in patients undergoing surgery for pheochromocytoma. However, its potentiating effects on perioperative analgesia and muscle relaxation have drawn attention recently. These characteristics of magnesium (anesthetic- and analgesic-sparing effect) enable anesthesiologists to reduce the use of anesthetics during surgery and the use of analgesics after surgery. Magnesium sulfate has a high therapeutic index and cost-effectiveness. Considering these diverse characteristics useful for anesthesia, appropriate use of magnesium sulfate would improve surgical outcome and patients' satisfaction.
    Korean journal of anesthesiology 07/2013; 65(1):4-8. DOI:10.4097/kjae.2013.65.1.4

  • European Journal of Anaesthesiology 12/2012; 30(4). DOI:10.1097/EJA.0b013e32835c1c3e · 2.94 Impact Factor
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    ABSTRACT: BACKGROUND There is little information on the interaction between magnesium sulphate (MgSO4) and rocuronium in elderly patients. With a growing number of older patients who need surgical procedures, it is increasingly important to study this age group.OBJECTIVE To evaluate the effects of MgSO4 administration on the pharmacodynamics of rocuronium in patients aged 60 years or older.DESIGNA randomised controlled trial.SETTINGA tertiary care hospital.PATIENTSSixty-four patients, aged 60 years or older, American Society of Anesthesiologists (ASA) physical status classes I to III, scheduled for elective oncological head and neck surgery. Exclusion criteria were severe renal insufficiency (calculated creatinine clearance <30mlmin(-1)), preoperatorive serum magnesium concentration of more than 1.25mmoll(-1) and patients receiving drugs known to affect neuromuscular function.INTERVENTIONSPatients were randomly allocated to one of two groups: in the magnesium group, patients received MgSO4 30mgkg(-1) intravenously, for 10min, and then a continuous intravenous infusion at a rate of 1gh(-1). The control group received the same volume of physiological saline. Neuromuscular function was evaluated continuously in both groups.MAIN OUTCOME MEASURESTotal recovery time was the primary outcome. Onset time, clinical duration, recovery index and recovery time were considered as secondary endpoints. Values are given as mean [SD].RESULTSTotal recovery time from neuromuscular block (NMB) was 113 [36] min in the magnesium group and 101 [39] min in the control group. Clinical duration was 69 [23] min in the magnesium group and 59 [28] min in the control group. Recovery index was 19 [36] min in the magnesium group and 17 [6] min in the control group. Recovery time was 44 [22] min in the magnesium group and 42 [18] min in the control group. There were no statistically significant differences between the groups in any of the recovery indices. In the magnesium group, the mean onset time was 144 [58] s, significantly shorter than the onset time in the group that received physiological saline, which was 187 [90] s (P=0.03). Group variances were compared using an F test: onset time varied significantly less in the magnesium group (P=0.02).CONCLUSION In oncology patients of 60 or more years of age, preadministration of MgSO4, with the doses used in this study, significantly reduced the onset time of NMB induced by rocuronium.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT01804205.
    European Journal of Anaesthesiology 04/2013; 30(10). DOI:10.1097/EJA.0b013e328361d342 · 2.94 Impact Factor
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