This document discusses a study that investigated whether magnesium decreases the efficacy of sugammadex for reversing rocuronium-induced neuromuscular block. The study administered a single IV infusion of magnesium to subjects and found that the efficacy of recommended doses of sugammadex for reversing both moderate and deep rocuronium-induced block was preserved despite magnesium administration. The conclusions state that recommended sugammadex doses allow encapsulation of the majority of rocuronium molecules at the neuromuscular junction and help reestablish neuromuscular reserve in addition to antagonizing the neuromuscular block.

1. Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland (CC, CL, NE, MRT)
Faculty of Medicine, University of Geneva, Geneva, Switzerland (MRT)
Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary (ET)
Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland (NE.

2. Neuromuscular endplate Neuromuscular monitoring: TOF Watch
Neuromuscular monitoring: Single twitch and Train-of-Four stimulation
Neuromuscular transmission

3. Sugammadex antagonises
Rocuronium through
encapsulation
Rocuronium Sugammadex Encapsulation

4. Magnesium is frequently used in daily clinical practice:
obstetrics, cardiology, intensive care, anaesthesiology
Magnesium interacts with neuromuscular transmission
Magnesium and neuromuscular transmission

5. Czarnetzki et al. Acta Anaesthesiol Scand 2010:54:299-306

6. To investigate whether magnesium decreases the
efficacy of sugammadex for the reversal of
rocuronium-induced neuromuscular block
Aim of the study
Hans et al. Eur J Anaesthesiol 2010; X: YYY-YYY
Vulnerability of the neuromuscular transmission after normalisation to TOF 0.9

7. Study design
Moderate block = 2 twitches
Deep block = Post-tetanic count 2

8. Results (I): Reversal of moderate block

9. Results (I): Reversal of deep block

10. The efficacy of recommended doses of sugammadex for the
reversal of moderate and deep rocuronium-induced block is
preserved despite the administration of a single IV infusion of
magnesium.
Conclusions
Recommended doses of sugammadex allow for encapsulating
the majority of rocuronium molecules that are present at the
neuromuscular junction.
Sugammadex, within the recommended dose regimens, not
only antagonizes the neuromuscular block but also
reestablishes neuromuscular reserve.