Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.07.023
Brazilian Journal of Anesthesiology
Original Investigation

Effects of magnesium sulphate on the onset time of rocuronium at different doses - a randomized clinical trial

Efeitos do sulfato de magnésio no tempo de início do rocurônio em diferentes doses: um ensaio clínico randomizado

Carlos Eduardo David de Almeida; Lidia Raquel de Carvalho; Carla Vasconcelos Caspar Andrade; Paulo do Nascimento Jr; Guilherme Antonio Moreira de Barros; Norma Sueli Pinheiro Modolo

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Abstract

Background and aims
Rocuronium may provide excellent onset time, but high doses are required for effective action. Several strategies have managed to shorten rocuronium onset time, including the use of Magnesium Sulphate (MgSO4).

Methods
One hundred and eighty patients were randomized into six groups according to rocuronium dose received (0.3, 0.6 or 1.2 mg.kg-1) and the administration of saline or MgSO4 (60 mg.kg-1). Correlations between tissue perfusion and rocuronium onset time was determined by variations in perfusion index.

Results
Median (quartiles) rocuronium onset times were 85.5 (74.0–92.0); 76.0 (52.0–87.0) and 50.0 (41.0–59.5) seconds for 0.3, 0.6 mg.kg-1 and 1.2 mg.kg-1 doses, respectively. MgSO4 decreased rocuronium onset at doses of 0.3 mg.kg-1 (60.0 [48.0–74.3] seconds) and 0.6 mg.kg-1 (44.0 [39.0–49.0] seconds) but not at 1.2 mg.kg-1 (38.0 [33.5–56.3] seconds) (p <  0.001). Perfusion index variations in groups that received MgSO4 were greater than in controls. A negative correlation between shorten onset and increased perfusion index was observed in rocuronium doses of 0.3 mg.kg-1 (r = -0.50; p < 0.001) and 0.6 mg.kg-1 (r = -0.424; p <  0.001), but not for 1.2 mg.kg-1 dose (r = -0.25; p = 0.07).

Conclusion
MgSO4 reduces rocuronium onset time at doses of 0.3 mg.kg-1 and 0.6 mg.kg-1 being that the latter has a similar effect when compared to the dose of 1.2 mg.kg-1, with or without the use of MgSO4.

Keywords

Magnesium sulphate;  Neuromuscular blocking agents;  Rocuronium

Resumo

Justificativa e objetivos: O rocurônio pode fornecer um excelente tempo de início, mas altas doses são necessárias para uma ação eficaz. Várias estratégias conseguiram encurtar o tempo de início do rocurônio, incluindo o uso de sulfato de magnésio (MgSO4). Métodos: Cento e oitenta pacientes foram randomizados em seis grupos de acordo com a dose recebida de rocurônio (0,3, 0,6 ou 1,2 mg.kg-1) e a administração de solução salina ou MgSO4 (60 mg.kg-1). As correlações entre a perfusão tecidual e o tempo de início do rocurônio foram determinadas por variações no índice de perfusão. Resultados: Os tempos médios (quartis) de início do rocurônio foram 85,5 (74,0- -92,0); 76,0 (52,0 -87,0) e 50,0 (41,0 - 59,5) segundos para doses de 0,3, 0,6 mg.kg-1 e 1,2 mg.kg-1, respectivamente. O MgSO4 diminuiu o início do rocurônio com doses de 0,3 mg.kg-1 (60,0 [48,0 --- 74,3] segundos) e 0,6 mg.kg-1 (44,0 [39,0 - 49,0] segundos), mas não com 1,2 mg.kg-1 (38,0 [33,5 - 56,3] segundos) (p <0,001). As variações do índice de perfusão nos grupos que receberam MgSO4 foram maiores do que nos controles. Uma correlação negativa entre início encurtado e índice de perfusão aumentado foi observada em doses de rocurônio de 0,3 mg.kg-1 (r = -0,50; p <0,001) e 0,6 mg.kg-1 (r = -0,424; p <0,001), mas não para a dose de 1,2 mg.kg-1 (r = -0,25; p = 0,07). Conclusão: O MgSO4 reduz o tempo de aparecimento do rocurônio nas doses de 0,3 mg.kg-1 e 0,6 mg.kg-1, sendo este último efeito semelhante quando comparado à dose de 1,2 mg.kg-1, com ou sem o uso de MgSO4.

Palavras-chave

Sulfato de magnésio; Agentes de bloqueio neuromuscular; Rocurônio

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