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.

Neuromuscular endplate Neuromuscular monitoring: TOF Watch

Neuromuscular monitoring: Single twitch and Train-of-Four stimulation

Neuromuscular transmission

Sugammadex antagonises Rocuronium through

encapsulation

Rocuronium Sugammadex Encapsulation

Magnesium is frequently used in daily clinical practice:obstetrics, cardiology, intensive care, anaesthesiology

Magnesium interacts with neuromuscular transmission

Magnesium and neuromuscular transmission

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

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

Study design

Moderate block = 2 twitches

Deep block = Post-tetanic count 2

Results (I): Reversal of moderate block

Results (I): Reversal of deep block

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.