Abstract：
The current study tested the hypothesis that magnesium sulfate after reversal with sugammadex causes recurarization.
A single-center, prospective, randomized, double-blind, controlled trial.
Terciary care hospital in Rio de Janeiro, Brazil.
Included 60 patients undergoing for elective otolaryngological surgery.
All patients received total intravenous anesthesia and a single dose of rocuronium (0.6 mg/kg). In 30 patients, the neuromuscular blockade was reversed with sugammadex (4 mg/kg) at the reappearance of one or two posttetanic counts (deep-blockade series). In 30 other patients, sugammadex (2 mg/kg) was administered at the reappearance of the second twitch of the train-of-four (moderate-blockade series). After the normalized train-of-four ratio recovered to ≥0.9, the patients in each series were randomized to receive intravenous magnesium sulfate (60 mg/kg) or placebo for 10 min. Neuromuscular function was measured by acceleromyography.
The primary outcome was the number of patients who exhibited recurarization (normalized train-of-four ratio < 0.9). The secondary outcome was rescue with an additional dose of sugammadex after 60 min.
In the deep-blockade series, a normalized train-of-four ratio < 0.9 occurred in 9/14 (64%) patients receiving magnesium sulfate and 1/14 (7%) receiving placebo, RR 9.0 (95% CI: 62-1.30), and (p = 0.002), with four rescues with sugammadex. In the moderate-blockade series, neuromuscular blockade recurred in 11/15 (73%) patients receiving magnesium sulfate and in 0/14 (0%) receiving placebo (p < 0.001), with two rescues. The absolute differences in recurarization were 57% and 73% in the deep-blockade and moderate-blockade, respectively.
Single-dose magnesium sulfate led to a normalized train-of-four ratio < 0.9, 2 min after recovery from rocuronium-induced deep and moderate neuromuscular blockade using sugammadex. Additional sugammadex reversed prolonged recurarization.
A single-center, prospective, randomized, double-blind, controlled trial.
Terciary care hospital in Rio de Janeiro, Brazil.
Included 60 patients undergoing for elective otolaryngological surgery.
All patients received total intravenous anesthesia and a single dose of rocuronium (0.6 mg/kg). In 30 patients, the neuromuscular blockade was reversed with sugammadex (4 mg/kg) at the reappearance of one or two posttetanic counts (deep-blockade series). In 30 other patients, sugammadex (2 mg/kg) was administered at the reappearance of the second twitch of the train-of-four (moderate-blockade series). After the normalized train-of-four ratio recovered to ≥0.9, the patients in each series were randomized to receive intravenous magnesium sulfate (60 mg/kg) or placebo for 10 min. Neuromuscular function was measured by acceleromyography.
The primary outcome was the number of patients who exhibited recurarization (normalized train-of-four ratio < 0.9). The secondary outcome was rescue with an additional dose of sugammadex after 60 min.
In the deep-blockade series, a normalized train-of-four ratio < 0.9 occurred in 9/14 (64%) patients receiving magnesium sulfate and 1/14 (7%) receiving placebo, RR 9.0 (95% CI: 62-1.30), and (p = 0.002), with four rescues with sugammadex. In the moderate-blockade series, neuromuscular blockade recurred in 11/15 (73%) patients receiving magnesium sulfate and in 0/14 (0%) receiving placebo (p < 0.001), with two rescues. The absolute differences in recurarization were 57% and 73% in the deep-blockade and moderate-blockade, respectively.
Single-dose magnesium sulfate led to a normalized train-of-four ratio < 0.9, 2 min after recovery from rocuronium-induced deep and moderate neuromuscular blockade using sugammadex. Additional sugammadex reversed prolonged recurarization.
摘要：
目的：当前的研究验证了用sugammadex逆转后硫酸镁引起复发的假设。
方法：单中心，prospective,随机化，双盲,对照试验。
方法：里约热内卢特级护理医院，巴西。
方法：包括60例接受择期耳鼻喉手术的患者。
方法：所有患者均接受全静脉麻醉和单剂量罗库溴铵（0.6mg/kg）。在30名患者中，神经肌肉阻滞在1或2次强直性后计数(深度阻滞系列)再次出现时被sugamadex(4mg/kg)逆转.在其他30名患者中，sugammadex（2mg/kg）在四组（中度阻断系列）的第二次抽搐重新出现时施用。在标准化的四组比率恢复到≥0.9后，每个系列的患者被随机分配接受静脉注射硫酸镁（60mg/kg）或安慰剂10分钟。神经肌肉功能通过加速肌电图测量。
方法：主要结果是表现出复发的患者数量（标准化4组比率<0.9）。次要结果是在60分钟后用额外剂量的sugammadex挽救。
结果：在深度封锁系列中，在接受硫酸镁的9/14（64％）和接受安慰剂的1/14（7％）患者中，标准化的四组比率<0.9，RR9.0（95%CI：62-1.30），和（p=0.002），用sugammadex进行了四次救援。在温和封锁系列中，神经肌肉阻滞在接受硫酸镁治疗的11/15（73%）患者和接受安慰剂治疗的0/14（0%）患者中复发（p<0.001），两次救援。在深度封锁和中度封锁中，递归的绝对差异分别为57％和73％，分别。
结论：单剂量硫酸镁在使用sugammadex从罗库溴铵诱导的深度和中度神经肌肉阻滞中恢复2分钟后，导致标准化的四组比率<0.9。额外的sugammadex逆转了长时间的递归。
方法：单中心，prospective,随机化，双盲,对照试验。
方法：里约热内卢特级护理医院，巴西。
方法：包括60例接受择期耳鼻喉手术的患者。
方法：所有患者均接受全静脉麻醉和单剂量罗库溴铵（0.6mg/kg）。在30名患者中，神经肌肉阻滞在1或2次强直性后计数(深度阻滞系列)再次出现时被sugamadex(4mg/kg)逆转.在其他30名患者中，sugammadex（2mg/kg）在四组（中度阻断系列）的第二次抽搐重新出现时施用。在标准化的四组比率恢复到≥0.9后，每个系列的患者被随机分配接受静脉注射硫酸镁（60mg/kg）或安慰剂10分钟。神经肌肉功能通过加速肌电图测量。
方法：主要结果是表现出复发的患者数量（标准化4组比率<0.9）。次要结果是在60分钟后用额外剂量的sugammadex挽救。
结果：在深度封锁系列中，在接受硫酸镁的9/14（64％）和接受安慰剂的1/14（7％）患者中，标准化的四组比率<0.9，RR9.0（95%CI：62-1.30），和（p=0.002），用sugammadex进行了四次救援。在温和封锁系列中，神经肌肉阻滞在接受硫酸镁治疗的11/15（73%）患者和接受安慰剂治疗的0/14（0%）患者中复发（p<0.001），两次救援。在深度封锁和中度封锁中，递归的绝对差异分别为57％和73％，分别。
结论：单剂量硫酸镁在使用sugammadex从罗库溴铵诱导的深度和中度神经肌肉阻滞中恢复2分钟后，导致标准化的四组比率<0.9。额外的sugammadex逆转了长时间的递归。
