Effectiveness of magnesium sulfate compared to rocuronium for rapid sequence tracheal intubation in adults: clinical randomized trial

Barbosa, Fabiano Timbó; Neto, Olavo Barbosa de Oliveira; Barbosa, Luciano Timbó; Andrade, Raul Ribeiro de; Ribeiro, Êurica Adélia Nogueira; Sousa‐Rodrigues, Célio Fernando de

doi:10.1016/j.bjane.2020.02.005

Cited by 2 publications

(5 citation statements)

References 12 publications

(11 reference statements)

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“…In the assessment of the need for muscle relaxants for orotracheal intubation, 39 randomised clinical trials, 2–40 one cohort study, 41 two systematic reviews, 42,43 and one clinical guideline 44 were included. We considered studies that investigated succinylcholine, rocuronium, atracurium, cisatracurium, rapacuronium, mivacurium and vecuronium in the adult population.…”

Section: Evidence Summary and Commentmentioning

confidence: 99%

Peri-operative management of neuromuscular blockade

Fuchs‐Buder

Romero

Lewald

et al. 2022

European Journal of Anaesthesiology

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Recent data indicated a high incidence of inappropriate management of neuromuscular block, with a high rate of residual paralysis and relaxant-associated postoperative complications. These data are alarming in that the available neuromuscular monitoring, as well as myorelaxants and their antagonists basically allow well tolerated management of neuromuscular blockade. In this first European Society of Anaesthesiology and Intensive Care (ESAIC) guideline on peri-operative management of neuromuscular block, we aim to present aggregated and evidence-based recommendations to assist clinicians provide best medical care and ensure patient safety. We identified three main clinical questions: Are myorelaxants necessary to facilitate tracheal intubation in adults? Does the intensity of neuromuscular blockade influence a patient's outcome in abdominal surgery? What are the strategies for the diagnosis and treatment of residual paralysis? On the basis of this, PICO (patient, intervention, comparator, outcome) questions were derived that guided a structured literature search. A stepwise approach was used to reduce the number of trials of the initial research (n = 24 000) to the finally relevant clinical studies (n = 88). GRADE methodology (Grading of Recommendations, Assessment, Development and Evaluation) was used for formulating the recommendations based on the findings of the included studies in conjunction with their methodological quality. A two-step Delphi process was used to determine the agreement of the panel members with the recommendations: R1 We recommend using a muscle relaxant to facilitate tracheal intubation (1A). R2 We recommend the use of muscle relaxants to reduce pharyngeal and/or laryngeal injury following endotracheal intubation (1C). R3 We recommend the use of a fast-acting muscle relaxant for rapid sequence induction intubation (RSII) such as succinylcholine 1 mg kg−1 or rocuronium 0.9 to 1.2 mg kg−1 (1B). R4 We recommend deepening neuromuscular blockade if surgical conditions need to be improved (1B). R5 There is insufficient evidence to recommend deep neuromuscular blockade in general to reduce postoperative pain or decrease the incidence of peri-operative complications. (2C). R6 We recommend the use of ulnar nerve stimulation and quantitative neuromuscular monitoring at the adductor pollicis muscle to exclude residual paralysis (1B). R7 We recommend using sugammadex to antagonise deep, moderate and shallow neuromuscular blockade induced by aminosteroidal agents (rocuronium, vecuronium) (1A). R8 We recommend advanced spontaneous recovery (i.e. TOF ratio >0.2) before starting neostigmine-based reversal and to continue quantitative monitoring of neuromuscular blockade until a TOF ratio of more than 0.9 has been attained. (1C)

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Section: Evidence Summary and Commentmentioning

confidence: 99%

Peri-operative management of neuromuscular blockade

Fuchs‐Buder

Romero

Lewald

et al. 2022

European Journal of Anaesthesiology

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“…A notable drawback is some studies' absence of pre-procedural assessments of difficult tracheal intubation. The oversight in evaluating the difficulty of tracheal intubation beforehand may impact the efficacy of MgSO 4 in addressing cardiovascular instability linked to laryngoscopy and tracheal intubation [28]. Second, discrepancies in the timing of MgSO 4 infusion were observed in certain studies, where the precise administration period was not clearly defined.…”

Section: Limitations Of Existing Studiesmentioning

confidence: 99%

“…Second, discrepancies in the timing of MgSO 4 infusion were observed in certain studies, where the precise administration period was not clearly defined. This lack of clarity regarding the timing could influence the interpretation of the results [28]. Furthermore, a subset of studies did not incorporate measurements of serum magnesium levels.…”

Section: Limitations Of Existing Studiesmentioning

confidence: 99%

“…Furthermore, a subset of studies did not incorporate measurements of serum magnesium levels. This omission hampers a comprehensive understanding of the pharmacokinetics and pharmacodynamics of MgSO 4 in the specific context of laryngoscopy and tracheal intubation [28]. Another limitation pertains to the comparative aspect of some investigations.…”

Section: Limitations Of Existing Studiesmentioning

confidence: 99%

“…While specific studies compared MgSO 4 to other agents, such as rocuronium, the absence of a control or placebo group was notable. This absence limits the ability to assess the effectiveness of MgSO 4 in isolation [28]. In addition, several studies featured a restricted patient population, potentially constraining the generalizability of their findings to a broader demographic [26].…”

Section: Limitations Of Existing Studiesmentioning

confidence: 99%

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A Comprehensive Review of Magnesium Sulfate Infusion: Unveiling the Impact on Hemodynamic Stability During Laryngoscopy and Tracheal Intubation in Ear, Nose, and Throat Surgeries

Sawant,

Sen

2024

Cureus

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This comprehensive review explores the potential of magnesium sulfate infusion in mitigating hemodynamic instability during laryngoscopy and tracheal intubation in ear, nose, and throat (ENT) surgeries. Hemodynamic fluctuations during these procedures pose challenges, and magnesium sulfate, with its vasodilatory, antiarrhythmic, and neuroprotective properties, emerges as a promising intervention. The review critically examines existing literature, emphasizing patient selection criteria, dosage protocols, and a comparative analysis with other hemodynamic stabilizers. Safety considerations, including known adverse effects and risk-benefit assessments, and monitoring and management strategies are elucidated. The implications for ENT surgery are discussed, highlighting the potential for enhanced hemodynamic management and individualized approaches. The review concludes with a call for continued research, emphasizing the ongoing evolution of understanding and practice incorporating magnesium sulfate into perioperative care. The insights offered aim to guide clinicians in navigating this dynamic landscape for improved patient outcomes in ENT surgeries.

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Effectiveness of magnesium sulfate compared to rocuronium for rapid sequence tracheal intubation in adults: clinical randomized trial

Cited by 2 publications

References 12 publications

Peri-operative management of neuromuscular blockade

Peri-operative management of neuromuscular blockade

A Comprehensive Review of Magnesium Sulfate Infusion: Unveiling the Impact on Hemodynamic Stability During Laryngoscopy and Tracheal Intubation in Ear, Nose, and Throat Surgeries

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