Prolonged neuromuscular block in a preeclamptic patient induced by magnesium sulfate

Berdaï, Mohamed Adnane; Labib, Smael; Harandou, Mustapha

doi:10.11604/pamj.2016.25.5.6616

Cited by 15 publications

(11 citation statements)

References 12 publications

(12 reference statements)

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“…By contrast, one study reported no clinically significant interaction between magnesium sulfate and calcium-antagonists among women with suspected preeclampsia, particularly with respect to neuromuscular weakness or other serious magnesium sulfate-related adverse effects [8]. In another study, in a woman receiving magnesium sulfate and a calcium-antagonist and undergoing C-section under general anesthesia, prolonged and deep neuromuscular blockade induced by vecuronium (6 mg) was antagonized 3 h later with neostigmine [7].…”

Section: Discussionmentioning

confidence: 96%

“…Pre-treatment with magnesium sulfate 40 mg/kg was observed to not significantly affect the recovery time of moderate neuromuscular blockade facilitated by sugammadex [6]. Combination of magnesium sulfate with a calcium-antagonist in patients undergoing C-section under general anesthesia may or may not prolong the neuromuscular blockade [7,8].…”

Section: Introductionmentioning

confidence: 89%

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Prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in cesarean section under general anesthesia: a case report

Moriwaki

Kayashima

2019

JA Clin Rep

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Background: We present a rare case of prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in a pregnant patient being treated with magnesium sulfate and nifedipine undergoing cesarean section under general anesthesia. Case presentation: A 37-year-old woman at 34 weeks gestation, weighing 42.5 kg, and receiving magnesium sulfate 94 mg/kg for preeclampsia and nifedipine 20 mg, underwent cesarean section under general anesthesia for abruptio placentae. Her trachea was intubated after administering rocuronium 0.94 mg/kg. Postoperatively, sugammadex 4.7 mg/kg was administered at post-tetanic count 2, 163 min after rocuronium administration. However, 9 min after sugammadex administration, the train-of-four ratio only reached 0.7. Fifteen min after sugammadex administration, extubation was successfully performed when the train-of-four ratio reached 0.9 after administration of atropine 0.5 mg and neostigmine 1.0 mg. Conclusions: Caution is required in pregnant women on high-dose magnesium sulfate with nifedipine, which may cause prolongation of neuromuscular blockade and insufficient reversal.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 89%

Prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in cesarean section under general anesthesia: a case report

Moriwaki

Kayashima

2019

JA Clin Rep

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“…Magnesium reduces muscle contraction in proportion to its concentration in the blood and accelerates the effects of NMBDs [ 68 69 ]. In contrast, calcium increases ACh release while maintaining action potential at the neuromuscular junction [ 70 ].…”

Section: Factors That Affect Muscle Contractilitymentioning

confidence: 99%

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

Kim

Sung

Yang

2017

Korean J Anesthesiol

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Neuromuscular blockade plays an important role in the safe management of patient airways, surgical field improvement, and respiratory care. Rapid-sequence induction of anesthesia is indispensable to emergency surgery and obstetric anesthesia, and its purpose is to obtain a stable airway, adequate depth of anesthesia, and appropriate respiration within a short period of time without causing irritation or damage to the patient. There has been a continued search for new neuromuscular blocking drugs (NMBDs) with a rapid onset of action. Factors that affect the onset time include the potency of the NMBDs, the rate of NMBDs reaching the effect site, the onset time by dose control, metabolism and elimination of NMBDs, buffered diffusion to the effect site, nicotinic acetylcholine receptor subunit affinity, drugs that affect acetylcholine (ACh) production and release at the neuromuscular junction, drugs that inhibit plasma cholinesterase, presynaptic receptors responsible for ACh release at the neuromuscular junction, anesthetics or drugs that affect muscle contractility, site and methods for monitoring neuromuscular function, individual variability, and coexisting disease. NMBDs with rapid onset without major adverse events are expected in the next few years, and the development of lower potency NMBDs will continue. Anesthesiologists should be aware of the use of NMBDs in the management of anesthesia. The choice of NMBD and determination of the appropriate dosage to modulate neuromuscular blockade characteristics such as onset time and duration of neuromuscular blockade should be considered along with factors that affect the effects of the NMBDs. In this review, we discuss the factors that affect the onset time of NMBDs.

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“…Moreover, it prevents progression to eclampsia, and it is recommended as the treatment of choice for seizures. 4 , 12 Doses used in this scenario increase the risk of hypermagnesemia, and consequently muscle relaxant interaction is more likely, especially in this population who is already more sensitive to these drugs. 12 During clinical practice, this drug interaction has not been valued enough in scenarios requiring rapid sequence intubation (obstetrics, e.g.)…”

mentioning

confidence: 99%

Magnesium: the underestimated ion

Módolo

Barros

2021

Brazilian Journal of Anesthesiology (English Edition)

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Prolonged neuromuscular block in a preeclamptic patient induced by magnesium sulfate

Cited by 15 publications

References 12 publications

Prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in cesarean section under general anesthesia: a case report

Prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in cesarean section under general anesthesia: a case report

Factors that affect the onset of action of non-depolarizing neuromuscular blocking agents

Magnesium: the underestimated ion

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