Canadian Journal of Anaesthesia

, Volume 50, Issue 2, pp 172–178

Magnesium potentiates neuromuscular blockade with cisatracurium during cardiac surgery

  • Anne Marie Pinard
  • François Donati
  • Raymond Martineau
  • André Y. Denault
  • Jean Taillefer
  • Michel Carrier
Cardiothoracic Anesthesia, Respiration and Airway

Abstract

Purpose

Magnesium potentiates the effect of nondepoiarizing neuromuscular blocking agents. It is used in cardiac anesthesia to prevent hypertension and arrhythmias. This study was performed to measure the interaction between magnesium and cisatracurium in cardiac surgery.

Methods

Twenty patients scheduled for elective cardiac surgery were randomly assigned to receive magnesium sulfate (70 mg· kg−1 at induction followed by 30 mg· kg−1· hr−1) or placebo. The ulnar nerve was stimulated and the electromyographic response of the adductor pollicis was measured, Cisatracurium 0.1 mg· kg−1 was given at induction, followed by 0.05 mg· kg−1 when the first twitch in the train-of-four reached 25%.

Results

Ionized magnesium was 1.32 ± 0.24 mmol· L−1 in the treatment group vs 0.47 ± 0.4 mmol· L−1 in the control group. Duration of action of the intubating dose was longer in the magnesium group (74 ± 20 min) than in the placebo group (42 ± 6 min,P = 0,0001), Duration of the first maintenance dose was 69 ± 16 min in the magnesium group vs 35 ± 7 min in the placebo group (P = 0,0001), Total dose of cisatracurium administered throughout surgery was 0.19 ± 0.07 mg· kg−1 in the magnesium group compared with 0.29 ± 0.01 mg· kg−1 in the placebo group (P = 0.017). Hemodynamic variables and temperature were similar in both groups.

Conclusion

In patients undergoing cardiac surgery, administration of magnesium sulfate, resulting in ionized levels of 1.3 mmol· L−1, results in a 30–35 min prolongation of the neuromuscular blockade induced with intubating and maintenance doses of cisatracurium and does not alter hemodynamic stability.

Le magnésium potentialise le blocage neuromusculaire réalisé avec du cisatracurium en cardiochirurgie

Résumé

Objectif

Le magnésium est utilisé en clinique pour traiter les arythmies et prévenir l’hypertension. Le but de cette étude est de mesurer l’interaction entre Se cisatracurium et le magnésium en chirurgie cardiaque.

Méthode

Vingt patients devant subir une intervention cardiaque programmée ont été randomisés pour recevoir du sulfate de magnésium (70 mg· kg−1 à l’induction puis 30 mg· kg−1· h−1) ou un placebo. Le nerf ulnaire était stimulé et la réponse électromyographique du muscle adducteur du pouce était enregistrée. Pour l’intubation, 0,1 mg· kg−1 de cisatracurium était utilisé et les doses suivantes de 0,05 mg· kg−1 ont été administrées lorsque Tl atteignait 25%.

Résultats

Le magnésium ionisé était de 1,32 ± 0,24 mmol· L−1 dans le groupe traité vs 0,47 ± 0,4 mmol· L−1 dans le groupe placebo. La durée d’action des doses d’intubation et de maintien dans le groupe traité au magnésium (74 ± 20 min et 69 ± 16) était plus longue que dans le groupe placebo (42 ± 6 et 35 ± 7, P = 0,0001). Les variables hémodynamiques et la température sont restés similaires dans les deux groupes. La quantité de cisatracurium administrée durant l’opération était moins grande dans le groupe ayant reçu du magnésium comparé au placebo (0,19 ± 0,07 mg· kg−1 vs 0,29 ± 0,01 mg· kg−1, P = 0,017).

Conclusion

Chez des patients subissant une intervention cardiaque, une magnésémie de 1,3 mmol· L−1 produit peu de changements hémodynamiques mais augmente la durée du bloc neuromusculaire produit par le cisatracurium d’environ 30–35 min.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Anne Marie Pinard
    • 1
  • François Donati
    • 2
  • Raymond Martineau
    • 3
  • André Y. Denault
    • 3
  • Jean Taillefer
    • 3
  • Michel Carrier
    • 4
  1. 1.Department of AnesthesiologyMaisonneuve-Rosemont HospitalMontrealCanada
  2. 2.Department of AnesthesiologyUniversity of MontrealCanada
  3. 3.Department of AnesthesiologyMontreal Heart InstituteMontrealCanada
  4. 4.Department of SurgeryMontreal Heart InstituteMontrealCanada

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