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Magnesium sulfate and sugammadex: implications for routine practice

Thomas Fuchs-Buder1, Denis Schmartz2, Benoît Plaud3

  • 1Université de Lorraine, CHRU Nancy, Hôpital de Brabois, Nancy, France.

Current Opinion in Anaesthesiology
|July 9, 2025
PubMed
Abstract

Insights

Sugammadex effectively reverses neuromuscular blockade caused by rocuronium, even with magnesium sulfate pretreatment. It also reliably counteracts blockade recurrence after magnesium administration post-recovery.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Neuromuscular Pharmacology

Background:

  • Magnesium sulfate (MgSO4) can prolong neuromuscular blockade induced by agents like rocuronium.
  • Administration of MgSO4 shortly after neuromuscular recovery may cause blockade recurrence.
  • Sugammadex is a reversal agent for steroidal neuromuscular blocking agents.

Purpose of the Study:

  • To assess the efficacy and safety of sugammadex in reversing neuromuscular blockade.
  • To evaluate sugammadex's role when neuromuscular blockade is affected by magnesium sulfate.
  • To determine sugammadex's effectiveness in managing recurrent neuromuscular blockade.

Main Methods:

  • Systematic review of clinical studies.
  • Analysis of sugammadex efficacy in patients pretreated with MgSO4.
  • Evaluation of sugammadex for MgSO4-induced recurrence of neuromuscular blockade.

Main Results:

  • Sugammadex dosing and timing are consistent regardless of MgSO4 pretreatment.
  • Caution is advised when administering MgSO4 after neuromuscular recovery due to potential recurrence.
  • Sugammadex effectively counteracts recurrence if blockade was induced by steroidal agents.

Conclusions:

  • Sugammadex provides rapid and reliable reversal of neuromuscular blockade in both evaluated scenarios.
  • Sugammadex is a safe and effective option for managing neuromuscular blockade influenced by magnesium sulfate.
Keywords:
magnesium sulfateneuromuscular blockaderesidual paralysissugammadex

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