Magnesium sulfate and sugammadex: implications for routine practice

Purpose of the review Magnesium sulfate (MgSO4) enhances neuromuscular blockade; it may accelerate onset, prolong clinical duration, and delay neuromuscular recovery. In addition, MgSO4 administration shortly after neuromuscular recovery may lead to the recurrence of neuromuscular blockade. This review aimed to assess the efficacy and safety of sugammadex in both scenarios. Recent findings Compelling evidence suggests that the dosing and timing of sugammadex administration remain unchanged whether the neuromuscular blockade is induced by rocuronium alone or results from magnesium pretreatment before rocuronium administration. Furthermore, particular caution is required when MgSO4 is administered shortly after recovery from neuromuscular blockade, as the reduced safety margin may lead to the reappearance of neuromuscular blockade. Sugammadex may also counteract this recurrence, provided that the initial neuromuscular blockade was induced by a steroidal neuromuscular blocking agent such as rocuronium or vecuronium. Summary In both clinical scenarios, sugammadex-induced reversal is rapid and reliable.