Author: Fuchs-Buder T, et al.
Current Opinion in Anesthesiology 38(4):349-352, August 2025. doi:10.1097/ACO.0000000000001507
This review discusses the interaction between magnesium sulfate (MgSO₄) and neuromuscular blockade, as well as the implications for reversal with sugammadex. Magnesium enhances neuromuscular blockade by accelerating onset, prolonging duration, and delaying recovery. Administering MgSO₄ soon after recovery may even trigger recurrence of neuromuscular weakness.
Evidence indicates that sugammadex dosing and timing remain effective and unchanged regardless of whether blockade is induced by rocuronium alone or potentiated by magnesium pretreatment. However, when magnesium is given after recovery, vigilance is needed because of the narrower safety margin and risk of re-blockade. Sugammadex can still provide reliable reversal if the initial agent was steroidal, such as rocuronium or vecuronium.
Key Takeaways
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Magnesium sulfate intensifies neuromuscular blockade and can delay recovery.
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Giving magnesium soon after recovery may cause recurrence of blockade.
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Sugammadex reversal works effectively regardless of magnesium pretreatment.
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Caution is warranted if MgSO₄ is administered post-recovery due to reduced safety margin.
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Sugammadex remains a rapid and dependable option when steroidal agents are used.
Thank you to Current Opinion in Anesthesiology for publishing this practical review on magnesium, sugammadex, and neuromuscular management.