Effectiveness of magnesium sulfate compared to rocuronium for rapid sequence tracheal intubation in adults: clinical randomized trial

Barbosa, Fabiano Timbó; Oliveira Neto, Olavo Barbosa de; Barbosa, Luciano Timbó; Andrade, Raul Ribeiro de; Ribeiro, Êurica Adélia Nogueira; Rodrigues, Célio Fernando de Sousa

doi:10.1016/j.bjane.2020.02.005

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Revista Brasileira de Anestesiologia

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Scientific Articles • Rev. Bras. Anestesiol. 70 (1) • Jan-Feb 2020 • https://doi.org/10.1016/j.bjane.2020.02.005 copy

Effectiveness of magnesium sulfate compared to rocuronium for rapid sequence tracheal intubation in adults: clinical randomized trial^☆ ☆ Study site: Hospital Geral do Estado Professor Osvaldo Brandão Vilela.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction and objectives:

Magnesium sulphate has been used in anesthesia because it has relevant clinical features such as: analgesia, autonomic response control and muscle relaxation. Using the agent to establish adequate conditions for tracheal intubation remains controversial. The aim of the study was to compare the effectiveness of magnesium sulfate and rocuronium for rapid sequence tracheal intubation in adults.

Methods:

Double blind, randomized, unicentric, prospective study assessed 68 patients, ASA 1 or 2, over 18 years, scheduled for appendectomy under general anesthesia. Patients were divided into two groups. GM patients received 50 mg.kg^-1magnesium sulfate and GR patients, 1 mg.kg^-1 rocuronium immediately before anesthesia induction. Arterial Blood Pressure (BP) and Heart Rate (HR) were measured in both groups at five times related to the administration of the drugs studied. The primary variable was the clinical status of tracheal intubation.

Trial Registry:

RBR-4xr92k.

Results:

GM was associated with no significant hemodynamic parameter change after injection. GM showed 85% (29/34) poor intubation clinical status, 15% (5/34) good, and 0% excellent (< 0.0001).

Conclusion:

Magnesium sulfate did not provide adequate clinical status when compared to rocuronium at a dose of 50 mg.kg^-1 for rapid sequence intubation in adult patients.

KEYWORDS
Orotracheal intubation; General anesthesia; Randomized clinical trial; Appendicitis

Assessment of intubation status^a a Intubation status: Excellent, all qualities are excellent; Good, all qualities are excellent or good; Poor, presence of only one quality listed as "poor"
Variable assessed	Clinically acceptable		Clinically unacceptable
Variable assessed	Excellent	Good	Poor
Laryngoscopy^b b Laryngoscopy: Easy, maxilla relaxed, no resistance to insertion of the blade; Fair, mandible not completely relaxed, light resistance to insertion of the blade; Difficult, mandible poorly relaxed, active resistance of patient to laryngoscopy.	Easy	Fair/good	Difficult
Position of vocal cords	Abducted	Intermediate or movement	Closed
Reaction to insertion of tracheal tube and cuff insufflation (Diaphragm movement/cough)	None	Light^c c Reaction to insertion: One to two weak contractions or movements for less than 5 s.	Vigorous or sustained^d d Reaction to insertion: More than two contractions and/or movements for more than 5 s.

Characteristics of patients	Group R	Group M	Value of p
Age (years)	34.3 ± 11.96	26.4 ± 9.85	0.10^a a Student t test.
Weight (kg)	68 ± 11.16	70.4 ± 17.38	0.76^a a Student t test.
Height (m)	1.61 ± 0.04	1.67 ± 0.08	0.05^b b Mann-Whitney U test.
BMI (kg. m²)	26.33 ± 4.15	24.74 ± 3.84	0.33^a a Student t test.
ASA I/II	24/10	25/9	0.9^c c Chi-Square.
Sex (m/f)	14/20	18/16	0.68^c c Chi-Square.

Groups	Clinically acceptable (excellent/good)	Clinically unacceptable (poor)	Value of p
R (n)	24/10	0	< 0.0001^a a Chi-square.
M (n)	0/5	29

Times	Group R	Group M	Value of p
FCa	92.5 ± 18.86	96.6 ± 17.09	0.074^a a ANOVA two factors.
FCap	92.8 ± 19.01	103.3 ± 14.43
FC1	102.9 ± 14.54	100.13 ± 13.55
FC3	108.8 ± 11.50	100.73 ± 15.01
FC5	95.2 ± 16.53	95 ± 16.85

Times	Group R	Group M	Value of p
PSa	138.1 ± 9.17	129.73 ± 14.74	0.114^a a Two-factor ANOVA.
PSap	125.6 ± 13.72	106 ± 13.27
PS1	127.5 ± 20.16	122.3 ± 18.53
PS3	123.9 ± 15.58	114.3 ± 18.38
PS5	114.4 ± 14.89	114.2 ± 19.61

Times	Group R	Group M	Value of p
PDa	75.9 ± 8.24	78.7 ± 11.35	0.683^a a Two-factor ANOVA.
PDap	72 ± 10.11	54.3 ± 9.35
PD1	74.7 ± 15.60	80.3 ± 20.88
PD3	69.2 ± 13.57	66.7 ± 13.77
PD5	62.5 ± 13.50	64.1 ± 13.92

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:fabiano.barbosa@famed.ufal.br (F.T. Barbosa).

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Effectiveness of magnesium sulfate compared to rocuronium for rapid sequence tracheal intubation in adults: clinical randomized trial☆ ☆ Study site: Hospital Geral do Estado Professor Osvaldo Brandão Vilela.

Abstract

Introduction and objectives:

Methods:

Trial Registry:

Results:

Conclusion:

Effectiveness of magnesium sulfate compared to rocuronium for rapid sequence tracheal intubation in adults: clinical randomized trial^☆ ☆ Study site: Hospital Geral do Estado Professor Osvaldo Brandão Vilela.