Effect of lidocaine and magnesium sulfate on rocuronium onset time: a randomized controlled experimental study
Efeito da lidocaína e do sulfato de magnésio sobre o tempo de início do rocurônio: um estudo experimental randomizado e controlado
Michele Cocenza Varrichio Crispim, Denise Aya Otsuki, Yuri Ferreira Vicentini, Danielly Roberta Penedo Rodrigues, Milena Gomes Parzianello Egúsquiza, José Otavio Costa Auler Junior
Abstract
Background
Neuromuscular blockers such as succinylcholine are widely used for airway management in critically ill patients; but their use may be contraindicated due to adverse effects. In rapid sequence intubation, the onset time of the neuromuscular blocker is critical and should be as short as possible. This study investigates whether lidocaine and magnesium sulfate could reduce the onset time of rocuronium bromide in an experimental model.
Methods
Eighteen animals were randomly assigned to three groups and treated with lidocaine, magnesium sulfate, or saline before receiving rocuronium bromide (3 mg.kg-1). After 10 minutes of neuromuscular blockade, reversal was performed with sugammadex (9 mg.kg-1). Onset and reversal times were measured by acceleromyography. Doses were standardized in a pilot study with four animals. Data were tested for normality using the Shapiro-Wilk and Anderson-Darling tests. Onset times are tested with a one-way ANOVA, followed by Fisher’s (LSD) post hoc test, and mean arterial pressure and heart rate with a two-way ANOVA, followed by Tukey’s post hoc test. Statistical significance was set at p ≤ 0.05.
Results
The results showed that lidocaine and magnesium sulfate significantly reduced the onset time of rocuronium bromide compared to the saline solution (p < 0.05) and did not affect
the onset time of reversal with sugammadex (p > 0.05). Both adjuvants caused hypotension, with a more significant effect observed with magnesium sulfate; however, blood pressure returned to baseline values.
Conclusion
In conclusion, lidocaine and magnesium sulfate facilitate airway access by reducing the onset time of rocuronium bromide.
Animal Ethics Committee approved 1749/2022.
Keywords
Resumo
Introdução
Bloqueadores neuromusculares como a succinilcolina são amplamente utilizados para o manejo de vias aéreas em pacientes criticamente enfermos, mas seu uso pode ser contraindicado devido a efeitos adversos. Na intubação em sequência rápida, o tempo de início do bloqueador neuromuscular é crítico e deve ser o mais curto possível. Este estudo investiga se a lidocaína e o sulfato de magnésio poderiam reduzir o tempo de início do brometo de rocurônio em um modelo experimental.
Métodos
Dezoito animais foram aleatoriamente distribuídos em três grupos e tratados com lidocaína, sulfato de magnésio ou solução salina antes de receberem brometo de rocurônio (3 mg.kg⁻¹). Após 10 minutos de bloqueio neuromuscular, a reversão foi realizada com sugammadex (9 mg.kg⁻¹). Os tempos de início e de reversão foram mensurados por aceleromiografia. As doses foram padronizadas em um estudo piloto com quatro animais. Os dados foram testados quanto à normalidade usando os testes de Shapiro-Wilk e Anderson-Darling. Os tempos de início foram testados com ANOVA unidirecional, seguida pelo teste post hoc de Fisher (LSD), e a pressão arterial média e a frequência cardíaca com ANOVA bidirecional, seguida pelo teste post hoc de Tukey. A significância estatística foi definida como p ≤ 0,05.
Resultados
Os resultados mostraram que a lidocaína e o sulfato de magnésio reduziram significativamente o tempo de início do brometo de rocurônio em comparação com a solução salina (p < 0,05) e não afetaram o tempo de início da reversão com o sugammadex (p > 0,05). Ambos os adjuvantes causaram hipotensão, com um efeito mais significativo observado com o sulfato de magnésio; entretanto, a pressão arterial retornou aos valores basais.
Conclusion
Em conclusão, a lidocaína e o sulfato de magnésio facilitam o acesso à via aérea ao reduzir o tempo de início do brometo de rocurônio.
Aprovado pelo Comitê de Ética em Uso Animal 1749/2022.
Palavras-chave
References
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Submitted date:
05/26/2025
Accepted date:
10/08/2025
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