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Background: Magnesium, ropivacaine, gentamicin, and rocuronium block neuromuscular (NM) transmission by differentmechanisms. Therefore, concurrent administration of these agents may induce prolonged muscle paralysis viasynergistic interaction. This study investigated the efficacy and safety of NM block caused by the administration of highconcentrations of magnesium in combination with ropivacaine, gentamicin, and rocuronium. Methods: Eighty-three left phrenic nerve-hemidiaphragms from male SD rats (150–250 g) were hung in Krebs solution. Three consecutive single twitch tension (ST, 0.1 Hz) and one tetanic tension (TT, 50 Hz for 1.9 s) were obtainedbefore drug application and at each new drug concentration. The concentration of MgCl2 and MgSO4 in Krebs solutionwas increased until an 80 to 90% reduction in ST was reached. To test the effects of combinations of NM agents, a Krebssolution was premixed with MgCl2 alone, MgCl2 and ropivacaine, or MgCl2, ropivacaine, and gentamicin. The concentrationof ropivacaine, gentamicin, or rocuronium was then progressively increased until an 80 to 90% reduction in ST wasreached. The effective concentrations were estimated with a probit model. Results: The potency of MgCl2 was greater than that of MgSO4, and pretreatment with MgCl2 increased the potency ofgentamicin and rocuronium. Unexpectedly, MgCl2 did not potentiate ropivacaine, and the potency of gentamicin androcuronium failed to show an increase when premixed with 0.5 μM ropivacaine. Conclusions: The concomitant administration of high concentrations of magnesium and ropivacaine together with clinicallyrelevant concentrations of gentamicin or rocuronium potentiated NM blockade but not with clinically relevant concentrationsof ropivacaine.

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