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Medicine Jan 2016To evaluate the evidence of effects and safety of magnesium sulfate on neuroprotection for preterm infants who had exposure in uteri. We searched electronic databases... (Meta-Analysis)
Meta-Analysis Review
To evaluate the evidence of effects and safety of magnesium sulfate on neuroprotection for preterm infants who had exposure in uteri. We searched electronic databases and bibliographies of relevant papers to identify studies comparing magnesium sulfate (MgSO4) with placebo or other treatments in patients at high risk of preterm labor and reporting effects and safety of MgSO4 for antenatal infants. Then, we did this meta-analysis based on PRISMA guideline. The primary outcomes included fatal death, cerebral palsy (CP), intraventricular hemorrhage, and periventricular leukomalacia. Secondary outcomes included various neonatal and maternal outcomes. Ten studies including 6 randomized controlled trials and 5 cohort studies, and involving 18,655 preterm infants were analyzed. For the rate of moderate to severe CP, MgSO4 showed the ability to reduce the risk and achieved statistically significant difference (odd ratio [OR] 0.61, 95% confidence interval [CI] 0.42-0.89, P = 0.01). The comparison of mortality rate between the MgSO4 group and the placebo group only presented small difference clinically, but reached no statistical significance (OR 0.92, 95% CI 0.77-1.11, P = 0.39). Summarily, the analysis of adverse effects on babies showed no margin (P > 0.05). Yet for mothers, MgSO4 exhibited obvious side-effects, such as respiratory depression, nausea and so forth, but there exited great heterogeneity. MgSO4 administered to women at high risk of preterm labor could reduce the risk of moderate to severe CP, without obvious adverse effects on babies. Although there exit many unfavorable effects on mothers, yet they may be lessened through reduction of the dose of MgSO4 and could be tolerable for mothers. So MgSO4 is both beneficial and safety to be used as a neuroprotective agent for premature infants before a valid alternative was discovered.
Topics: Cerebral Palsy; Female; Humans; Infant, Newborn; Infant, Premature; Magnesium Sulfate; Mothers; Neuroprotective Agents; Obstetric Labor, Premature; Pregnancy
PubMed: 26735551
DOI: 10.1097/MD.0000000000002451 -
Journal of Korean Medical Science Nov 2023Though antenatal magnesium sulfate (MgSO) is widely used for fetal neuroprotection, suspicions about the long-term neuroprotection of antenatal MgSO have been raised.
BACKGROUND
Though antenatal magnesium sulfate (MgSO) is widely used for fetal neuroprotection, suspicions about the long-term neuroprotection of antenatal MgSO have been raised.
METHODS
We investigated short- and long-term outcomes of antenatal MgSO4 use for 468 infants weighing < 1,500 g with a gestational age of 24-31 weeks.
RESULTS
Short-term morbidities and the risk of developmental delay, hearing loss, and cerebral palsy at a corrected age of 18-24 months and 3 years of age did not decrease in the MgSO group (infants who were exposed to MgSO for any purpose) or neuroprotection group (infants who were exposed to MgSO for fetal neuroprotection) compared with the control group (infants who were not exposed to MgSO). The z-scores of weight, height, and head circumference did not increase in the MgSO group or neuroprotection group compared with the control group.
CONCLUSION
Antenatal MgSO including MgSO for neuroprotection did not have beneficial effects on long-term neurodevelopmental and growth outcomes.
Topics: Infant; Humans; Pregnancy; Female; Infant, Newborn; Magnesium Sulfate; Premature Birth; Neuroprotective Agents; Prenatal Care; Infant, Very Low Birth Weight
PubMed: 37967876
DOI: 10.3346/jkms.2023.38.e350 -
Archives of Disease in Childhood. Fetal... Mar 2022Magnesium sulfate given to women before birth at <30 weeks' gestation reduces the risk of cerebral palsy in their children. Our study aimed to assess the impact of a...
Magnesium sulfate given to women before birth at <30 weeks' gestation reduces the risk of cerebral palsy in their children. Our study aimed to assess the impact of a local quality improvement programme, primarily using plan-do-study-act cycles, to increase the use of antenatal magnesium sulfate. After implementing our quality improvement programme, an average of 86% of babies delivered at <30 weeks' gestation were exposed to antenatal magnesium sulfate compared with a historical baseline rate of 63%. Our study strengthens the case for embedding quality improvement programmes in maternal perinatal care to reduce the impact of cerebral palsy on families and society.
Topics: Calcium Channel Blockers; Cerebral Palsy; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Magnesium Sulfate; Pregnancy; Premature Birth
PubMed: 34233908
DOI: 10.1136/archdischild-2021-321817 -
The Clinical Journal of Pain Aug 2021With the popularization of ultrasound, nerve blocks have been widely implemented in current clinical practice. Although, they have seen limited success due to their... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
With the popularization of ultrasound, nerve blocks have been widely implemented in current clinical practice. Although, they have seen limited success due to their shorter duration and suboptimal analgesia. Magnesium sulfate as a local anesthetic adjuvant for peripheral nerve blocks could enhance the effects of local anesthetics. However, previous investigations have not thoroughly investigated the analgesic efficacy of magnesium sulfate as an adjunct to local anesthetics for peripheral nerve blocks. Thus, we attempted to fill the gap in the existing literature by conducting a meta-analysis.
MATERIALS AND METHODS
We performed of a quantitative systematic review of randomized controlled trials published between May 30, 2011 and November 1, 2018. Inclusion criteria were: (1) magnesium sulfate used as adjuvant mixed with local anesthetic for nerve blockade, (2) complete articles and published abstracts of randomized controlled trials, (3) English language.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome measures were time of onset, total duration of the sensory blockade, and Visual Analog Scale pain scores. The secondary outcomes were postoperative oral and intravenous analgesics consumption and the incidence of nausea and vomiting.
RESULTS
The 21 trials analyzed in this study included 1323 patients. Magnesium sulfate effectively prolonged the total duration of sensory blockade (mean difference [MD]=114.59 min, 95% confidence interval [CI]: 89.31-139.88), reducing Visual Analog Scale pain scores at 6 hours (MD=1.36 points, 95% CI: -2.09 to -0.63) and 12 hours (MD=1.54 points, 95% CI: -2.56 to -0.53) postsurgery. Magnesium sulfate also effectively reduced postoperative analgesic use within 24 hours postsurgery (standard MD=-2.06, 95% CI: -2.67 to -1.35). Furthermore, adjuvant magnesium sulfate significantly reduced the incidence of nausea and vomiting after transversus abdominis plane blockade (odds ratio: 0.39, 95% CI: 0.18-0.81).
CONCLUSION
Adjuvant magnesium sulfate enhanced the anesthetic effects of local anesthetics and improved postoperative analgesia following the perineural blockade.
Topics: Anesthetics, Local; Humans; Magnesium Sulfate; Nerve Block; Pain, Postoperative; Peripheral Nerves
PubMed: 34128482
DOI: 10.1097/AJP.0000000000000944 -
Current Drug Delivery 2020In vitro diffusion experiments were performed to assess the permeation of magnesium sulfate across pig skin.
OBJECTIVE
In vitro diffusion experiments were performed to assess the permeation of magnesium sulfate across pig skin.
METHODS
The mean thickness of the dermatomed porcine skin was 648 ± 12 µm. Magnesium concentration was measured using inductively coupled plasma-optical emission spectroscopy. Transdermal flux of magnesium sulfate across MN-treated and untreated porcine skin was obtained from the slope of the steady-state linear portion of cumulative amount versus time curve.
RESULTS
Statistical analysis of the results was done with Student's t-test. The transdermal flux of magnesium sulfate across microneedle-treated porcine skin was 134.19 ± 2.4 µg/cm2/h and transdermal flux across untreated porcine skin was 4.64 ± 0.05 µg/cm2/h. Confocal microscopy was used to visualize the microchannels created by a solid microneedle roller (500 µm).
CONCLUSION
From our confocal microscopy studies, it was evident that the 500 μm long microneedles disrupted the stratum corneum and created microchannels measuring 191 ± 37 µm. The increase in transdermal flux across the microneedle-treated skin was statistically significant compared to that of controls, i.e., without the application of microneedles. With the application of microneedles, the transdermal flux of magnesium permeated over 12 h was approximately 33-fold higher in comparison to passive diffusion across an intact stratum corneum.
Topics: Administration, Cutaneous; Animals; Diffusion; Drug Delivery Systems; Magnesium Sulfate; Microinjections; Microscopy, Confocal; Needles; Skin; Skin Absorption; Swine
PubMed: 31845631
DOI: 10.2174/1567201817666191217093936 -
Drugs in R&D Sep 2020The pharmacokinetic basis of magnesium sulphate (MgSO) dosing regimens for preeclampsia (PE) prophylaxis and treatment is not clearly established. The aim of study is to... (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVE
The pharmacokinetic basis of magnesium sulphate (MgSO) dosing regimens for preeclampsia (PE) prophylaxis and treatment is not clearly established. The aim of study is to develop a population pharmacokinetic (PK) model of MgSO in PE, and to determine key covariates having an effect in MgSO pharmacokinetics in preeclampsia (PE) and to determine key covariates having an effect in MgSO PK.
METHODS
A prospective cohort study was conducted from June 2016 to February 2018 in patients with PE administered MgSO as a 4-g bolus followed by continuous infusion at a rate of 1 g/h. Serum magnesium concentrations were obtained before treatment administration and 2, 6, 12, and 18 h after the initial dose. The software Monolix was used to estimate population PK parameters of MgSO [clearance (CL), volume of distribution (V), half-life] and to develop a PK model with baseline patient demographic, clinical, and laboratory covariates.
RESULTS
The study population consisted of 109 patients. The PK profile of MgSO was adequately described by a one-compartment PK model. The model estimate of the population CL was 1.38 L/h; for V, it was 13.3 L; and the baseline magnesium concentration was 0.77 mmol/L (1.87 mg/dL). The baseline body weight and serum creatinine statistically influenced MgSO CL and V, respectively. The model was parameterized as CL and V.
CONCLUSION
The PK of MgSO in pregnant women with PE is significantly affected by creatinine and body weight. Pregnant women with PE and higher body weight have a higher V and, consequently, a lower elimination rate of MgSO. Pregnant women with PE and a higher serum creatinine value show lower CL and, therefore, lower MgSO elimination rate.
Topics: Adolescent; Adult; Anticonvulsants; Clinical Protocols; Cohort Studies; Female; Humans; Infusions, Intravenous; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Prospective Studies; Young Adult
PubMed: 32642964
DOI: 10.1007/s40268-020-00315-2 -
The Journal of Craniofacial Surgery Mar 2015The purpose of this systematic review was to evaluate the effect of magnesium sulfate in the treatment of acute traumatic brain injury. (Review)
Review
BACKGROUND
The purpose of this systematic review was to evaluate the effect of magnesium sulfate in the treatment of acute traumatic brain injury.
MATERIALS AND METHODS
A systematic search of ClinicalTrials.gov, the Cochrane Library database, EMBASE, MEDLINE, Web of Science, and the World Health Organization trial registry, plus manual searches of gray literature, was undertaken in April 2013. Two reviewers independently extracted the data with a predefined data extraction form. RevMan 5 software was used to synthesize data and calculate the risk ratio for mortality with the 95% confidence interval. For the Glasgow Outcome Scale and posttreatment Glasgow Coma Scale data, the weighted mean difference was calculated with the 95% confidence interval.
RESULTS
A total of 8 randomized controlled trials with a total of 786 patients were included. Meta-analysis showed that there was no significant difference between the groups for mortality. The Glasgow Outcome Scale of the treatment group was higher than that of the control group, although the significance was borderline. The Glasgow Coma Scale score change posttreatment was significantly higher than that of the control.
CONCLUSIONS
The present meta-analysis of existing randomized controlled trials does not identify a significant beneficial effect in the mortality of traumatic brain injury patients; however, it suggests that magnesium sulfate shows a tendency to improve the Glasgow Outcome Scale and Glasgow Coma Scale scores, which is a promising result for traumatic brain injury therapy. Further effort is necessary to explore which subgroup of traumatic brain injury patients could benefit from magnesium sulfate.
Topics: Brain Injuries; Cause of Death; Glasgow Coma Scale; Glasgow Outcome Scale; Humans; Magnesium Sulfate; Neuroprotective Agents; Survival Rate
PubMed: 25723660
DOI: 10.1097/SCS.0000000000001339 -
Cirugia Y Cirujanos 2022Postoperative intraabdominal adhesions are obvious cause of postoperative morbidity. In this experimental study, our aim is to compare the effects of 4% icodextrin...
OBJECTIVE
Postoperative intraabdominal adhesions are obvious cause of postoperative morbidity. In this experimental study, our aim is to compare the effects of 4% icodextrin produced for adhesion prevention, magnesium sulfate used as an anticonvulsant in obstetrics and also as a thickening lubricant in the detergent industry, and saline, which we use most frequently in abdominal irrigation, on adhesion formation.
MATERIALS AND METHODS
A total of 4 groups were formed, 8 in the control group (K), 8 in the icodextrin group (I), 8 in the magnesium sulfate group (M), and 8 in the saline group (SF). Adhesions were quantitatively evaluated with the classification defined by Nair and microscopic grading defined by Zuhlke.
RESULTS
The macroscopic staging degree was statistically significantly lower in Group M, I, and SF compared to Group K. Again, the degree of microscopic staging was significantly lower in Group M and I compared to Group K.
CONCLUSIONS
Three different materials were used in our study. It was observed that they significantly reduced adhesions. This study once again demonstrates the limited ability of these materials to prevent adhesion, despite the wide variety of materials used, and the need for careful adherence to tissue-respectful surgical techniques.
Topics: Humans; Icodextrin; Magnesium Sulfate; Postoperative Complications; Sodium Chloride; Tissue Adhesions
PubMed: 35349560
DOI: 10.24875/CIRU.21000162 -
Acta Obstetricia Et Gynecologica... Feb 2016The optimal dosing regimen of magnesium sulfate for treating preeclampsia and eclampsia is unclear. Evidence from the Cochrane review of randomized controlled trials... (Review)
Review
INTRODUCTION
The optimal dosing regimen of magnesium sulfate for treating preeclampsia and eclampsia is unclear. Evidence from the Cochrane review of randomized controlled trials (RCTs) was inconclusive due to lack of relevant data.
MATERIAL AND METHODS
To complement the evidence from the Cochrane review, we assessed available data from non-randomized studies on the comparative efficacy and safety of alternative magnesium sulfate regimens for the management of preeclampsia and eclampsia. Sources included Medline, EMBASE, Popline, CINAHL, Global Health Library, African Index Medicus, Biological abstract, BIOSIS and reference lists of eligible studies. We selected non-randomized study designs including quasi-RCTs, cohort, case-control and cross-sectional studies that compared magnesium sulfate regimens in women with preeclampsia or eclampsia.
RESULTS
Of 6178 citations identified, 248 were reviewed in full text and five studies of low to very low quality were included. Compared with standard regimens, lower-dose regimens appeared equally as good in terms of preventing seizures [odds ratio (OR) 1.02, 95% confidence interval (CI) 0.46-2.28, 899 women, four studies], maternal morbidity (OR 0.47, 95%CI 0.32-0.71, 796 women, three studies), and fetal and/or neonatal mortality (OR 0.87, 95%CI 0.38-2.00, 800 women, four studies). Comparison of loading dose only with maintenance dose regimens showed no differences in seizure rates (OR 0.99, 95%CI 0.22-4.50, 146 women, two studies), maternal morbidity (OR 0.53, 95%CI 0.15-1.93, 146 women, two studies), maternal mortality (OR 0.63, 95%CI 0.05-7.50, 146 women, two studies), and fetal and/or neonatal mortality (OR 0.49, 95%CI 0.23-1.03, 146 women, two studies).
CONCLUSION
Lower-dose and loading dose-only regimens could be as safe and efficacious as standard regimens; however, this evidence comes from low to very low quality studies and further high quality studies are needed.
Topics: Adult; Eclampsia; Female; Humans; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Tocolytic Agents
PubMed: 26485229
DOI: 10.1111/aogs.12807 -
BMJ Clinical Evidence Jan 2016About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an... (Review)
Review
INTRODUCTION
About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an increased risk of death, but patients with mild to moderate disease are also at risk of exacerbations. Most guidelines about the management of asthma follow stepwise protocols. This overview does not endorse or follow any particular protocol, but presents the evidence about a specific intervention, magnesium sulfate.
METHODS AND OUTCOMES
We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of magnesium sulfate for acute asthma? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS
At this update, searching of electronic databases retrieved 50 studies. After deduplication and removal of conference abstracts, 24 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 10 studies and the further review of 14 full publications. Of the 14 full articles evaluated, one systematic review was updated and one systematic review was added at this update. We performed a GRADE evaluation for five PICO combinations.
CONCLUSIONS
In this systematic overview, we categorised the efficacy for two comparisons based on information about the effectiveness and safety of magnesium sulfate (iv) versus placebo and magnesium sulfate (nebulised) plus short-acting beta2 agonists (inhaled) versus short-acting beta2 agonists (inhaled) alone.
Topics: Acute Disease; Administration, Inhalation; Adrenergic beta-2 Receptor Antagonists; Adult; Anti-Asthmatic Agents; Asthma; Humans; Magnesium Sulfate
PubMed: 26761432
DOI: No ID Found