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Acta Obstetricia Et Gynecologica... Apr 2023Preterm delivery and its complications are among the biggest challenges and health risks in obstetrical practice. Several tocolytic agents are used in clinical practice,...
INTRODUCTION
Preterm delivery and its complications are among the biggest challenges and health risks in obstetrical practice. Several tocolytic agents are used in clinical practice, although the efficacy and side effect profiles of these drugs are not satisfying. The aim of this study was to investigate the uterus relaxant effect of the coadministration of β -mimetic terbutaline and magnesium sulfate (MgSO ) in an isolated organ bath and to perform in vivo smooth muscle electromyographic (SMEMG) studies in pregnant rats. In addition, we also investigated whether the tachycardia-inducing effect of terbutaline can be reduced by the presence of magnesium, due to the opposite heart rate modifying effects of the two agents.
MATERIAL AND METHODS
In the isolated organ bath studies, rhythmic contractions of 22-day- pregnant Sprague-Dawley rats were stimulated with KCl, and cumulative dose-response curves were constructed in the presence of MgSO or terbutaline. The uterus-relaxing effects of terbutaline were also investigated in the presence of MgSO in both normal buffer and Ca -poor buffer. The in vivo SMEMG studies were carried out under anesthesia with the subcutaneous implantation of an electrode pair. The animals were treated with MgSO or terbutaline alone or in combination in a cumulative bolus injection. The implanted electrode pair also detected the heart rate.
RESULTS
Both MgSO and terbutaline reduced uterine contractions in vitro and in vivo, furthermore, the administration of a small dose of MgSO significantly enhanced the relaxant effect of terbutaline, especially in the lower range. However, in Ca -poor environment, MgSO was not able to increase the effect of terbutaline, indicating the role of MgSO as a Ca channel blocker. In the cardiovascular studies, MgSO significantly decreased the tachycardia-inducing effect of terbutaline in late pregnant rats.
CONCLUSIONS
The combined application of MgSO and terbutaline may have clinical significance in tocolysis, which must be confirmed in clinical trials. Furthermore, MgSO could substantially reduce the tachycardia-inducing side effect of terbutaline.
Topics: Pregnancy; Female; Rats; Animals; Terbutaline; Magnesium Sulfate; Rats, Sprague-Dawley; Tocolytic Agents; Uterus
PubMed: 36808376
DOI: 10.1111/aogs.14532 -
Anaesthesiology Intensive Therapy 2022The search for an effective sedation schedule in managing delirium tremens that would ensure an adequate sedation level and good safety profile is an urgent problem of... (Randomized Controlled Trial)
Randomized Controlled Trial Observational Study
INTRODUCTION
The search for an effective sedation schedule in managing delirium tremens that would ensure an adequate sedation level and good safety profile is an urgent problem of modern intensive care medicine. In this respect, the use of dexmedetomidine combined with magnesium preparations seems to be promising.
MATERIAL AND METHODS
A quasi-randomized prospective observational study was conducted on 80 patients with alcoholic delirium, who were divided into 4 groups. Assessment parameters were delirium duration, mean arterial pressure and heart rate, and plasma magnesium, urea, creatinine, transaminase, cortisol, and serotonin levels. The control-group patients underwent standard sedation therapy with benzodiazepines. In group 1, standard sedation was supplemented by magnesium sulphate. In group 2, dexmedetomidine infusion was used. In group 3, dexmedetomidine was supplemented by the correction of hypomagnesemia.
RESULTS
The duration of delirium proved to be significantly shorter in all study groups (3.4 ± 0.6 days in group 1; 1.55 ± 0.61 days in group 2) as compared to the control (5.4 ± 1.48 days), P < 0.001, being the shortest in group 3 (1.1 ± 0.18 days), P < 0.001. Cases of hypotension were detected only in the control group (2 cases [10%]) and group 1 (4 cases [20%]). The patients of groups 2 and 3 showed significant improvement in plasma levels of cortisol (16.7 ± 2.25 nmol L-1; 15.62 ± 1.63 nmol L-1) compared with the control (18.77 ± 2.76 nmol L-1), P = 0.019; P = 0.003. Serotonin level was higher in the experimental group 3 (87.8 ± 7.32 ng mL-1) as compared to the control (62.81 ± 9.81ng mL-1) and group 2 (71.73 ± 9.61 ng mL-1), P < 0.001.
CONCLUSIONS
Dexmedetomidine infusion combined with magnesium sulphate proved to be effective in the treatment of patients with alcohol delirium.
Topics: Humans; Dexmedetomidine; Hypnotics and Sedatives; Magnesium Sulfate; Magnesium; Hydrocortisone; Serotonin; Delirium; Intensive Care Units
PubMed: 36734446
DOI: 10.5114/ait.2022.123137 -
The Journal of Physiology Dec 2018Brain injury around birth is associated with nearly half of all cases of cerebral palsy. Although brain injury is multifactorial, particularly after preterm birth, acute... (Review)
Review
Brain injury around birth is associated with nearly half of all cases of cerebral palsy. Although brain injury is multifactorial, particularly after preterm birth, acute hypoxia-ischaemia is a major contributor to injury. It is now well established that the severity of injury after hypoxia-ischaemia is determined by a dynamic balance between injurious and protective processes. In addition, mothers who are at risk of premature delivery have high rates of diabetes and antepartum infection/inflammation and are almost universally given treatments such as antenatal glucocorticoids and magnesium sulphate to reduce the risk of death and complications after preterm birth. We review evidence that these common factors affect responses to fetal asphyxia, often in unexpected ways. For example, glucocorticoid exposure dramatically increases delayed cell loss after acute hypoxia-ischaemia, largely through secondary hyperglycaemia. This critical new information is important to understand the effects of clinical treatments of women whose fetuses are at risk of perinatal asphyxia.
Topics: Animals; Asphyxia; Fetal Hypoxia; Glucocorticoids; Humans; Hypoxia-Ischemia, Brain; Magnesium Sulfate
PubMed: 29774532
DOI: 10.1113/JP274949 -
Pediatrics International : Official... Jan 2022Ritodrine and magnesium sulfate are administered to prevent preterm labor. Magnesium sulfate is also administered to prevent preeclampsia. These drugs have been reported...
BACKGROUND
Ritodrine and magnesium sulfate are administered to prevent preterm labor. Magnesium sulfate is also administered to prevent preeclampsia. These drugs have been reported to increase potassium levels in pregnant women and neonates. The aim of this study was to investigate the relationship between potassium levels in preterm infants and antenatal treatment.
METHODS
This prospective cohort study was conducted at Saiseikai Suita Hospital. Preterm infants born at <35 weeks' gestation between October 2012 and September 2014 were recruited and divided into four groups based on the antenatal treatment their mothers received. Serum and urine electrolyte levels at birth and serum potassium levels 1 day after birth were measured.
RESULTS
The mothers of 16 infants received no antenatal treatment (condition C); the mothers of 29 infants received antenatal ritodrine (R); the mothers of seven infants received magnesium sulfate (M); and the mothers of 15 infants received both magnesium sulfate and ritodrine (M + R). At birth, potassium levels were similar among the four groups. However, potassium levels a day after birth were significantly higher in the M + R group than in the other groups: median (min.-max.) mEq/L 4.8 (3.8-6.2), 4.8 (3.6-6.0), and 4.4 (3.8-5.9) vs. 5.8 (4.9-7.2), in the C, R, and M groups versus the M + R group, respectively (P < 0.01). Significantly more infants in the M + R group exhibited a fractional excretion of potassium of <10% compared with those in the other groups.
CONCLUSION
The increased potassium levels we observe in preterm infants of mothers who received antenatal magnesium sulfate and ritodrine administration on postnatal day 1 warrant monitoring by neonatologists.
Topics: Infant; Infant, Newborn; Female; Pregnancy; Humans; Ritodrine; Infant, Premature; Magnesium Sulfate; Sulfates; Cohort Studies; Prospective Studies; Potassium
PubMed: 36331237
DOI: 10.1111/ped.15315 -
American Journal of Obstetrics &... Sep 2021The prevention of postpartum depression is an important area of investigation given its association with major maternal and neonatal sequelae, yet few evidence-based...
BACKGROUND
The prevention of postpartum depression is an important area of investigation given its association with major maternal and neonatal sequelae, yet few evidence-based treatments to reduce the frequency of postpartum depression are used. Recent data suggest that N-methyl-D-aspartate receptor antagonists may lead to rapid improvement of depressive symptoms lasting up to 2 weeks. We hypothesized that the N-methyl-D-aspartate receptor antagonist magnesium sulfate would elicit antidepressant effects subsequent to its receipt by women receiving peripartum seizure prophylaxis for a hypertensive disorder of pregnancy.
OBJECTIVE
This study aimed to compare the frequency of depressive symptoms at 2 weeks and 6 weeks after delivery between women who did and did not receive peripartum magnesium sulfate for a hypertensive disorder of pregnancy.
STUDY DESIGN
This prospective cohort study included women with a hypertensive disorder of pregnancy at ≥34 weeks' gestation with singleton gestations. Magnesium sulfate for seizure prophylaxis was administered at the obstetrician's discretion. The Quick Inventory of Depressive Symptomatology survey was administered before hospital discharge and again at 2 weeks and 6 weeks after delivery to assess for postpartum depressive symptoms. The primary outcome for this study was the change in Quick Inventory of Depressive Symptomatology score from baseline to 2 weeks after delivery, which was analyzed both continuously and categorically (any symptom worsening vs stability or improvement). Secondary outcomes included the change in Quick Inventory of Depressive Symptomatology score from baseline to 6 weeks after delivery and the proportion of women who experienced an increase in Quick Inventory of Depressive Symptomatology score at 6 weeks after delivery.
RESULTS
Of the 342 women enrolled, 39% (n=134) received magnesium sulfate. Compared with women who did not receive magnesium, women who received magnesium had a significantly smaller change in their mean Quick Inventory of Depressive Symptomatology score (0.6±3.4 vs 1.6±3.0; P=.015) and also were less likely to have an increase in Quick Inventory of Depressive Symptomatology score at 2 weeks after delivery (52% vs 67%; P=.022). These differences were not present at 6 weeks after delivery. After controlling for potential confounders, women who received magnesium continued to have a lower odds of having an increased Quick Inventory of Depressive Symptomatology score from baseline at 2 weeks after delivery than women who did not receive magnesium (adjusted odds ratio, 0.88; 95% confidence interval, 0.78-0.98).
CONCLUSION
Peripartum magnesium was associated with less of an exacerbation in depressive symptoms in the immediate postpartum period. Given the implications of postpartum depression on maternal and child health and the lack of existing prophylaxis, randomized trials should examine this novel potential prophylactic therapy.
Topics: Child; Depression; Female; Humans; Infant, Newborn; Magnesium Sulfate; Peripartum Period; Postpartum Period; Pregnancy; Prospective Studies
PubMed: 34058422
DOI: 10.1016/j.ajogmf.2021.100407 -
Naunyn-Schmiedeberg's Archives of... Mar 2023Magnesium (Mg) is the fourth most abundant cation in the human body and is involved in maintaining varieties of cellular and neurological functions. Magnesium deficiency...
Magnesium (Mg) is the fourth most abundant cation in the human body and is involved in maintaining varieties of cellular and neurological functions. Magnesium deficiency has been associated with numerous diseases, particularly neurological disorders, and its supplementation has proven beneficial. However, magnesium therapy in neurological diseases is limited because of the inability of magnesium to cross the blood-brain barrier (BBB). The present study focuses on developing magnesium sulphate nanoparticles (MGSN) to improve blood-brain barrier permeability. MGSN was prepared by precipitation technique with probe sonication. The developed formulation was characterized by DLS, EDAX, FT-IR and quantitative and qualitative estimation of magnesium. According to the DLS report, the average size of the prepared MGSN is found to be 247 nm. The haemocompatibility assay studies revealed that the prepared MGSN are biocompatible at different concentrations. The in vitro BBB permeability assay conducted by Parallel Artificial Membrane Permeability Assay (PAMPA) using rat brain tissue revealed that the prepared MGSN exhibited enhanced BBB permeability as compared to the marketed i.v. MgSO injection. The reversal effect of MGSN to digoxin-induced Na/K ATPase enzyme inhibition using brain microslices confirmed that MGSN could attenuate the altered levels of Na and K and is useful in treating neurological diseases with altered expression of Na/K ATPase activity.
Topics: Humans; Rats; Animals; Magnesium Sulfate; Magnesium; Spectroscopy, Fourier Transform Infrared; Blood-Brain Barrier; Nervous System Diseases; Sodium-Potassium-Exchanging ATPase
PubMed: 36474021
DOI: 10.1007/s00210-022-02356-7 -
The Journal of Maternal-fetal &... Nov 2014Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity. When uncontrolled, asthma can place significant limits on daily... (Review)
Review
BACKGROUND
Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity. When uncontrolled, asthma can place significant limits on daily life, and is sometimes fatal. The use of magnesium sulphate (MgSO4) is one of numerous treatment options available during acute severe asthma in children. The efficacy of intravenous, or inhaled MgSO4 has been demonstrated, while little is known about the actual clinical use of either intravenous (IV) or inhaled MgSO4.
OBJECTIVE
To assess the effectiveness of intravenous (IV) and/or inhaled MgSO4 on hospital admissions and pulmonary function in children with asthma. This systematic review assessed the best available evidence for the use of either intravenous or inhaled MgSO4 in children with acute asthma. Magnesium deficiency is a common electrolyte disorder in children with acute severe asthma. Several authors reported that IV magnesium was effective in the treatment of moderate to acute asthma in children but evidence for nebulised magnesium was insufficient. In addition, it is used in severe, progressed cases to prevent respiratory failure and/or admission to the intensive care unit. It has bronchodilating and anti-inflammatory effects and modulates ion transport and influences intracellular calcium concentration. Intravenous MgSO4 therapy helps in achieving earlier improvement in clinical signs and symptoms of asthma, e.g. respiratory function and significantly reduced hospital admission, in children with acute severe asthma. The role of nebulised MgSO4 in asthmatic children requires further investigation.
CONCLUSION
According to the previous studies, the author recommends the use of intravenous MgSO4 as a safe and effective adjunct to conventional bronchodilator therapy in acute severe asthma in children.
Topics: Administration, Inhalation; Administration, Intravenous; Asthma; Bronchodilator Agents; Child; Health; Humans; Magnesium; Magnesium Sulfate; Treatment Outcome
PubMed: 24345031
DOI: 10.3109/14767058.2013.876620 -
Journal of Clinical Pharmacology Nov 2019Magnesium sulfate is the anticonvulsant of choice for eclampsia prophylaxis and treatment; however, the recommended dosing regimens are costly and cumbersome and can be...
Magnesium sulfate is the anticonvulsant of choice for eclampsia prophylaxis and treatment; however, the recommended dosing regimens are costly and cumbersome and can be administered only by skilled health professionals. The objectives of this study were to develop a robust exposure-response model for the relationship between serum magnesium exposure and eclampsia using data from large studies of women with preeclampsia who received magnesium sulfate, and to predict eclampsia probabilities for standard and alternative (shorter treatment duration and/or fewer intramuscular injections) regimens. Exposure-response modeling and simulation were applied to existing data. A total of 10 280 women with preeclampsia who received magnesium sulfate or placebo were evaluated. An existing population pharmacokinetic model was used to estimate individual serum magnesium exposure. Logistic regression was applied to quantify the serum magnesium area under the curve-eclampsia rate relationship. Our exposure-response model-estimated eclampsia rates were comparable to observed rates. Several alternative regimens predicted magnesium peak concentration < 3.5 mmol/L (empiric safety threshold) and eclampsia rate ≤ 0.7% (observed response threshold), including 4 g intravenously plus 10 g intramuscularly followed by either 8 g intramuscularly every 6 hours × 3 doses or 10 g intramuscularly every 8 hours × 2 doses and 10 g intramuscularly every 8 hours × 3 doses. Several alternative magnesium sulfate regimens with comparable model-predicted efficacy and safety were identified that merit evaluation in confirmatory clinical trials.
Topics: Adult; Anticonvulsants; Eclampsia; Female; Humans; Magnesium Sulfate; Pre-Eclampsia; Pregnancy
PubMed: 31157410
DOI: 10.1002/jcph.1448 -
The Journal of Pediatrics Nov 2023To assess magnesium sulfate (MgSO) as a neuroprotective agent in hypoxic-ischemic encephalopathy. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess magnesium sulfate (MgSO) as a neuroprotective agent in hypoxic-ischemic encephalopathy.
STUDY DESIGN
For this systematic review, PubMed, EMBASE, the Cochrane Library, EMCARE, and MedNar were searched in November 2022 for randomized controlled trials (RCTs). Meta-analysis was conducted using Stata 16.0 and RevMan 5.3.
RESULTS
Twenty RCTs with a total sample size of 1485 were included, of which 16 were from settings where therapeutic hypothermia (TH) was not offered. Regarding MgSO in settings where TH was not offered, only 1 study evaluated composite outcome of death or disability at ≥18 months and reported such poor outcome in 8 of 14 control infants and 4 of 8 in the MgSO group. MgSO was not associated with mortality (RR, 0.86; 95% CI, 0.72-1.03; 13 RCTs) or hypotension (RR, 1.02; 95% CI, 0.88-1.18; 5 RCTs). Thirteen studies reported that MgSO improved in-hospital outcomes, such as reduced seizure burden and improved neurological status at discharge. MgSO reduced the risk of poor suck feeds (RR, 0.52; 95% CI, 0.40-0.68; 6RCTs) and abnormal electroencephalogram (RR, 0.64; 95% CI, 0.45-0.93; 5 RCTs). Certainty of evidence was moderate for mortality and low or very low for other outcomes. For studies with MgSO as an adjunct to TH, none reported on death or neurodevelopmental disability at ≥18 months. MgSO was not associated with mortality (RR, 0.65; 95% CI, 0.34-1.27; 3 RCTs) or hypotension (RR, 1.0; 95% CI, 0.71-1.40; 3 RCTs).
CONCLUSIONS
Evidence around long-term outcomes of MgSO when used with or without TH was scant. MgSO therapy may improve in-hospital neurological outcomes without affecting mortality in settings where TH is not offered. Well-designed RCTs for neuroprotection are needed, especially in low-resource settings.
TRIAL REGISTRATION
"Open Science Forum" (https://doi.org/10.17605/OSF.IO/FRM4D).
Topics: Infant, Newborn; Infant; Humans; Magnesium Sulfate; Hypoxia-Ischemia, Brain; Seizures; Hypotension
PubMed: 37468038
DOI: 10.1016/j.jpeds.2023.113610 -
Hypertension in Pregnancy May 2020: This meta-analysis aimed to compare the benefits and risks of shortened magnesium sulfate with traditional 24 h for severe postpartum preeclampsia.: We systematically... (Meta-Analysis)
Meta-Analysis
: This meta-analysis aimed to compare the benefits and risks of shortened magnesium sulfate with traditional 24 h for severe postpartum preeclampsia.: We systematically searched the Cochrane, Embase, Web of science and Pubmed database from inception till May 15 2019. Studies included type is limited to randomized controlled trial (RCT). Pooled risks difference (RDs), odds risks (ORs), mean difference (MD), standard mean difference (SMD) and 95% confifidence intervals (CIs) were used to summarize the effect sizes.: Totally studies included are 7 randomized controlled trials (RCTs). Shortened magnesium sulfate treatment has the same risk as eclampsia (RD 0.00, 95%CI-0.01-0.01) and total complications (OR 0.78, 95% CI 0.53-1.15), however, significant difference was observed in both groups pertaining to flushing (OR 0.40, 95% CI 0.20-0.82), and the need for prolonged treatment (RD 0.05, 95% CI 0.01 - 0.1), Others factors,namely the benefits of shortened magnesium sulfate treatment,showed differences in both groups.: Shortened postpartum magnesium sulfate treatment was as effective as traditional 24 h magnesium sulfate in seizure prevention and total complications. But flushing and needed for prolonged treatment in the shortened groups warrants further research.
Topics: Drug Administration Schedule; Female; Humans; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 32338165
DOI: 10.1080/10641955.2020.1753067