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American Family Physician Jan 2024Asthma exacerbations, defined as a deterioration in baseline symptoms or lung function, cause significant morbidity and mortality. Asthma action plans help patients...
Asthma exacerbations, defined as a deterioration in baseline symptoms or lung function, cause significant morbidity and mortality. Asthma action plans help patients triage and manage symptoms at home. In patients 12 years and older, home management includes an inhaled corticosteroid/formoterol combination for those who are not using an inhaled corticosteroid/long-acting beta2 agonist inhaler for maintenance, or a short-acting beta2 agonist for those using an inhaled corticosteroid/long-acting beta2 agonist inhaler that does not include formoterol. In children four to 11 years of age, an inhaled corticosteroid/formoterol inhaler, up to eight puffs daily, can be used to reduce the risk of exacerbations and need for oral corticosteroids. In the office setting, it is important to assess exacerbation severity and begin a short-acting beta2 agonist and oxygen to maintain oxygen saturations, with repeated doses of the short-acting beta2 agonist every 20 minutes for one hour and oral corticosteroids. Patients with severe exacerbations should be transferred to an acute care facility and treated with oxygen, frequent administration of a short-acting beta2 agonist, and corticosteroids. The addition of a short-acting muscarinic antagonist and magnesium sulfate infusion has been associated with fewer hospitalizations. Patients needing admission to the hospital require continued monitoring and systemic therapy similar to treatments used in the emergency department. Improvement in symptoms and forced expiratory volume in one second or peak expiratory flow to 60% to 80% of predicted values helps determine appropriateness for discharge. The addition of inhaled corticosteroids, consideration of stepping up asthma maintenance therapy, close follow-up, and education on asthma action plans are important next steps to prevent future exacerbations.
Topics: Child; Humans; Anti-Asthmatic Agents; Administration, Inhalation; Asthma; Formoterol Fumarate; Adrenal Cortex Hormones; Oxygen; Drug Therapy, Combination
PubMed: 38227870
DOI: No ID Found -
Medical Gas Research 2024Postoperative sore throat is one well-recognized complication, occurring most frequently following tracheal intubation. Effective prevention of postoperative sore throat... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of adding magnesium sulfate, dexmedetomidine and ondansetron to lidocaine for gargling before laryngoscopy and endotracheal intubation to prevent sore throat: a randomized clinical trial.
Postoperative sore throat is one well-recognized complication, occurring most frequently following tracheal intubation. Effective prevention of postoperative sore throat has been recognized as a top priority, bringing pleasant feelings and satisfaction to patients. This study aimed to assess the efficacy of magnesium sulfate, dexmedetomidine and ondansetron gargle with lidocaine administrated prior to laryngoscopy and tracheal intubation for postoperative sore throat prevention alongside hemodynamic management. This double-blind randomized clinical trial enrolled 105 general anesthesia-administered patients who had undergone laryngoscopy and endotracheal intubation, and they were equally randomized into three groups: magnesium sulfate, dexmedetomidine, and ondansetron groups. No significant intergroup difference was seen in oxygen saturation, non-invasive blood pressure, heart rate, duration of surgery, postoperative complications, analgesic consumption, and incidence of cough and hoarseness. The results showed statistically significant intergroup differences in pain scores and average pain intensity in the dexmedetomidine group was significantly lower than the other groups. Results suggest that dexmedetomidine gargle with lidocaine before general anesthesia induction could be recommended as an option depending on the patient's general condition and the anesthesiologist's discretion.
Topics: Humans; Lidocaine; Magnesium Sulfate; Dexmedetomidine; Ondansetron; Laryngoscopy; Pain; Pharyngitis; Intubation, Intratracheal
PubMed: 37929508
DOI: 10.4103/2045-9912.372664 -
JAMA Aug 2023
Topics: Female; Humans; Infant, Newborn; Pregnancy; Gestational Age; Infant, Premature; Magnesium Sulfate; Neuroprotection; Neuroprotective Agents; Parturition
PubMed: 37581684
DOI: 10.1001/jama.2023.10673 -
Journal of the Air & Waste Management... Nov 2023The Interagency Monitoring of PROtected Visual Environments (IMPROVE) network has collected airborne particulate matter (PM) samples at locations throughout the United...
The Interagency Monitoring of PROtected Visual Environments (IMPROVE) network has collected airborne particulate matter (PM) samples at locations throughout the United States since 1988 and provided chemical speciation measurements on the samples using several techniques including X-ray fluorescence (XRF). New XRF instruments for measuring PM elemental content of IMPROVE samples were introduced in 2011. To evaluate the performance of these new instruments relative to the old instruments, archived sample from three IMPROVE monitoring sites were retrieved and analyzed on the new instruments. The agreement between the two instruments varied by element. Comparisons of the results were very good (slopes within 10% of unity) for most elements regularly measured well above the detection limits (sulfur, chlorine, potassium, titanium, vanadium, manganese, iron, copper, zinc, selenium, lead). Different particle compositions at the three sites highlighted different measurement interferences. High sea salt concentrations at the coastal site emphasized corrections applied in the old systems to light elements - sodium and magnesium - and resulted in poor agreement for these elements. Comparisons of the XRF measurements with collocated sulfate measurements by ion chromatography suggest that sulfur measurements from the new instruments are more precise but slight underestimates. Comparing elemental ratios to expected ratios for soil-derived PM demonstrate the new instruments are better at resolving the aluminum and silicon peaks.: The presented work represents a comprehensive analysis of the method change enacted within the Interagency Monitoring of PROtected Visual Environments (IMPROVE) air monitoring network. This work describes the implications of the last change in elemental quantification methodology. The most important point for data users performing longitudinal analyses is that light elements (e.g., sodium - sulfur) were affected; the old instrumentation overestimated these elements while the current measurements are slightly underestimated. The authors recommend these results to be taken into consideration when interpreting sea salt and crustal sources of atmospheric dust.
Topics: United States; Air Pollutants; Air Pollution; Environmental Monitoring; Particulate Matter; Sodium; Sulfur
PubMed: 37768033
DOI: 10.1080/10962247.2023.2262417 -
Cureus Mar 2024In the field of general anesthesia, magnesium sulfate (MgSO4) has become a valuable adjunct because it provides a range of benefits that enhance and optimize... (Review)
Review
In the field of general anesthesia, magnesium sulfate (MgSO4) has become a valuable adjunct because it provides a range of benefits that enhance and optimize conventional aesthetic procedures. This review highlights the various intra-anesthetic benefits of MgSO4 while examining its complex function in the treatment using anesthesia. Magnesium inhibits the release of acetylcholine at the motor endplate and blocks calcium channels at presynaptic nerve terminals. This reduces the amplitude of endplate potential and the excitability of muscle fibers, which increases the potency of a neuromuscular blockade by nondepolarizing neuromuscular blockers. This activity may lessen the need for primary muscle relaxants. Moreover, its capacity to potentially reduce the total amount of main aesthetic agents needed emphasizes its function in maximizing anesthesia dosage, ensuring sufficient depth while perhaps potentially reducing adverse effects linked with increased dosages. MgSO4's adaptable qualities present a viable path for improving anesthetic outcomes, possibly improving patient safety and improving surgical results.
PubMed: 38633961
DOI: 10.7759/cureus.56348 -
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 -
Paediatric Respiratory Reviews Feb 2024Asthma is the most prevalent chronic disease in children and constitutes a significant healthcare burden. First-line therapy for acute asthma exacerbations is well... (Review)
Review
BACKGROUND
Asthma is the most prevalent chronic disease in children and constitutes a significant healthcare burden. First-line therapy for acute asthma exacerbations is well established. However, secondary treatments, including intravenous magnesium sulfate (IV-MgSO4), remain variable due to scarcity of data on its efficacy and safety.
OBJECTIVE
To assess the effectiveness and safety of IV-MgSO4 as a second line of treatment in managing children with asthma exacerbations.
METHODS
We searched five databases from inception until April 2023 on randomized clinical trials of IV-MgSO4 in children with acute asthma exacerbations. The primary outcomes were hospitalization rate and length, and change in the severity score. Secondary outcomes included percentage increase in peak expiratory flow rate (PEFR), hospital re-admission rate, need and length for pediatric intensive care unit (PICU) treatment, and adverse effects. Meta-analysis was performed for three outcomes with estimated odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs).
RESULTS
Eleven studies met the final criteria. In comparison to control, administration of IV-MgSO4 was associated with a reduced hospitalization risk (OR 0.15; 95%CI: 0.03, 0.73) in four studies, and improvement of lung function (MD 26.77% PEFR; 95%CI: 18.41, 54.79) in two studies. There were no significant differences in the length of stay between groups. Due to heterogeneity, a narrative synthesis of other outcomes was performed.
CONCLUSION
The use of IV-MgSO4 demonstrated a reduction in the hospitalization rate and PEFR improvement in children with asthma exacerbations. Adverse effects were rare. Further well-designed studies are needed to better determine the efficacy and safety profile of IV-MgSO4.
PubMed: 38395640
DOI: 10.1016/j.prrv.2024.01.003 -
Journal of Clinical Medicine May 2024Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal... (Review)
Review
Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal surgery because of its analgesic properties and modulation of neurotransmitters and autonomic nervous system. Existing evidence regarding the use of magnesium sulfate is partial and controversial, necessitating a comprehensive meta-analysis to evaluate its efficacy and safety. The aim of this study was to conduct a comprehensive meta-analysis to evaluate the efficacy and safety of magnesium sulfate in spinal surgery compared to other available options. This meta-analysis adhered to the PRISMA guidelines. Patients undergoing spinal surgery were included, with the intervention group receiving intravenous magnesium sulfate (MS) at various doses or combinations, whereas the comparison group received other alternatives or a placebo. The efficacy and safety outcomes were assessed. Data were collected from multiple databases and analyzed using Review Manager version 5.4. Heterogeneity was assessed and fixed- or random-effects models were applied. The meta-analysis included eight studies ( = 541). Magnesium sulfate demonstrated significant reductions in pain at 24 h (MD -0.20, 95% CI: -0.39 to -0.02) and opioid consumption (SMD -0.66, 95% CI: -0.95 to -0.38) compared to placebo. Additionally, a decrease in the use of muscle relaxants (SMD -0.91, 95% CI: -1.65 to -0.17) and remifentanil (SMD -1.52, 95% CI: -1.98 to -1.05) was observed. In contrast, an increase in extubation time (MD 2.42, 95% CI: 1.14 to 3.71) and verbal response (MD 1.85, 95% CI: 1.13 to 2.58) was observed compared to dexmedetomidine. In conclusion, magnesium sulfate administration in spinal surgery reduced pain and opioid consumption, and prolonged orientation and verbal response. No significant differences in blood pressure or heart rate were observed between the groups.
PubMed: 38892833
DOI: 10.3390/jcm13113122 -
Critical Care Nursing Clinics of North... Sep 2023Asthma is a complex chronic disease characterized by inflammatory disorder causing airflow obstruction due to inflammation, bronchospasms, and mucus plugging. Children... (Review)
Review
Asthma is a complex chronic disease characterized by inflammatory disorder causing airflow obstruction due to inflammation, bronchospasms, and mucus plugging. Children who fail to respond to initial first-line therapies often require hospitalization, and many with severe exacerbations and near-fatal asthma require admission to the pediatric intensive care unit (PICU). Nursing care of these PICU patients requires close monitoring and excellent assessment of their respiratory status. Administration of medications, such as albuterol, methylprednisolone, magnesium sulfate, and sedatives, is needed. Close communication with the care team is vital, including providers and respiratory therapy, to coordinate care and to communicate assessment findings.
Topics: Child; Humans; Bronchodilator Agents; Asthma; Albuterol; Hospitalization; Intensive Care Units, Pediatric
PubMed: 37532387
DOI: 10.1016/j.cnc.2023.04.007 -
Antenatal magnesium sulfate and the need for mechanical ventilation in the first three days of life.Pediatrics and Neonatology Nov 2023Antenatal administration of magnesium sulfate (MgSO) to women in preterm labor has gained widespread use. This study examined the relationship between MgSO exposure with...
BACKGROUND
Antenatal administration of magnesium sulfate (MgSO) to women in preterm labor has gained widespread use. This study examined the relationship between MgSO exposure with neonatal respiratory outcomes.
METHODS
Very low birth weight (VLBW) infants exposed to antenatal MgSO were included. Infants who were intubated anytime during the first three days of life were compared to those who were not intubated regarding their demographic and clinical characteristics, MgSO therapy, immediate respiratory outcomes, and occurrence of intraventricular hemorrhage (IVH) using student t-test, chi square testing and logistic regression analysis to control for confounding variables. Correlation coefficient of MgSO cumulative dose given and duration of infusion with delivery room resuscitation and need for mechanical ventilation in the first 3 days of life were also calculated. Multilinear regression analysis was used to control for confounding factors.
RESULTS
Intubated group included 96 infants while non-intubated group included 171 infants. Although, intubated group has younger gestational age (26 vs. 29 weeks, p < 0.01) and lower birth weight (786 vs. 1115 g (g), p < 0.01), there were no significant differences between groups in regard to MgSO cumulative dose (24 vs. 27 g, p = 0.29), infusion time (14.6 vs. 18 h, p = 0.19) or infants' serum magnesium level (2.6 vs. 2.8 milliequivalents (mEq)/L p = 0.86). There was no correlation between cumulative MgSO4 dose with endotracheal intubation or cardiac resuscitation in the delivery room (cc: -0.03, p = 0.66; and 0.02, p = 0.79, respectively) or the need for mechanical ventilation in the first 3 days of life (cc: -0.04 to -0.07, p = 0.21-0.51). In addition, there was no relationship between MgSO dose, duration of infusion, or infant's serum magnesium level and occurrence of IVH.
CONCLUSION
Regardless of dose or duration of infusion, antenatal MgSO exposure is not associated with increased intubation or mechanical ventilation early in life.
Topics: Infant, Newborn; Humans; Female; Pregnancy; Magnesium Sulfate; Respiration, Artificial; Magnesium; Gestational Age; Obstetric Labor, Premature
PubMed: 37280122
DOI: 10.1016/j.pedneo.2022.10.008