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Stroke May 2022Intracerebral hemorrhage (ICH) is the deadliest form of stroke. In observational studies, lower serum magnesium has been linked to more hematoma expansion (HE) and... (Observational Study)
Observational Study Randomized Controlled Trial
BACKGROUND
Intracerebral hemorrhage (ICH) is the deadliest form of stroke. In observational studies, lower serum magnesium has been linked to more hematoma expansion (HE) and intracranial hemorrhage, implying that supplemental magnesium sulfate is a potential acute treatment for patients with ICH and could reduce HE. FAST-MAG (Field Administration of Stroke Therapy - Magnesium) was a clinical trial of magnesium sulfate started prehospital in patients with acute stroke within 2 hours of last known well enrolled. CT was not required prior to enrollment, and several hundred patients with acute ICH were enrolled. In this ancillary analysis, we assessed the effect of magnesium sulfate treatment upon HE in patients with acute ICH.
METHODS
We retrospectively analyzed data that were prospectively collected in the FAST-MAG study. Patients received intravenous magnesium sulfate or matched placebo within 2 hours of onset. We compared HE among patients allocated to intravenous magnesium sulfate or placebo with a Mann-Whitney . We used the same method to compare neurological deficit severity (National Institutes of Health Stroke Scale) and global disability (modified Rankin Scale) at 3 months.
RESULTS
Among 268 patients with ICH meeting study entry criteria, mean 65.4±13/4 years, 33% were female, and 211 (79%) had a history of hypertension. Initial deficit severities were median (interquartile range) of 4 (3-5) on the Los Angeles Motor Scale in the field and National Institutes of Health Stroke Scale score of 16 (9.5-25.5) early after hospital arrival. Follow-up brain imaging was performed a median of 17.1 (11.3-22.7) hours after first scan. The magnesium and placebo groups did not statistically differ in hematoma volume on arrival, 10.1 (5.6-28.7) versus 12.4 (5.6-28.7) mL (=0.6), or HE, 2.0 (0.1-7.4) versus 1.5 (-0.2 to 8) mL (=0.5). There was no difference in functional outcomes (modified Rankin Scale score of 3-6), 59% versus 50% (=0.5).
CONCLUSIONS
Magnesium sulfate did not reduce HE or improve functional outcomes at 90 days. A benefit for patients with initial hypomagnesemia was not addressed.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT00059332.
Topics: Cerebral Hemorrhage; Female; Hematoma; Humans; Magnesium; Magnesium Sulfate; Male; Retrospective Studies; Stroke; United States
PubMed: 35380053
DOI: 10.1161/STROKEAHA.121.037999 -
European Journal of Obstetrics,... Jan 2021Magnesium sulfate (MgSO) is among the most commonly used medications in labor and delivery units. It has been used as a mean to protect against eclampsia and a... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Magnesium sulfate (MgSO) is among the most commonly used medications in labor and delivery units. It has been used as a mean to protect against eclampsia and a neuroprotective agent for fetuses at risk of preterm birth. In the present study we investigated its impact in the occurrence of postpartum uterine atony and hemorrhage.
METHODS
We searched the Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, Clinicaltrials.gov and Google Scholar databases for randomized trials and observational studies. Statistical analysis was performed with the Hartung-Knapp-Sidik-Jonkman model in RStudio using the meta package.
RESULTS
Twelve studies fitted the predetermined criteria and these involved 41,190 women of whom 10,565 (25.6 %) received MgSO The meta-analysis revealed that the risk of postpartum uterine atony was similar among patients that received MgSO and those that did not (OR 1.93, 95 % CI 0.78, 4.81). Estimated blood loss (SMD 0.04, 95 % CI -0.10, 0.18) as well as the risk of postpartum hemorrhage (OR 1.82, 95 % CI 0.99, 3.35) also did not differ. Subgroup analysis revealed that evidence drawn from observational studies indicates a significant effect of MgSO on the odds of postpartum uterine atony and hemorrhage; however, randomized trials do not support this.
CONCLUSIONS
The results of our meta-analysis suggest that it is reasonable to consider MgSO4 in women at risk of delivering before the completion of its elimination half-life. However, physicians should be vigilant in cases at risk of postpartum hemorrhage as current data are very heterogeneous and should not be considered as definitive.
Topics: Female; Humans; Infant, Newborn; Magnesium Sulfate; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Premature Birth; Uterine Inertia
PubMed: 33246200
DOI: 10.1016/j.ejogrb.2020.11.005 -
Archives of Gynecology and Obstetrics Mar 2024Magnesium sulfate (MgSO) has been widely used in obstetrics as a mean to help decrease maternal and neonatal morbidity in various antenatal pathology. As a factor, it... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Magnesium sulfate (MgSO) has been widely used in obstetrics as a mean to help decrease maternal and neonatal morbidity in various antenatal pathology. As a factor, it seems to regulate immunity and can, thus, predispose to infectious morbidity. To date, it remains unknown if its administration can increase the risk of chorioamnionitis. In the present meta-analysis, we sought to accumulate the available evidence.
METHODS
We systematically searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases in our primary search along with the reference lists of electronically retrieved full-text papers.
RESULTS
Eight studies were included that investigated the incidence of chorioamnionitis among parturient that received MgSO and control patients. Magnesium sulfate was administered in 3229 women and 3330 women served as controls as they did not receive MgSO. The meta-analysis of data revealed that there was no association between the administration of magnesium sulfate and the incidence of chorioamnionitis (OR 0.98, 95% CI 0.73, 1.32). Rucker's analysis revealed that small studies did not significantly influence the statistical significance of this finding (OR 1.12, 95% CI 0.82, 1.53). Trial sequential analysis revealed that the required number to safely interpret the primary outcome was not reached. Two studies evaluated the impact of MgSO in neonates delivered in the setting of chorioamnionitis. Neither of these indicated the presence of a beneficial effect in neonatal morbidity, including the risk of cerebral palsy, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, stillbirth, or neonatal death.
CONCLUSION
Current evidence indicates that magnesium sulfate is not associated with an increased risk of maternal chorioamnionitis. However, it should be noted that its effect on neonatal outcomes of offspring born in the setting of chorioamnionitis might be subtle if any, although the available evidence is very limited.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Chorioamnionitis; Magnesium Sulfate; Stillbirth; Fetal Diseases; Perinatal Death
PubMed: 37768342
DOI: 10.1007/s00404-023-07221-3 -
Obstetrical & Gynecological Survey May 2020In cases of anticipated preterm delivery, corticosteroids for fetal lung maturation and magnesium sulfate for fetal neuroprotection may improve neonatal outcomes. (Review)
Review
IMPORTANCE
In cases of anticipated preterm delivery, corticosteroids for fetal lung maturation and magnesium sulfate for fetal neuroprotection may improve neonatal outcomes.
OBJECTIVE
The aim of this study was to summarize and compare published guidelines from 4 leading medical societies on the administration of antenatal corticosteroids and magnesium sulfate.
EVIDENCE ACQUISITION
A descriptive review of major national guidelines on corticosteroids and magnesium sulfate was conducted: National Institute for Health and Care Excellence on "Preterm labour and birth," World Health Organization on "WHO recommendations on interventions to improve preterm birth outcomes," American College of Obstetricians and Gynecologists on "Antenatal corticosteroid therapy for fetal maturation" and "Magnesium sulfate use in obstetrics," and Society of Obstetricians and Gynecologists of Canada on "Antenatal corticosteroid therapy for improving neonatal outcomes" and "Magnesium sulphate for fetal neuroprotection."
RESULTS
A variation in the appropriate timing of administration exists, whereas repeated courses are not routinely recommended for corticosteroids or magnesium sulfate. In addition, the recommendations are the same for singleton and multiple gestations, and no specific recommendation exists according to maternal body mass index. Finally, a variation in guidelines regarding the administration of corticosteroids before cesarean delivery exists.
CONCLUSION
The adoption of an international consensus on corticosteroids and magnesium sulfate may increase their endorsement by health care professionals, leading to more favorable neonatal outcomes after preterm delivery.
Topics: Adrenal Cortex Hormones; Cesarean Section; Drug Administration Schedule; Female; Humans; Magnesium Sulfate; Practice Guidelines as Topic; Pregnancy; Premature Birth; Prenatal Care; Tocolytic Agents
PubMed: 32469415
DOI: 10.1097/OGX.0000000000000778 -
Tropical Medicine & International... Oct 2021Tetanus is a rare life-threatening condition often complicated by repetitive spasms, dysautonomia and neuromuscular respiratory failure contributing to high fatality...
Tetanus is a rare life-threatening condition often complicated by repetitive spasms, dysautonomia and neuromuscular respiratory failure contributing to high fatality rates in its severe form. Benzodiazepines used to treat muscle spasms pose a high risk of respiratory failure requiring mechanical ventilation, which is unaffordable and inaccessible for many. Magnesium sulfate, a cheap and widely available medication in all urban and rural health centres of LMICs for the treatment of eclampsia, can be used to control muscle spasms and dysautonomia. We thus conducted a systematic review of evidence to assess the safety and efficacy of magnesium sulfate in the treatment of tetanus. Any study published before April 15, 2021, discussing the efficacy and/or safety of MgSO4 infusion in the treatment of tetanus was systemically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our systematic review included data from 13 studies, three were randomised, double-blind and controlled trials. The remaining ten studies were observational; six prospective and four retrospective studies. Our review showed no mortality benefit associated with the use of magnesium sulfate. However, magnesium sulfate was found to be effective in reducing spasms along with diazepam, leading to better control of dysautonomia, reduced need for mechanical ventilation and shorter hospital stay by 3-7 days. The incidence of magnesium toxicity was very low in the studies included.
Topics: Anticonvulsants; Humans; Magnesium Sulfate; Tetanus
PubMed: 34403179
DOI: 10.1111/tmi.13667 -
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 -
Pediatrics and Neonatology Mar 2021Antenatal magnesium sulfate is widely used as a tocolytic, for maternal seizures, and for seizure prophylaxis in preeclampsia. Recent studies have suggested that...
BACKGROUND
Antenatal magnesium sulfate is widely used as a tocolytic, for maternal seizures, and for seizure prophylaxis in preeclampsia. Recent studies have suggested that antenatal magnesium sulfate use is associated with favorable neurodevelopmental outcomes in preterm infants. However, there are concerns regarding the effects of antenatal magnesium sulfate on neonates, especially regarding gastrointestinal morbidities. This study aims to explore the effects of antenatal magnesium sulfate on intestinal morbidities requiring surgery in preterm infants.
METHODS
This was a retrospective cohort study of 181 preterm infants who were born at less than 28 weeks of gestational age. Subjects were categorized as infants exposed to antenatal magnesium sulfate and those not exposed to antenatal magnesium sulfate.
RESULTS
Antenatal magnesium sulfate was associated with a decreased risk of surgical conditions of the intestine (OR 0.393, 95% CI 0.170-0.905). The multivariate analysis showed that the duration of antenatal magnesium sulfate use was associated with surgical conditions of the intestine (adjusted OR 0.766, 95% CI 0.589-0.997). In the <26 weeks of gestational age subgroup, the use of antenatal magnesium sulfate was significantly associated with decreased intestinal morbidities requiring surgery (adjusted OR 0.234, 95% CI 0.060-0.922).
CONCLUSION
Antenatal magnesium sulfate use appears to have a protective effect on intestinal morbidities requiring surgery in preterm infants in a duration-dependent manner. Association of antenatal magnesium sulfate use and decreased intestinal morbidities requiring surgery was more distinct in preterm infants <26 weeks of gestational age.
Topics: Cohort Studies; Drug Administration Schedule; Enterocolitis, Necrotizing; Female; Humans; Infant; Infant, Extremely Premature; Infant, Newborn; Infant, Premature, Diseases; Intestinal Perforation; Magnesium Sulfate; Male; Pregnancy; Prenatal Care; Retrospective Studies; Tocolytic Agents
PubMed: 33495105
DOI: 10.1016/j.pedneo.2020.12.009 -
Intensive Care Medicine Nov 2023Studies have suggested benefits from magnesium sulphate in thrombotic thrombocytopenic purpura (TTP). We aimed to measure the effects of magnesium sulphate... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Studies have suggested benefits from magnesium sulphate in thrombotic thrombocytopenic purpura (TTP). We aimed to measure the effects of magnesium sulphate supplementation on TTP recovery.
METHODS
In this multicenter, randomised, double-blind, controlled, superiority study, we enrolled adults with a clinical diagnosis of TTP. Patients were randomly allocated to receive magnesium sulphate (6 g intravenously followed by a continuous infusion of 6 g/24 h for 3 days) or placebo, in addition to the standard treatment. The primary outcome was the median time to platelet normalisation (defined as a platelet count ≥ 150 G/L). Efficacy and safety were assessed by intention-to-treat.
RESULTS
Overall, we enrolled 74 participants, including one who withdrew his/her consent. Seventy-three patients were further analyzed, 35 (48%) allocated to magnesium sulphate and 38 (52%) to placebo. The median time to platelet normalisation was 4 days (95% confidence interval [CI], 3-4) in the magnesium sulphate group and 4 days (95% CI 3-5) in the placebo group. The cause-specific hazard ratio of response was 0.93 (95% CI 0.58-1.48, p = 0.75). The number of patients with ≥ 1 serious adverse reactions was similar in the two groups. By day 90, four patients in the magnesium sulphate group and two patients in the placebo group had died (p = 0.42). The most frequent adverse event was low blood pressure occurring in 34% in the magnesium sulphate group and 29% in the placebo group (p = 0.80).
CONCLUSION
Among patients with TTP, the addition of magnesium sulphate to the standard of care did not result in a significant improvement in time to platelet normalisation.
Topics: Adult; Female; Humans; Male; Death; Double-Blind Method; Magnesium Sulfate; Platelet Count; Purpura, Thrombotic Thrombocytopenic; Treatment Outcome
PubMed: 37867165
DOI: 10.1007/s00134-023-07178-6 -
Andes Pediatrica : Revista Chilena de... Jun 2021Second-line drugs for acute asthma, such as salbutamol, magnesium sulfate, and aminophylline, are generally intravenously administered. (Comparative Study)
Comparative Study Randomized Controlled Trial
INTRODUCTION
Second-line drugs for acute asthma, such as salbutamol, magnesium sulfate, and aminophylline, are generally intravenously administered.
OBJECTIVE
To compare the efficacy and safety of using mag nesium sulfate or aminophylline in children who did not respond to initial treatment.
PATIENTS AND METHOD
Randomized clinical trial. Children who did not improve the Modified Pulmonary Index Score (mPSI) receive at random magnesium sulfate (50 mg/kg/single dose) or aminophylline (5 mg/ kg/dose followed by continuous infusion at 1 mg/kg/hour for 3 hours). Primary endpoints were changes in mPSI and oxygen saturation; secondary endpoints: hospitalization rate, need for transfer to the intensive care unit, use of a third intervention, and adverse effects.
RESULTS
131 patients were studied (66 patients in the aminophylline group and 65 MgSO4). The mean age was 5 ± 2.3 years, the demographic and clinical parameters did not differ between the groups. In the group that received magnesium sulfate, the mPSI and oxygen saturation changed significantly in favor from 13.1 ± 1.3 to 4.9 ± 2.5 (p < 0.001) and from 3.3 ± 2.5; (p 0.021), respectively, and their risk of hospital admission (RR 0.68 95% CI [0.56, 0.82]) and of secondary failure (0.16 95% CI 95% [0 , 07; 0.38]) decreased. Only one adverse event (tachycardia) was recorded.
CONCLUSION
The administration of a single dose of magnesium sulfate proved to be more effective and safe than the use of aminophylline as a second- line drug.
Topics: Acute Disease; Aminophylline; Anti-Asthmatic Agents; Asthma; Child; Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Emergency Service, Hospital; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Magnesium Sulfate; Male; Severity of Illness Index; Treatment Outcome
PubMed: 34479242
DOI: 10.32641/andespediatr.v92i3.2969 -
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