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International Journal of Gynaecology... Dec 2022To evaluate possible interactions of magnesium sulfate-the drug of choice in the management of pre-eclampsia/eclampsia-in response to a few case reports that revealed...
OBJECTIVE
To evaluate possible interactions of magnesium sulfate-the drug of choice in the management of pre-eclampsia/eclampsia-in response to a few case reports that revealed maternal electrolyte disturbances, especially symptomatic changes, following magnesium sulfate administration in pre-eclampsia.
METHODS
Prospectively, women with pre-eclampsia were given 4 g of intravenous magnesium sulfate followed by a 2 g/h infusion up to 24 h after delivery. Sequential blood samples were drawn from each patient and used to measure the serum levels of sodium, potassium, calcium, phosphorus, magnesium, and parathyroid hormone.
RESULTS
A total of 30 pregnant women with pre-eclampsia were evaluated. They were aged between 20 and 41 years with median gestational age of 37.6 (interquartile range 35.4-38.9) weeks. Only five patients reached the therapeutic window of magnesium in at least one of our measuring intervals during magnesium sulfate infusion. Plasma magnesium concentrations increased significantly during magnesium sulfate administration and dropped during the next 12 and 24 h after infusion discontinuation (P < 0.05). Fifteen of 30 (50%) patients developed asymptomatic hypocalcemia, mainly at hour 24 of infusion. Negative moderate correlations were detected between the calcium and magnesium concentrations at 12 and 24 hours of infusion (ρ = -0.390, P = 0.044 and ρ = 0.315, P = 0.096, respectively). None of the patients with hypocalcemia reached the therapeutic level of magnesium or experienced parallel hyperphosphatemia. Eleven of 30 (36.6%) patients developed hyperphosphatemia mainly at 2 and 12 h of magnesium sulfate infusion.
CONCLUSIONS
Our study implies that magnesium sulfate could cause hypermagnesemia-induced hypocalcemia in women with pre-eclampsia, independent from parathyroid hormone. The negative correlations between calcium and magnesium concentrations could be indicative of dose-dependent associations between serum magnesium level and degree of hypocalcemia in our study.
Topics: Female; Humans; Pregnancy; Infant; Magnesium Sulfate; Parathyroid Hormone; Pre-Eclampsia; Hypocalcemia; Magnesium; Calcium; Hyperphosphatemia; Electrolytes
PubMed: 35656755
DOI: 10.1002/ijgo.14296 -
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 -
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 -
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 -
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 -
Neonatology 2020Magnesium sulfate (MgSO4) is frequently administered for maternal and fetal neuroprotection in preeclampsia (PE) and imminent preterm birth, respectively.
INTRODUCTION
Magnesium sulfate (MgSO4) is frequently administered for maternal and fetal neuroprotection in preeclampsia (PE) and imminent preterm birth, respectively.
OBJECTIVE
To assess whether MgSO4 affects neonatal cerebral oxygenation, blood flow, and cerebral autoregulation (CAR) during the first postnatal days independently from PE.
METHODS
148 neonates <32 weeks gestational age were included. Cerebral fractional tissue oxygen extraction (cFTOE) was extracted from a daily 2-h period, during which peak systolic blood flow velocity (PSV) and resistance index (RI) of the pericallosal artery were obtained. The percent time of impaired CAR (correlation coefficient between mean arterial blood pressure and cerebral oxygen saturation >0.5) was determined. Linear mixed models were applied.
RESULTS
MgSO4 exposure was recorded in 77 neonates. Twenty-nine neonates were born following PE. MgSO4 independently lowered cFTOE (B: -0.026, 95% CI: -0.050 to 0.002, p < 0.05) but did not affect PSV and RI. PE was associated with a lower cFTOE (B: -0.041, 95% CI: -0.067 to -0.015, p < 0.05) and a tendency towards both lower PSV (B: -4.285, 95% CI: -9.067 to 0.497, p < 0.1) and more impaired CAR (B: 4.042, 95% CI: -0.028 to 8.112, p < 0.1), which seemed to be strongly mediated by fetal brain sparing. MgSO4 did not alter CAR.
CONCLUSIONS
In contrast to fetal brain sparing in PE, MgSO4 seems to lower cFTOE by lowering cerebral oxygen demands in preterm neonates without affecting the cerebrovasculature.
Topics: Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Premature Birth
PubMed: 32516784
DOI: 10.1159/000507705 -
Developmental Medicine and Child... Nov 2022We performed a systematic review and network meta-analysis (NMA) to obtain comparative effectiveness estimates and rankings of non-surgical interventions used to treat... (Meta-Analysis)
Meta-Analysis Review
AIM
We performed a systematic review and network meta-analysis (NMA) to obtain comparative effectiveness estimates and rankings of non-surgical interventions used to treat infantile spasms.
METHOD
All randomized controlled trials (RCTs) including children 2 months to 3 years of age with infantile spasms (with hypsarrhythmia or hypsarrhythmia variants on electroencephalography) receiving appropriate first-line medical treatment were included. Electroclinical and clinical remissions within 1 month of starting treatment were analyzed.
RESULTS
Twenty-two RCTs comparing first-line treatments for infantile spasms were reviewed; of these, 17 were included in the NMA. Both frequentist and Bayesian network rankings for electroclinical remission showed that high dose adrenocorticotropic hormone (ACTH), methylprednisolone, low dose ACTH and magnesium sulfate (MgSO ) combination, low dose ACTH, and high dose prednisolone were most likely to be the 'best' interventions, although these were not significantly different from each other. For clinical remission, low dose ACTH/MgSO combination, high dose ACTH (with/without vitamin B ), high dose prednisolone, and low dose ACTH were 'best'.
INTERPRETATION
Treatments including ACTH and high dose prednisolone are more effective in achieving electroclinical and clinical remissions for infantile spasms.
WHAT THIS PAPER ADDS
Adrenocorticotropic hormone and high dose prednisolone are more effective than other medications for infantile spasms. Symptomatic etiology decreases the likelihood of remission even after adjusting for treatment lag.
Topics: Adrenocorticotropic Hormone; Anticonvulsants; Child; Humans; Infant; Magnesium Sulfate; Methylprednisolone; Network Meta-Analysis; Spasms, Infantile; Treatment Outcome; Vitamins
PubMed: 35765990
DOI: 10.1111/dmcn.15330 -
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