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Metabolic Brain Disease Aug 2019Brain edema is a fatal complication of acute ischemic stroke and associated with worse outcomes in patients. This study was designed to evaluate the effects of magnesium...
Brain edema is a fatal complication of acute ischemic stroke and associated with worse outcomes in patients. This study was designed to evaluate the effects of magnesium sulfate on vasogenic brain edema formation and blood-brain barrier (BBB) disruption caused by ischemia-reperfusion (IR) in a rat model of ischemic stroke. A total of 72 male Sprague-Dawley rats were categorized into the following three primary groups: sham, control ischemic, magnesium-sulfate-treated (300 mg/kg loading dose, followed by an additional 100 mg/kg) ischemic (n = 24 in each group). Transient focal cerebral ischemia was induced by 60-min-long occlusion of the left middle cerebral artery, followed by 24-h-long reperfusion. Sensorimotor deficits, infarct volume, and brain edema were evaluated at the end of the reperfusion period. The BBB permeability was assessed by Evans Blue extravasation technique. Lipid peroxidation levels were assessed by measuring the malondialdehyde content in the brain tissue homogenate, and the activities of the antioxidant enzymes superoxide dismutase, catalase, and glutathione peroxidase were detected according to the technical manual of the assay kits. Induction of cerebral ischemia in the control group produced considerable BBB damage in conjunction with severe brain edema formation. Treatment with magnesium sulfate significantly attenuated brain edema and protected BBB integrity in the ischemic lesioned hemisphere. In addition, magnesium sulfate reduced lipid peroxidation and increased antioxidant protection of brain tissue by upregulating the activities of antioxidant enzymes. Treatment with magnesium sulfate protected BBB integrity against IR-induced damage and reduced vasogenic edema formation partly via antioxidant mechanisms in a rat model of acute ischemic stroke.
Topics: Animals; Blood-Brain Barrier; Brain; Brain Edema; Brain Ischemia; Catalase; Disease Models, Animal; Glutathione Peroxidase; Lipid Peroxidation; Magnesium Sulfate; Male; Malondialdehyde; Neuroprotective Agents; Permeability; Rats; Rats, Sprague-Dawley; Stroke; Superoxide Dismutase
PubMed: 31037556
DOI: 10.1007/s11011-019-00419-y -
European Review For Medical and... May 2020To explore the regulatory effect of magnesium sulfate combined with nifedipine and labetalol on disease-related molecules in serum and placenta in the treatment of...
OBJECTIVE
To explore the regulatory effect of magnesium sulfate combined with nifedipine and labetalol on disease-related molecules in serum and placenta in the treatment of preeclampsia.
PATIENTS AND METHODS
Altogether 100 patients with preeclampsia admitted to the Children & Women's Healthcare of Laiwu City were selected. They were divided into control group and experimental group according to different treatment methods. Among them, 51 patients in the control group were treated with magnesium sulfate combined with nifedipine, and 49 patients in the experimental group were treated with labetalol on the basis of the treatment in the control group. The therapeutic effects of the two methods were compared. The levels of the following factors in the two groups were compared: kallikrein expression, pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific β1 glycoprotein (SPI), placental growth factor (PLGF), human placental prolactin (HPL), transforming growth factor β1(TGF-β1), vascular cell adhesion molecule 1 (VCAM-1) and E-selectin in serum and placenta tissues.
RESULTS
After treatment, the blood pressure in the experimental group was lower than that in the control group (p<0.05). The expression of kallikrein in serum and placental tissue of the patients in the experimental group was higher than that of the patients in the control group (p<0.05); PAPP-A level was lower than that in the control group (p<0.05); TGF-β1 level was higher than that in the control group (p<0.05); VCAM-1 and E-selectin were lower than those in the control group (p<0.05), and kallikrein and TGF-β1 in serum and placenta in the non-occurrence group were higher than those in the occurrence group (p<0.05). The serum and placenta PAPP-A, VCAM-1, and E-selectin in the non-occurrence group were lower than those in the occurrence group (p<0.05).
CONCLUSIONS
Magnesium sulfate combined with nifedipine and labetalol has good efficacy in the treatment of preeclampsia. They can promote the expression of endogenous kallikrein, reduce the level of pregnancy-related hypertension predictors, and weaken the infiltration ability of cytotrophoblasts.
Topics: Administration, Oral; Adult; E-Selectin; Female; Humans; Labetalol; Magnesium Sulfate; Nifedipine; Pre-Eclampsia; Pregnancy; Prospective Studies; Transforming Growth Factor beta1; Vascular Cell Adhesion Molecule-1; Young Adult
PubMed: 32432770
DOI: 10.26355/eurrev_202005_21199 -
Anales de Pediatria Dec 2022The published evidence on the association between magnesium sulphate (MgSO) and delayed passage of meconium (DPM) is contradictory.
INTRODUCTION
The published evidence on the association between magnesium sulphate (MgSO) and delayed passage of meconium (DPM) is contradictory.
OBJECTIVES
To determine whether there is an association between the administration of MgSO to the mother and DPM in the neonate, and to analyse serum magnesium levels in neonates in relation to the cumulative dose of MgSO administered to the mother.
POPULATION AND METHODS
Retrospective and prospective descriptive and analytical study conducted in patients delivered at or before 32 weeks of gestation in 2 tertiary care hospitals. Delayed passage of meconium was defined as failure to pass meconium within 48 h of birth and/or need for rectal stimulation on 2 or more occasions to pass stool and/or interval of at least 48 h between the first and second bowel movements.
RESULTS
The study included 283 patients (204 retrospectively and 79 prospectively), of who 152 (53.7%) experienced DPM. Delayed passage of meconium was not associated with antenatal MgSO administration, the cumulative maternal MgSO4 dose or neonatal serum magnesium levels. Older gestational age (OR, 0.8; confidence interval [CI], 0.69-0.93; P = 0.003) was an independent protective factor against DPM, while the need for advanced resuscitation (OR, 2.24; CI 1.04-4.86; P = 0.04) was a risk factor for DPM.
CONCLUSION
The neonatal serum levels of magnesium reached with the doses of MgSO administered to mothers were not associated with DPM. Lower gestational age and the need for advanced resuscitation were predictors associated with an increased risk of DPM.
Topics: Infant, Newborn; Humans; Female; Pregnancy; Magnesium Sulfate; Retrospective Studies; Magnesium; Gestational Age; Meconium
PubMed: 36202742
DOI: 10.1016/j.anpede.2022.08.012 -
American Journal of Perinatology Dec 2022Since 2010, the American College of Obstetrics and Gynecology have released three committee opinions to recommend and reaffirm the utility of magnesium sulfate for...
OBJECTIVE
Since 2010, the American College of Obstetrics and Gynecology have released three committee opinions to recommend and reaffirm the utility of magnesium sulfate for neuroprotection and later for tocolysis to achieve antenatal steroid course completion in preterm labor. We sought to determine changes in antenatal magnesium sulfate exposure and other tocolytic agents for pregnancies resulting in neonatal intensive care unit (NICU)-admitted preterm infants.
STUDY DESIGN
Using the Pediatrix Clinical Data Warehouse, we evaluated all inborn infants delivered between 22 and 33 weeks' gestation and admitted to the intensive care units from 2009 to 2018. We classified patients based on antenatal exposure to tocolytic medications: calcium channel blockers (nifedipine and amlodipine), betamimetics (terbutaline, theophylline, and ritodrine), prostaglandin inhibitors (indomethacin), and magnesium sulfate.
RESULTS
A total of 229,781 patients met inclusion criteria. During the study period, magnesium sulfate exposure increased from 27.6 to 57.7% of births while betamimetic exposure decreased from 10.2 to 5.2%. Increasing magnesium sulfate exposure over time was seen at all gestational ages examined and magnesium exposure was most common between 23 and 31 weeks' gestation. By 2017 to 2018, 70.5% of 24 to 29 weeks' gestation NICU infants received exposure to at least one tocolytic agent while this remained at 53.7% of 32 to 33 weeks' NICU admitted infants. Antenatal steroid exposure increased from 74.8 to 87.4% during the study period.
CONCLUSION
For NICU-admitted preterm infants, prenatal exposure patterns to tocolytic agents has shifted since 2009 with prenatal magnesium sulfate exposure increasing significantly. Antenatal steroid exposure has risen concurrently. Exposure to tocolytic agents is the highest among preterm infants born between 24 and 29 weeks' gestation.
KEY POINTS
· Exposure to magnesium sulfate significantly increased from 2009 to 2018 for NICU admitted infants.. · Concurrently, the use of other tocolytics decreased significantly.. · The use of antenatal steroids has been rising over time..
Topics: Humans; Infant, Newborn; Infant; Female; Pregnancy; Tocolytic Agents; Intensive Care Units, Neonatal; Magnesium Sulfate; Infant, Premature; Tocolysis
PubMed: 35045576
DOI: 10.1055/a-1745-3262 -
Acta Oto-laryngologica 2023The pain that occurs after septorhinoplasty is an important factor affecting the comfort of the patient. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The pain that occurs after septorhinoplasty is an important factor affecting the comfort of the patient.
OBJECTIVES
To investigate the effect of perioperative intravenous magnesium sulfate infusion on postoperative pain and quality of recovery in patients underwent septorhinoplasty surgery.
MATERIAL AND METHODS
One hundred twenty patients who underwent septorhinoplasty were randomly divided into two groups. Magnesium group received intravenous magnesium after induction of anesthesia (30 mg/kg), then infused until the end of the surgical procedure (9 mg/kg). The placebo group received the same volume of saline infusion. The VAS score was used for postoperative pain assessment, and the Quality of Recovery-40 (QoR-40) score was used for the assessment of recovery status.
RESULTS
The postoperative 30 min, 1st, 2nd, 4th ( < .001) and 24th hour ( < .05) VAS scores of the patients in the magnesium infusion group were significantly lower compared to the placebo group. Also; in terms of physical comfort ( < .001), emotional state ( < .05), psychological support, pain and total score values ( < .001), patients in magnesium group had significantly higher QoR-40 scores than those in placebo group.
CONCLUSION
Intraoperative magnesium infusion, which is widely used in many surgeries to provide controlled hypotension, also contributes significantly to patient comfort with its positive effect on postoperative pain and recovery scores.
Topics: Humans; Magnesium Sulfate; Magnesium; Double-Blind Method; Infusions, Intravenous; Pain, Postoperative
PubMed: 38108626
DOI: 10.1080/00016489.2023.2289584 -
International Journal of Gynaecology... Jun 2024Preterm birth remains the leading cause of mortality among under-5's and is a major contributor to the reduction in quality-of-life adjusted years and reduction in human... (Review)
Review
Preterm birth remains the leading cause of mortality among under-5's and is a major contributor to the reduction in quality-of-life adjusted years and reduction in human capital. Globally, there are many interventions and care bundles that aim to reduce the impact of preterm birth once preterm labor has ensued and into the neonatal period; not all of these are applicable in all settings. Here, we introduce the FIGO PremPrep-5 initiative, which aims to disseminate key information on the most simple and effective interventions with the aim of increasing implementation globally. Before delivery, we recommend a course of antenatal corticosteroids, and intrapartum magnesium sulfate. At delivery, we recommend delayed cord clamping. Postnatally, we recommend early feeding with breast milk and immediate kangaroo care. While there are many other interventions that may improve outcomes at the time of labor and after preterm birth, these are clinically effective and relatively inexpensive options that can be practiced in most settings and supplemented with more advanced care. We include examples of a training video and infographics that will be used for dissemination.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Breast Feeding; Delivery, Obstetric; Global Health; Infant, Premature; Kangaroo-Mother Care Method; Magnesium Sulfate; Premature Birth
PubMed: 38264849
DOI: 10.1002/ijgo.15269 -
The Journal of Maternal-fetal &... Oct 2022To survey OB-GYNs regarding their practice patterns and perspectives when it comes to using magnesium sulfate (magnesium) in the prevention of eclampsia.
OBJECTIVE
To survey OB-GYNs regarding their practice patterns and perspectives when it comes to using magnesium sulfate (magnesium) in the prevention of eclampsia.
STUDY DESIGN
We conducted a cross-sectional web-based 18-item survey given to 564 practicing OB-GYNs in the Pregnancy-Related Care Research Network. The survey used clinical scenarios to look at provider practices for preventing eclampsia in patients who have preeclampsia and relative contraindications to magnesium. Next, we assessed provider attitudes toward magnesium and inquired about their experiences with complications related to its use. The survey also contained an embedded educational component that addressed the signs and symptoms of magnesium toxicity followed by a 2-item quiz for those providers who self-identified as having never treated magnesium toxicity.
RESULTS
Nearly 30% of OB-GYNs contacted completed the survey. For patients with preeclampsia and a contraindication to magnesium such as myasthenia gravis, 44.4% of respondents would administer an alternative antiepileptic and 42.5% of them would administer no antiepileptic at all. For patients with pulmonary edema complicating preeclampsia, 32.5% would give magnesium at the usual dose, 33.1% would give magnesium at less than the usual dose, 12.3% would give an alternative antiepileptic and 22.1% would give no antiepileptic at all. For patients with laboratory evidence of renal compromise complicating preeclampsia, most respondents (89.6%) said they would give magnesium at less than the usual dose. Regarding complications of magnesium that clinicians have encountered, over one-third of respondents have administered calcium gluconate for magnesium toxicity in patients with preeclampsia. For those providers who have not treated magnesium toxicity and were prompted to receive the educational component and quiz, all knew the correct initial bolus dosing of magnesium and the majority were able to identify symptoms of toxicity. The majority (81.8%) of respondents said that continuous magnesium infusions cause an increased demand for dedicated personnel to care for the patients on them. Almost 57% of respondents endorsed the need for an alternative antiepileptic to magnesium in the prevention of eclampsia. Most write-in responses supporting this need cited a concern with magnesium's safety and side effects.
CONCLUSION
There is wide variation among OB-GYNs regarding the prevention of eclampsia and complications of magnesium are not uncommon. The survey revealed that OB-GYNs are using alternative antiepileptics in scenarios where there is concern for magnesium's safety profile. In addition, over half of those surveyed believe there is a need for validated antiepileptics other than magnesium for the prevention of eclampsia in patients with preeclampsia. These findings suggest that OB-GYNs would support further research into alternative antiepileptics in the prevention of eclampsia.
Topics: Anticonvulsants; Cross-Sectional Studies; Eclampsia; Female; Humans; Magnesium; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Surveys and Questionnaires
PubMed: 33135513
DOI: 10.1080/14767058.2020.1843017 -
Brazilian Journal of Anesthesiology... 2023Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption.
OBJECTIVE
We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries.
METHODS
Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5.ßmg.kg bolus then 0.12.ßmg.kg.h infusion for the first 24.ßhours postoperatively. Group KM: received ketamine 0.5.ßmg.kg and Mg sulfate 50.ßmg.kg, then ketamine 0.12.ßmg.kg.h and Mg sulfate 8.ßmg.kg.h infusions for the first 24.ßhours postoperative. The primary outcome was the morphine consumption in the first 24.ßhours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain.
RESULTS
Group KM had less postoperative opioid consumption (14.12.ß...ß5.11.ßmg) than Group K (19.43.ß...ß6.8.ßmg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain.
CONCLUSION
Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Female; Ketamine; Analgesics, Opioid; Magnesium Sulfate; Double-Blind Method; Prospective Studies; Analgesics; Morphine; Fentanyl; Pain, Postoperative; Breast Neoplasms; Analgesia
PubMed: 34332956
DOI: 10.1016/j.bjane.2021.07.015 -
The Journal of International Medical... Jul 2021Magnesium sulfate is considered to be an effective adjuvant to rocuronium in general anaesthesia. We conducted a meta-analysis to clarify its efficacy. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Magnesium sulfate is considered to be an effective adjuvant to rocuronium in general anaesthesia. We conducted a meta-analysis to clarify its efficacy.
METHODS
We searched the PubMed, Embase, Web of Science, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) of magnesium sulfate as an adjuvant to rocuronium from the start of the database establishment until May 2020.
RESULTS
Eleven RCTs were analysed. The pooled meta-analysis showed that using magnesium sulfate as an adjuvant significantly shortened the onset time and prolonged the clinical duration of neuromuscular blockade by rocuronium compared with the control group without magnesium sulfate. However, there was no significant difference in recovery index of neuromuscular block between the magnesium and control groups. Furthermore, magnesium sulfate significantly increased the rates of excellent and clinically acceptable intubation conditions.
CONCLUSION
Adding magnesium sulfate to rocuronium during general anaesthesia can alter the neuromuscular parameters, including shortening the anaesthesia-onset time and prolonging the clinical duration, without significantly increasing the recovery time. Pretreatment with magnesium sulfate may also improve intubation conditions during general anaesthesia.
Topics: Androstanols; Anesthesia, General; China; Humans; Magnesium Sulfate; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Rocuronium
PubMed: 34311594
DOI: 10.1177/03000605211027736 -
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