-
Anesthesiology Research and Practice 2022Magnesium sulfate has analgesic properties during the postoperative period. However, there is a knowledge gap in pharmacology related to the use of the real, ideal, or...
BACKGROUND
Magnesium sulfate has analgesic properties during the postoperative period. However, there is a knowledge gap in pharmacology related to the use of the real, ideal, or corrected ideal body weight to calculate its dose in obese patients. This trial compared postoperative analgesia using actual and corrected ideal body weight.
METHODS
Seventy-five obese patients scheduled to undergo laparoscopic gastroplasty or cholecystectomy under general anesthesia were randomly assigned to three groups. The patients in the control group did not receive magnesium sulfate; the other two groups received magnesium sulfate at 40 mg·kg of actual body weight or corrected ideal body weight.
RESULTS
In patients with body mass index >30 mg·kg (mean body mass index ranging from 32.964 kg·m to 33.985 kg·m, according to the groups) scheduled for video laparoscopic cholecystectomy, there were no differences in the blood magnesium concentrations in the groups receiving magnesium sulfate throughout the study, regardless of whether the strategy to calculate its dose was based on total or corrected ideal body weight. Patients in the groups receiving magnesium sulfate showed a significant reduction in morphine consumption ( ≤ 0.001) and pain scores (=0.006) in the postoperative period compared to those in the control group. There were no significant differences in morphine consumption (=0.323) or pain scores (=0.082) between the two groups receiving magnesium sulfate. There were no differences in the total duration of neuromuscular block induced by cisatracurium among the three groups (=0.181).
CONCLUSIONS
Magnesium sulfate decreased postoperative pain and morphine consumption without affecting the recovery time of cisatracurium in obese patients undergoing laparoscopic cholecystectomy. Strategies to calculate the dose based on the actual or corrected ideal body weight had similar outcomes related to analgesia and the resulting blood magnesium concentration. However, as the sample in this trial presented body mass indices ranging from 30.11 kg·m to 47.11 kg/m, further studies are needed to confirm these findings in more obese patients, easily found in centers specialized.
PubMed: 36398042
DOI: 10.1155/2022/8424670 -
PloS One 2021Intravenous magnesium sulfate (MgSO4) is used in equine practice to treat hypomagnesemia, dysrhythmias, neurological disorders, and calcium dysregulation. MgSO4 is also...
Intravenous magnesium sulfate (MgSO4) is used in equine practice to treat hypomagnesemia, dysrhythmias, neurological disorders, and calcium dysregulation. MgSO4 is also used as a calming agent in equestrian events. Hypercalcemia affects calcium-regulating hormones, as well as plasma and urinary electrolytes; however, the effect of hypermagnesemia on these variables is unknown. The goal of this study was to investigate the effect of hypermagnesemia on blood parathyroid hormone (PTH), calcitonin (CT), ionized calcium (Ca2+), ionized magnesium (Mg2+), sodium (Na+), potassium (K+), chloride (Cl-) and their urinary fractional excretion (F) after intravenous administration of MgSO4 in healthy horses. Twelve healthy female horses of 4-18 years of age and 432-600 kg of body weight received a single intravenous dose of MgSO4 (60 mg/kg) over 5 minutes, and blood and urine samples were collected at different time points over 360 minutes. Plasma Mg2+ concentrations increased 3.7-fold over baseline values at 5 minutes and remained elevated for 120 minutes (P < 0.05), Ca2+ concentrations decreased from 30-60 minutes (P < 0.05), but Na+, K+ and Cl- concentrations did not change. Serum PTH concentrations dropped initially to rebound and remain elevated from 30 to 60 minutes, while CT concentrations increased at 5 minutes to return to baseline by 10 minutes (P < 0.05). The FMg, FCa, FNa, FK, and FCl increased, while urine osmolality decreased from 30-60 minutes compared baseline (P < 0.05). Short-term experimental hypermagnesemia alters calcium-regulating hormones (PTH, CT), reduces plasma Ca2+ concentrations, and increases the urinary excretion of Mg2+, Ca2+, K+, Na+ and Cl- in healthy horses. This information has clinical implications for the short-term effects of hypermagnesemia on calcium-regulation, electrolytes, and neuromuscular activity, in particular with increasing use of Mg salts to treat horses with various acute and chronic conditions as well as a calming agent in equestrian events.
Topics: Administration, Intravenous; Animals; Calcitonin; Calcium; Calcium-Regulating Hormones and Agents; Chlorides; Electrolytes; Female; Horse Diseases; Horses; Magnesium; Magnesium Sulfate; Parathyroid Hormone; Potassium; Sodium
PubMed: 34181644
DOI: 10.1371/journal.pone.0247542 -
Brazilian Journal of Anesthesiology... 2023This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control. (Review)
Review
BACKGROUND
This study evaluated the efficacy of epidurally administered magnesium associated with local anesthetics on postoperative pain control.
METHODS
The study protocol was registered in PROSPERO as CRD42021231910. Literature searches were conducted on Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing epidural administration of magnesium added to local anesthetics for postoperative pain in elective surgical adult patients. Primary outcomes were the time to the first Postoperative (PO) Analgesic Request (TFAR), 24-hour postoperative opioid consumption, and Visual Analog Scale (VAS) scores at the first six and 24 postoperative hours. Secondary outcomes included Postoperative Nausea and Vomiting (PONV), pruritus, and shivering. Quality of evidence was assessed using GRADE criteria.
RESULTS
Seventeen studies comparing epidural were included. Effect estimates are described as weighted Mean Differences (MD) and 95% Confidence Intervals (95% CI) for the main outcomes: TFAR (MD = 72.4 min; 95% CI = 10.22-134.58 min; p < 0.001; I = 99.8%; GRADE: very low); opioid consumption (MD = -7.2 mg (95% CI = -9.30 - -5.09; p < 0.001; I = 98%; GRADE: very low). VAS pain scores within the first six PO hours (VAS) (MD = -1.01 cm; 95% CI = -1.40-0.64 cm; p < 0.001; I = 88%; GRADE: very low), at 24 hours (MD = -0.56 cm; 95% CI = -1.14-0.01 cm; p = 0.05; I = 97%; GRADE: very low).
CONCLUSIONS
Magnesium sulfate delayed TFAR and decreased 24-hour opioid consumption and early postoperative pain intensity. However, imprecision and inconsistency pervaded meta-analyses, causing very low certainty of effect estimates.
Topics: Humans; Anesthetics, Local; Magnesium Sulfate; Analgesics, Opioid; Magnesium; Pain, Postoperative
PubMed: 36087812
DOI: 10.1016/j.bjane.2022.08.005 -
Journal of Clinical Medicine Sep 2022Several studies have suggested the potential role of Magnesium Sulfate (MgSO) for the treatment of Atrial Fibrillation (AF) but, in clinical practice, the use of...
Several studies have suggested the potential role of Magnesium Sulfate (MgSO) for the treatment of Atrial Fibrillation (AF) but, in clinical practice, the use of magnesium is not standardized although it is largely used for the treatment of supraventricular arrhythmias. Objectives. We evaluated the role of MgSO infusion in association with flecainide in cardioversion of patients presenting in ED with symptomatic AF started less than 48 h before. We retrospectively searched for all patients presented in ED from 1 January 2019 to 31 December 2019 requiring pharmacological cardioversion with flecainide 2 mg/kg. Ninety-seven patients met these criteria, 46 received the administration of intravenous MgSO 2 gr (Group A), and 51 did not (Group B). Among the 97 patients, the overall cardioversion rate was 85.6%, 91.3% in Group A and 80.4% in Group B. In 27 patients out of 97, the Flecainide was not administered because of spontaneous restoration of sinus rhythm of 9 pts (Group B) and 18 pts (Group A). We also found a statistical significance in the HR at the time of cardioversion between Group A (77.8 ± 19.1 bpm) and Group B (87 ± 21.7 bpm). No complications emerged. The association between MgSO and Flecainide has not yielded statistically significant results. However, in consideration of its high safety profile, MgSO administration may play a role in ED cardioversion of acute onset AF, reducing the need for antiarrhythmic medications and electrical cardioversion procedures, relieving symptoms reducing heart rate, and reducing the length of stay in the ED.
PubMed: 36233391
DOI: 10.3390/jcm11195527 -
Prilozi (Makedonska Akademija Na... Jul 2022: Multimodal anesthesia represents a technique that can improve analgesia and lower the occurrence of opioid side effects in the postoperative period, such as... (Randomized Controlled Trial)
Randomized Controlled Trial
: Multimodal anesthesia represents a technique that can improve analgesia and lower the occurrence of opioid side effects in the postoperative period, such as postoperative nausea and vomiting (PONV). It can be achieved by providing different types of medication during the intraoperative period which can decrease the need for opioids. PONV happens more often in patients who have received large amounts of opioids during laparoscopic cholecystectomy. In this study, our aim was to observe the occurrence of PONV between three different groups of patients who received lidocaine, ketamine and magnesium sulfate in combination with fentanyl in the intraoperative period. We also observed any additional nausea and vomiting in the three groups as well as the amount of fentanyl given to these groups during operation. : 120 patients aged 20-65 years old were included in this randomized and prospective study, ASA classification 1 and 2, scheduled for laparoscopic cholecystectomy. Patients were classified into three groups randomly: Group 1 (lidocaine group-LG), these patients received lidocaine at 1 mg/kg during induction to general anesthesia and 2 mg/kg/h after intubation in continuous intravenous infusion; Group 2 (ketamine group-KG) these patients received ketamine at 0.5 mg/kg during induction to general anesthesia; and Group 3 (magnesium group-MG) these patients received magnesium sulfate at 1.5 gr/hr as a continuous intravenous infusion after intubation. In all three groups, patients additionally received bolus doses of fentanyl. Postoperative nausea and vomiting were monitored in all three groups at 1, 4, 8, 12, and 24 hours after surgery as a primary objective, and if patients had complainant of vomiting, they were treated with 10 mg of metoclopramid. Between the five control time points, additional nausea and vomiting was recorded as well, as a secondary objective. The third objective was to measure of the total amount of fentanyl given in the intraoperative period. : Patients from the lidocaine group experienced less PONV and they received less fentanyl compared to patients of ketamine and magnesium groups. Patients from the ketamine group had more nausea than other groups. In the magnesium group, the rate of vomiting was higher, and they received higher amounts of fentanyl during surgery. Additional nausea and vomiting occurred in 3 patients in the LG, 2 in the KG, and 3 in the MG between the five control time points. The patients from the magnesium group received the highest dose of fentanyl during surgery (307.50 ± 130.4), followed by the patients from the ketamine group (292.50 ± 60.5), and then patients from the lidocaine group (258.75 ± 60.9). The doses of fentanyl that patients received during surgery in all three groups were not statistically significant. : Multimodal anesthesia has been shown to lower PONV 24 hours after laparoscopic cholecystectomy and can lower need for opioids during laparoscopic cholecystectomy.
Topics: Adult; Aged; Analgesics, Opioid; Anesthesia; Cholecystectomy, Laparoscopic; Double-Blind Method; Fentanyl; Humans; Ketamine; Lidocaine; Magnesium; Magnesium Sulfate; Middle Aged; Pain, Postoperative; Postoperative Nausea and Vomiting; Prospective Studies; Young Adult
PubMed: 35843914
DOI: 10.2478/prilozi-2022-0018 -
Journal of Obstetrics and Gynaecology... Aug 2022Survival of preterm infants has improved drastically. In addition to significant contribution to neonatal mortality, impact of prematurity among survivors may continue...
BACKGROUND
Survival of preterm infants has improved drastically. In addition to significant contribution to neonatal mortality, impact of prematurity among survivors may continue through life impairing long-term physical life through neuro-disability and increased risk of cerebral palsy. Maternal administration of magnesium sulfate prior to impending preterm birth is an effective strategy to reduce neuromorbidity.
AIM
To investigate the effectiveness of antenatal magnesium sulfate for neuroprotection in preterm infants between 26 and 34 weeks in preventing early neonatal morbidity and mortality. Secondary objective was to assess any adverse events with the use of magnesium sulfate on the mother and neonate.
METHOD
This was a prospective observational comparative study for 2 years at our tertiary care hospital of 100 pregnant women who gave preterm births. Fifty infants each were born to mothers who were either not given MgSO (Group 1) or given 4gm intravenous loading dose MgSO (Group 2), preferably 4 h prior to preterm birth.
RESULTS
Among all the preterm in our study, 81% delivered between 30 and 34 weeks. There was no significant difference in terms of maternal mortality or serious morbidity including postpartum hemorrhage, caesarian section rates or length of hospital stay among women receiving MgSO versus no MgSO. Mild maternal side effects secondary to magnesium sulfate were experienced in 8% cases. There were no significant differences between both groups for low 5 min APGAR, need for NICU admission, neonatal convulsions, hyperbilirubinemia, necrotizing enterocolitis, periventricular leukomalacia and septicemia. There was a trend toward reduced risk in the magnesium sulfate group for need for mechanical ventilation and ongoing respiratory support, intraventricular hemorrhage, neonatal hypotension, hypothermia, length of NICU stay. IVH was less frequent and less severe in babies exposed to antenatal MgSO (8%) as compared to non-MgSO group (16%). Neonatal morbidities were more when antenatal MgSO was given less than 4 h from delivery.
CONCLUSION
MgSO is a safe drug to use in antenatal women at risk for impending preterm. Antenatal magnesium sulfate given to women in established preterm labor conferred significant neuroprotective advantage to the neonate. MgSO also has protective effect on the need of invasive ventilatory support in preterm infants. Given the breadth of evidence in its favor, it is time for us to start using MgSO in clinical practice for neuroprotective intent in all our extreme preterm births.
PubMed: 34393393
DOI: 10.1007/s13224-021-01531-9 -
Journal of Anesthesia, Analgesia and... Oct 2021Breast cancer surgery is usually managed using opioid-inclusive anesthesia (OIA), although opioids are associated with several adverse events, including nausea,...
BACKGROUND
Breast cancer surgery is usually managed using opioid-inclusive anesthesia (OIA), although opioids are associated with several adverse events, including nausea, vomiting, and constipation. Multimodal opioid-free anesthesia (OFA) has been introduced to reduce the incidence of these side effects. In this single-center retrospective study, we investigated whether ketamine, combined with magnesium and clonidine, could effectively control postoperative pain in patients undergoing quadrantectomy, while reducing postoperative nausea and vomiting (PONV).
RESULTS
A total of 89 patients submitted to quadrantectomy were included and divided into an OFA group (38 patients) and an OIA group (51 patients) according to the received anesthetic technique. Analgesia in the OIA group was based on an intraoperative infusion of remifentanil, and analgesia in the OFA consisted of an intraoperative infusion of ketamine and magnesium sulfate. Postoperative pain in both groups was managed with nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol. Postoperative pain, assessed with the numeric rating scale (NRS), requirements for additional analgesics, the incidence of PONV, and patient satisfaction evaluated using a QoR-40 questionnaire were compared between the two groups. Levels of pain at 30 min and 6, 12, and 24 h after surgery; number of paracetamol rescue doses; and the incidence of PONV were lower in the OFA group (p <0.05). Patient satisfaction was comparable in the two groups.
CONCLUSIONS
A combination of ketamine, magnesium, and clonidine could be more effective than opioid-based analgesia in reducing postoperative pain and lowering PONV occurrence after quadrantectomy for breast cancer.
PubMed: 37386556
DOI: 10.1186/s44158-021-00008-5 -
Archives of Academic Emergency Medicine 2023There has been growing interest in the potential role of adjunctive magnesium sulfate in improving pain management. This systematic review and meta-analysis aimed to...
INTRODUCTION
There has been growing interest in the potential role of adjunctive magnesium sulfate in improving pain management. This systematic review and meta-analysis aimed to assess the effect of intra-operative adjunctive magnesium sulfate on pain management and opioid consumption in total knee arthroplasty (TKA).
METHODS
A comprehensive search was conducted in Medline, Embase, Scopus, Web of Science, and Cochrane Library databases, covering studies up to April 2023. The extracted data included pain management outcomes, opioid consumption, and adverse effects from the selected studies. Standardized mean differences (SMDs) were calculated for continuous outcomes, while risk ratios (RRs) were calculated for dichotomous outcomes. Meta-analysis was conducted employing random-effects models in STATA 17.
RESULTS
In this meta-analysis of 8 randomized controlled trials involving 536 patients, adjunctive magnesium sulfate in TKA was found to significantly reduce opioid consumption during the first 24 hours after operation (SMD: -1.88, 95% confidence interval (CI): [-3.66 to -0.10]; p = 0.038). It also resulted in lower pain scores at rest 24 hours after surgery (SMD: -1.53, 95% CI: [-2.70 to -0.37]; p = 0.010). There were no significant differences in time to first rescue analgesic and adverse effects between the groups. The included studies were assessed to have low to high levels of risk of bias.
CONCLUSION
This study presents evidence at low to moderate levels supporting the use of intra-operative adjunctive magnesium sulfate in TKA for improved pain management and reduced opioid consumption. However, further research is needed to address the heterogeneity and to explore optimal dosing regimens and routes of administration to maximize the benefits of magnesium sulfate in TKA.
PubMed: 37671273
DOI: 10.22037/aaem.v11i1.2058 -
European Review For Medical and... Sep 2023The effects of preemptive magnesium sulfate (MgSO4) infusion on perioperative hemodynamics and postoperative analgesia in female patients who underwent mastectomy were... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The effects of preemptive magnesium sulfate (MgSO4) infusion on perioperative hemodynamics and postoperative analgesia in female patients who underwent mastectomy were evaluated.
PATIENTS AND METHODS
American Society of Anesthesiologists (ASA) I-II female patients aged 18 years and over who underwent mastectomy were randomized into 2 groups, including 34 individuals each. The study group (Group I) was given 50 mg/kg MgSO4 in 250 ml isotonic 30 minutes before the induction, and the control group (Group II) was given 250 ml of normal isotonic solution. Standardized anesthesia was applied. Perioperative oxygen saturation, mean arterial pressure (MAP), pulse (HR), sedation scores (ss) in the recovery unit, Verbal Numeric Rating Scale (VNRS), need for rescuer fentanyl, and analgesic needs in the surgical period were evaluated.
RESULTS
Demographic variables were similar. There was no statistical difference between the two groups in terms of the MAP, HR, and oxygen saturation values measured at entry, post-intubation, 15th, 30th, 45th, 60th minutes, and after extubation. There was a statistically significant difference between the two groups in terms of VNRS scores in the recovery unit and at the 2nd, 4th, 8th, and 12th hours during the postoperative surgical period (p=0.0001, 0.001, 0.001, 0.004, 0.021, respectively). The need for rescue analgesics in the first 2 hours of recovery was found to be lower in the study group (p=0.005). The need for postoperative analgesics in the surgical period was not statistically significant (p=0.1).
CONCLUSIONS
Preemptive use of MgSO4 reduces postoperative VNRS scores without affecting hemodynamic parameters during induction and maintenance of general anesthesia.
Topics: Humans; Female; Adolescent; Adult; Mastectomy; Magnesium Sulfate; Breast Neoplasms; Pain, Postoperative; Anesthesia, General
PubMed: 37750619
DOI: 10.26355/eurrev_202309_33549 -
European Journal of Translational... Sep 2022The aim of the present study is to compare the effect of intravenous (IV)injectionof magnesium sulfate and lidocaine on the prevention of laryngospasm, and analgesic...
The aim of the present study is to compare the effect of intravenous (IV)injectionof magnesium sulfate and lidocaine on the prevention of laryngospasm, and analgesic requirement in tonsillectomy surgeries. In this double-blinded clinical trial, 62 children are randomly selected and categorized into two groups. Two minutes after intubation, group A received 15 mg/kg IV magnesium sulfate, while group B received 1 mg/kg IV 2% lidocaine. Laryngospasm frequency, nausea and vomiting, hemodynamic status (in 15 minutes after extubating), sedation score, analgesic requirement, and duration of recovery were compared between the two groups. Data were analyzed using SPSS software version 21 and with a 95% confidence interval. Both groups had no significant difference based on the age and weight means, as well as sex frequency. 10 patients (32.3%) in the lidocaine group and 3 patients in the magnesium group (9.7%) had stridor, and the difference between the two groups was statistically significant (p = 0.026). Laryngospasm only occurred in a patient of the lidocaine group. The frequency of nausea and vomiting, agitation and analgesic requirement in the lidocaine group were higher than the magnesium group (p= 0.001). However, sedation score and recovery time were higher in the magnesium group (p=0.001). No statistically significant difference was seen between the two groups in terms of hemodynamics. Magnesium sulfate and lidocaine had no difference in the incidence of laryngospasm, but magnesium sulfate was associated with a lower rate of stridor, nausea, vomiting, agitation and analgesic requirement in recovery in comparison to lidocaine.
PubMed: 36165596
DOI: 10.4081/ejtm.2022.10732