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Anesthesiology and Pain Medicine Feb 2021The International Association for the Study of Pain (IASP) defines chronic pain as pain that persists or recurs for longer than 3 months. Chronic pain has a significant... (Review)
Review
CONTEXT
The International Association for the Study of Pain (IASP) defines chronic pain as pain that persists or recurs for longer than 3 months. Chronic pain has a significant global disease burden with profound effects on health, quality of life, and socioeconomic costs.
EVIDENCE ACQUISITION
Narrative review.
RESULTS
There are several treatment options, including pharmacological therapy, physical rehabilitation, psychological therapies, and surgical interventions, for chronic pain management. Magnesium has been FDA-approved for several indications including hypomagnesemia, arrhythmia, prevention of seizures in eclampsia/preeclampsia, and constipation. Magnesium has been used for numerous off-label uses, notably for acute and chronic pain management. The mechanism of magnesium in pain management is primarily through its action as a voltage-gated antagonist of NMDA receptors, which are involved in pain transduction.
CONCLUSIONS
This narrative review will focus on the current evidence and data surrounding the utilization of magnesium as a treatment option for chronic pain.
PubMed: 34221945
DOI: 10.5812/aapm.112348 -
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 -
Cureus Aug 2021Eclampsia is a common complication of preeclampsia patients and can be life-threatening for both the mother and the fetus. Hence, timely intervention and appropriate... (Review)
Review
Eclampsia is a common complication of preeclampsia patients and can be life-threatening for both the mother and the fetus. Hence, timely intervention and appropriate management of this detrimental condition are extremely crucial. Eclampsia is described as the occurrence of generalized convulsions in patients with preeclampsia. Magnesium sulfate (MgSO) is the drug of choice for treating and preventing eclampsia. This review aims to study and analyze the available literature on the pathogenesis of eclampsia, the pharmacology of MgSO, and its effectiveness in the management of eclampsia. Other proposed treatments and their comparative study with MgSO are also discussed. Additionally, we examine the data regarding the impact of eclampsia, its public health burden, and the cost-effectiveness of MgSO. One of the major drawbacks associated with the use of MgSO in low-income countries has been the cost of treatment and the lack of resources. We have analyzed the trials that have proposed alternate treatment regimens which could shape new guidelines to resolve these issues. For this review, we extensively studied abstract and full-text articles from multiple databases. This article discusses the pathophysiology of eclampsia, the pharmacology of MgSO, the issues surrounding eclampsia management, and how MgSO benefits these patients.
PubMed: 34567870
DOI: 10.7759/cureus.17322 -
Magnesium sulfate treatment for acute severe asthma in adults-a systematic review and meta-analysis.Frontiers in Allergy 2023Add-on magnesium sulfate (MgSO4) for refractory asthma exacerbation has been much debated. The aim of this review and meta-analysis is, therefore, to provide an update... (Review)
Review
INTRODUCTION
Add-on magnesium sulfate (MgSO4) for refractory asthma exacerbation has been much debated. The aim of this review and meta-analysis is, therefore, to provide an update on the current evidence for the efficacy of MgSO4 in exacerbations of asthma in adults refractory to standard of care treatment.
METHODS
A systematic review was performed in accordance with the PRISMA guidelines. The search was performed in the PubMed database (updated April 2023). For the meta-analysis, a random-effects model was applied using the metaphor package for RStudio (RStudio, Inc.).
RESULTS
A total of 17 randomized controlled trials were included. Three of the nine studies addressing treatment with intravenous (IV) MgSO4 found a significant effect on lung function compared to placebo. Of the eight studies investigating hospital admission rate, only two found a significant effect of MgSO4. Six of the nine studies investigating treatment with nebulized MgSO4 compared to placebo found a favorable effect on forced expiratory volume in 1. second (FEV) and peak expiratory flow rate (PEF). Only two of the five studies investigating the effect on hospital admission rate found an effect of MgSO4. Comparing effect sizes in a meta-analysis revealed a greater effect on PEF in asthma patients treated with nebulized MgSO4 (MD, 23.57; 95% CI, -2.48 to 49.62, < 0.01) compared to placebo. The analysis of patients treated with i.v. MgSO4 compared to placebo showed no statistically significant difference (MD, 5.49; 95% CI, -18.67 to 29.65, = 0.10).
CONCLUSION
Up to two out of three studies revealed an effect of MgSO4 treatment for asthma exacerbation when assessed by FEV/PEF, but fewer studies were positive for the outcome of hospital admissions.
PubMed: 37577333
DOI: 10.3389/falgy.2023.1211949 -
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 -
Gels (Basel, Switzerland) Nov 2023Self-assembly of the blood protein fibrinogen is a highly relevant topic in materials science and medical research. This originates from fibrinogen's beneficial material...
Self-assembly of the blood protein fibrinogen is a highly relevant topic in materials science and medical research. This originates from fibrinogen's beneficial material properties such as cell interaction and biocompatibility. Within recent decades, several enzyme-free strategies to create fibers and hydrogels out of fibrinogen have been presented, broadening the spectrum of fibrinogen-based material enormously. Herein, we describe a further method to obtain such a material by adding specifically MgSO to fibrinogen. The key of this material is the combination of Mg and a kosmotropic anion, for example sulfate or (hydrogen)phosphate. This effect is most likely related to occupancy of fibrinogen's well-known binding sites for Mg, resulting in a significant increase in fiber yield and gel stability. Here, we shine light on the question of how electrostatic interactions via Mg enhance fibrillogenesis and the gelation of fibrinogen and discuss first insights into the material's properties.
PubMed: 37998982
DOI: 10.3390/gels9110892 -
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 -
Prilozi (Makedonska Akademija Na... Jul 2022: The administration of high doses of opioids during surgery can lead to higher postoperative pain scores at rest and when coughing. Multimodal analgesia may lower the... (Randomized Controlled Trial)
Randomized Controlled Trial
: The administration of high doses of opioids during surgery can lead to higher postoperative pain scores at rest and when coughing. Multimodal analgesia may lower the need for opioids during surgery and the suffering of postoperative pain. Multimodal analgesia can be achieved by providing non-opioid drugs (lidocaine, ketamine, and magnesium sulfate), three different types of drugs. Each of these drugs as different analgesic effects and they belong to three different pharmacological groups. The aim of this study is to develop a better understanding of the effects of each drug (lidocaine, ketamine, and magnesium sulfate) on postoperative analgesia, the needs for rescue analgesics, and analyze the total amount of fentanyl during the intraoperative period in patients undergoing laparoscopic cholecystectomy. : 120 patients were enrolled in this randomized controlled study. They were classified as ASA 1 and 2 and were scheduled for laparoscopic cholecystectomy. They were further divided into 3 groups. Group 1, or the lidocaine group, had received lidocaine at 1 mg/kg and a continuous intravenous infusion with lidocaine at 2 mg/kg/h. Group 2, or the ketamine group, received ketamine at 0.5 mg/kg. Group 3, or the magnesium sulfate group, received a continuous intravenous infusion of magnesium sulfate at 1.5 gr/kg. The intensity of postoperative pain was assessed using a VAS score at rest and when coughing, with evaluation at 1, 4, 8, 12, and 24 hours, postoperatively. Also, the needs for rescue analgesics and the total amount of fentanyl during the intraoperative period in all groups was also followed. : The patients from the lidocaine group had the highest scores of pain in the postoperative period at rest and when coughing, and the ketamine group had the lowest pain scores. Rescue analgesia was given the most to lidocaine group, and less so in the magnesium group. The magnesium group received the highest dose of fentanyl during surgery and the lowest dose was received by patients from the lidocaine group. : Multimodal analgesia can lower the need for opioids in the intra- and postoperative period after laparoscopic cholecystectomy.
Topics: Analgesia; Analgesics; Analgesics, Opioid; Cholecystectomy, Laparoscopic; Double-Blind Method; Fentanyl; Humans; Ketamine; Lidocaine; Magnesium; Magnesium Sulfate; Pain Measurement; Pain, Postoperative
PubMed: 35843915
DOI: 10.2478/prilozi-2022-0017 -
Nutrients May 2022Little information exists about the plasma target nutritional needs of the >15 million premature infants <37 weeks gestation. Investigating ascorbic acid’s (AscA) role... (Observational Study)
Observational Study
Little information exists about the plasma target nutritional needs of the >15 million premature infants <37 weeks gestation. Investigating ascorbic acid’s (AscA) role in infant health, our study details the relationship of infant characteristics and maternal health on infant plasma AscA level (pAscA) during postnatal development. Furthermore, we determined pAscA influence during the first week of life (EpAscA) with later infant morbidities. We hypothesize that pAscA is influenced by gestational organ immaturity, as well as maternal factors, with EpAscA associated with greater morbidity risk. We conducted a prospective longitudinal observational study of pAscA, demographics and hospital course detailed in infants ≤34 weeks. Sixty-three subjects were included, with >200 urine and plasma data points analyzed. Maternal smoking, exposure to magnesium sulfate (MgSO4) and advancing gestational and postnatal age were associated with lower pAscA. Non-white infants and those ≤30 weeks that developed bronchopulmonary dysplasia or retinopathy of prematurity had lower pAscA. Prenatal smoking, MgSO4, birth gestational age and race negatively influence pAscA. These results show prenatal and postnatal developmental factors influencing initial pAscA and metabolism, potentially setting the stage for organ health and risk for disease. Assessment of dietary targets may need adjustment in this population.
Topics: Ascorbic Acid; Female; Gestational Age; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Magnesium Sulfate; Pregnancy; Prospective Studies
PubMed: 35683989
DOI: 10.3390/nu14112189 -
BMC Anesthesiology Dec 2023Laparoscopic radical resection of gastrointestinal cancer is associated with a high incidence of postoperative catheter-related bladder discomfort (CRBD). Studies on the... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of magnesium sulfate perioperative infusion on postoperative catheter-related bladder discomfort in male patients undergoing laparoscopic radical resection of gastrointestinal cancer: a prospective, randomized and controlled study.
BACKGROUND
Laparoscopic radical resection of gastrointestinal cancer is associated with a high incidence of postoperative catheter-related bladder discomfort (CRBD). Studies on the benefits of magnesium sulfate intravenous infusion during the perioperative period post-laparoscopic surgery are yet lacking.
METHODS
A total of 88 gastrointestinal cancer male patients scheduled for laparoscopic radical resection were randomly divided into two groups: normal saline (control) and magnesium. In the magnesium group, a 40 mg/kg loading dose of intravenous magnesium sulfate was administered for 10 min just after the induction of anesthesia, followed by continuous intravenous infusion of 15 mg/kg/h magnesium sulfate until the end of the surgery; the control group was administered the same dose of normal saline. Subsequently, 2 μg/kg sufentanil was continuously infused intravenously by a postoperative patient-controlled intravenous analgesia (PCIA) device. The primary outcome was the incidence of CRBD at 0 h after the surgery. The secondary outcomes included incidence of CRBD at 1, 2, and 6 h postsurgery, the severity of CRBD at 0, 1, 2, and 6 h postsurgery. Remifentanil requirement during surgery, sufentanil requirement within 24 h postsurgery, the postoperative numerical rating scale (NRS) score at 48 h after the surgery, magnesium-related side effects and rescue medication (morphine) requirement were also assessed.
RESULTS
The incidence of CRBD at 0, 1, 2, and 6 h postoperatively was lower in the magnesium group than the control group (0 h: P = 0.01; 1 h: P = 0.003; 2 h: P = 0.001; 6 h: P = 0.006). The incidence of moderate to severe CRBD was higher in the control group at postoperative 0 and 1 h (0 h: P = 0.002; 1 h: P = 0.028), remifentanil requirement during surgery were significantly lower in the magnesium group than the control group. Sufentanil requirements during the 24 h postoperative period were significantly lower in the magnesium group than the control group. The NRS score was reduced in the magnesium group compared to the control group in the early postoperative period. Magnesium-related side effects and rescue medication (morphine) did not differ significantly between the two groups.
CONCLUSIONS
Intravenous magnesium sulfate administration reduces the incidence and severity of CRBD and remifentanil requirement in male patients undergoing radical resection of gastrointestinal cancer. Also, no significant side effects were observed.
TRIAL REGISTRATION
Chictr.org.cn ChiCTR2100053073. The study was registered on 10/11/2021.
Topics: Humans; Male; Magnesium Sulfate; Urinary Bladder; Sufentanil; Magnesium; Remifentanil; Prospective Studies; Saline Solution; Pain, Postoperative; Urinary Catheters; Postoperative Period; Double-Blind Method; Laparoscopy; Morphine Derivatives; Neoplasms
PubMed: 38042781
DOI: 10.1186/s12871-023-02346-z