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Journal of Clinical Anesthesia Jun 2022Emergence agitation (EA) is a common complication in pediatric patients after general anesthesia. The effectiveness of magnesium sulfate in decreasing the incidence of... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
Emergence agitation (EA) is a common complication in pediatric patients after general anesthesia. The effectiveness of magnesium sulfate in decreasing the incidence of EA in children remains controversial. Therefore, a systematic review and meta-analysis was performed to assess the efficacy of magnesium sulfate in preventing EA in pediatric patients following general anesthesia.
DESIGN
Systematic review and meta-analysis.
SETTING
PubMed, Embase, Web of Science, and Cochrane Library were searched to identify eligible randomized controlled trials from their respective database inception dates to June 30, 2021.
PATIENTS
Pediatric patients (< 18 years old) undergoing general anesthesia.
INTERVENTIONS
Intravenous administration of magnesium sulfate.
MEASUREMENTS
The primary outcome of the meta-analysis was EA incidence. The risk of bias of the included studies was evaluated using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Grading of Recommendations, Assessment, Development, and Evaluation was applied to assess the level of certainty.
MAIN RESULTS
Eight studies with 635 participants were identified. The forest plot revealed no significant difference in the incidence of EA between patients treated with magnesium sulfate and the control group (risk ratio = 0.69, 95% confidence interval [0.44, 1.07]; P = 0.10, I = 74%, moderate level of certainty). Additionally, magnesium sulfate did not reduce postoperative pediatric anesthesia emergence delirium scores but prolonged the emergence time. No significant differences were observed in postoperative complications (nausea, vomiting, laryngospasm, breath-holding, coughing, oxygen desaturation, and cardiac arrhythmias).
CONCLUSIONS
Administration of magnesium sulfate during general anesthesia did not affect the occurrence of EA in pediatric patients. However, magnesium sulfate can prolong the emergence time without adverse effects. PROSPERO registration number: CRD42021252924.
Topics: Adolescent; Anesthesia, General; Child; Emergence Delirium; Humans; Magnesium Sulfate; Nausea; Vomiting
PubMed: 35151145
DOI: 10.1016/j.jclinane.2022.110669 -
Patient Safety in Surgery Aug 2022Maintenance of adequate peripheral perfusion during controlled hypotension is necessary for patient safety and improved surgical outcomes during controlled hypotension...
BACKGROUND
Maintenance of adequate peripheral perfusion during controlled hypotension is necessary for patient safety and improved surgical outcomes during controlled hypotension in nasal surgery. The hypothesis of this study was to investigate the effect of perioperative magnesium sulfate and labetalol infusion on peripheral perfusion and postoperative pain in patients undergoing nasal surgery.
METHODS
A total of 50 patients were randomly assigned into two equal groups in this double-blind clinical study: the magnesium sulfate group; received 40 mg/kg loading dose of intravenous (IV) magnesium sulfate followed by 10-15 mg/kg/h continuous IV infusion and the labetalol group; received 0.25 mg/kg loading dose of IV labetalol followed by 0.5-1 mg/kg/h continuous IV infusion to achieve a mean arterial blood pressure (MABP) of = 55-65 mmHg. The primary outcome was to compare the effect of perioperative magnesium sulfate and labetalol infusion on peripheral perfusion during nasal surgery. The secondary outcomes were the assessment of serum lactate, postoperative pain, time to the first call for pethidine (rescue analgesic) and total pethidine consumption.
RESULTS
PPI was comparable between the groups at baseline, intubation, and 5 min. In contrast, magnesium sulfate group had a significantly higher PPI than the labetalol group. The magnesium sulfate group had a significantly higher MABP and heart rate compared to labetalol group. The time to reach the target MABP was significantly prolonged in magnesium sulfate than the labetalol group [21.6 ± 1.7 vs 6.9 ± 1.5] min. VAS scores were significantly lower for 2 hs postoperatively in the magnesium sulfate group than the labetalol group. The time to first call of pethidine was significantly prolonged in the magnesium sulfate group compared to the labetalol group [113.1 ± 5.2 vs 28.2 ± 1.5] min.
CONCLUSIONS
Magnesium sulfate maintains wider PPI and offers better postoperative pain relief compared to labetalol during induced hypotension in nasal surgery.
TRIAL REGISTRATION
Institutional review board approval (ref: 6601/20-12-2020).
CLINICALTRIAL
gov (ref: NCT04688203 , date of registration: 29 -12-2020).
PubMed: 35986325
DOI: 10.1186/s13037-022-00336-7 -
AJOG Global Reports Nov 2021Current intramuscular magnesium dosing regimens in low and middle-income countries are based on indirect absorption parameters to inform pharmacokinetic and...
BACKGROUND
Current intramuscular magnesium dosing regimens in low and middle-income countries are based on indirect absorption parameters to inform pharmacokinetic and pharmacodynamic response.
OBJECTIVE
To determine if therapeutic serum magnesium levels are obtained in women with severe preeclampsia receiving intramuscular administration of magnesium sulfate using the Pritchard regimen and to compare the key pharmacokinetic variables to those previously published.
STUDY DESIGN
Serum magnesium levels were obtained at multiple time points at baseline and after magnesium sulfate administration from women with severe preeclampsia receiving the standard Pritchard regimen for seizure prophylaxis at Bayero University, Kano, Nigeria. The pharmacokinetic profiles were constructed for the study cohort and the updated pharmacokinetic model was compared with the one that was previously published.
RESULTS
A total of 80 blood samples were collected from 20 women with severe preeclampsia (45 collected before childbirth and 35 collected after childbirth). After 11.5 hours of magnesium sulfate administration, 63% of women in the cohort had serum magnesium levels of ≥2.0 mmol/L. Data from women receiving the Pritchard regimen combined with data from women previously modeled after the receipt of intravenous magnesium sulfate were adequately described using a 2-compartment model with first-order absorption and linear elimination from the central compartment. All structural pharmacokinetic parameters including clearance, central volume of distribution, peripheral volume of distribution, and intercompartment clearance were adjusted for maternal weight, and the clearance was further adjusted for serum creatinine level and antepartum or postpartum status. The simulated pharmacokinetic profiles of the updated pharmacokinetic model and the previously published pharmacokinetic model are similar. In previously published pharmacokinetic modeling, absorption rate constant=0.32 and absolute bioavailability=0.86. In the updated pharmacokinetic model, absorption rate constant=0.45 and absolute bioavailability=0.91.
CONCLUSION
These data support the use of the Pritchard regimen as acceptable to achieve therapeutic serum magnesium levels and support the reported simulation of serum magnesium levels and eclampsia response associated with different intramuscular regimens.
PubMed: 36277458
DOI: 10.1016/j.xagr.2021.100018 -
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 -
RSC Advances Mar 2022In this research, the core objective is to explore the effect of super-absorbent polymer material (poly(sodium acrylate)) on the heat storage performance of magnesium...
In this research, the core objective is to explore the effect of super-absorbent polymer material (poly(sodium acrylate)) on the heat storage performance of magnesium sulfate and to investigate the heat transfer behavior of 13X-zeolite, nano-aluminum oxide (nano-AlO) and poly(sodium acrylate) modified magnesium sulfate in a reactor. Finally it provides support for future material and reactor design. All characterizations and performance tests were done in the laboratory and a numerical simulation method was used to investigate the heat transfer behavior of the reactor. Through hydrothermal treatment, bulk MgSO·6HO was changed into nanoparticles (200-500 nm) when composited with poly(sodium acrylate), 13X-zeolite and nano-AlO. Among these materials, MgSO·6HO shows the highest activation energy (36.8 kJ mol) and the lowest energy density (325 kJ kg). The activation energy and heat storage energy density of nano-AlO modified composite material MA-1 are 28.5 kJ mol and 1305 kJ kg, respectively. Poly(sodium acrylate) modified composite material, MPSA-3, shows good heat storage energy density (1100 kJ kg) and the lowest activation energy (22.3 kJ mol) due its high water-absorbing rate and dispersing effect. 13X-zeolite modified composite material MZ-2 shows lower activation energy (32.4 kJ mol) and the highest heat storage density (1411 kJ kg), which is 4.3 times higher than that of pure magnesium sulfate hexahydrate. According to the heat transfer numerical simulation, hygroscopic additives could prominently change the temperature distribution in the reactor and efficiently release heat to the thermal load side. The experimental and numerical simulation temperatures are similar. This indicates that the result of the numerical simulation is very close to the actual heat transfer behavior. This reactor could output heat at around 50 °C and absorb heat in the range of 100-200 °C. All these results further prove the strategy that thermochemical nanomaterial synthesis technology combined with material-reactor heat transfer numerical simulation is feasible for future material and reactor design.
PubMed: 35424807
DOI: 10.1039/d2ra00344a -
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 -
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 -
Materials (Basel, Switzerland) Nov 2022Herein, novel monodisperse basic magnesium sulfate whiskers (5Mg(OH)·MgSO·7HO) were prepared under low-temperature and atmospheric-pressure conditions, using the...
Herein, novel monodisperse basic magnesium sulfate whiskers (5Mg(OH)·MgSO·7HO) were prepared under low-temperature and atmospheric-pressure conditions, using the admixture sodium citrate. X-ray diffraction, Raman spectroscopy, scanning electron microscopy, energy-dispersive spectroscopy, transmission electron microscopy, selected area electron diffraction, thermogravimetric analysis, Fourier-transform infrared spectroscopy, and X-ray photoelectron spectroscopy were used to characterize the structure and morphology of the whisker products. The analysis results showed that the product was composed of high-purity basic magnesium sulfate whiskers. The lengths and diameters of the whiskers were 10-20 μm and 0.1-0.2 μm, respectively, and their aspect ratios were higher than 30. The formation mechanism of 5Mg(OH)·MgSO·7HO involved direct assembly from the precursors without the formation of magnesium hydroxide for redissolution. High-purity MgO whiskers with smooth surfaces were prepared using the as-prepared whisker products via thermal decomposition. Thus, the findings of this study can provide technical support for the cost-effective industrial-scale preparation of basic magnesium-sulfate whiskers and associated whisker products.
PubMed: 36431506
DOI: 10.3390/ma15228018 -
BMC Pregnancy and Childbirth Jun 2024To establish the population pharmacokinetics (PPK) of magnesium sulfate (MgSO)in women with preeclampsia (PE), and to determine the key covariates having an effect in...
OBJECTIVE
To establish the population pharmacokinetics (PPK) of magnesium sulfate (MgSO)in women with preeclampsia (PE), and to determine the key covariates having an effect in magnesium pharmacokinetics in Chinese PE.
METHODS
Pregnant women with PE prescribed MgSO4 were enrolled in this prospective study from April 2021 to April 2023. On the initial day of administration, the patients were administered a loading dose of 5 g in conjunction with 10 g of magnesium sulfate as a maintenance dose. On the second day, only the maintenance dose was administration, and maternal blood samples were taken at 0, 4, 5, and 12 h after the second day's 10 g maintenance dose. The software Phoenix was used to estimate PPK parameters of MgSO4, such as clearance (CL) and volume of distribution (V), and to model PPK models with patient demographic, clinical, and laboratory covariates.
RESULTS
A total of 199 blood samples were collected from 51 women with PE and PPK profiles were analyzed. The PPK of MgSO is consistent with to a one-compartment model. The base model adequately described the maternal serum magnesium concentrations after magnesium administration. The population parameter estimates were as follows: CL was 2.98 L/h, V was 25.07 L. The model predictions changed significantly with covariates (BMI, creatinine clearance, and furosemide). Furosemide statistically influences V. The creatinine clearance, BMI and furosemide jointly affects CL. Monte Carlo simulation results showed that a loading dose combined with a maintenance dose would need to be administered daily to achieve the therapeutic blood magnesium concentrations. For the non-furosemide group, the optimal dosing regimen was a 5 g loading dose combined with a 10 g maintenance dose of MgSO4. For the furosemide group, the optimal dosing regimen was a 2.5 g loading dose combined with a 10 g maintenance dose of MgSO4.
CONCLUSIONS
The magnesium PPK model was successfully developed and evaluated in Chinese preeclampsia population, and the dose optimization of MgSO was completed through Monte Carlo simulation.
Topics: Humans; Female; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Adult; Prospective Studies; China; Young Adult; Dose-Response Relationship, Drug; East Asian People
PubMed: 38872116
DOI: 10.1186/s12884-024-06620-x -
Plants (Basel, Switzerland) Dec 2022Soil salinity is major threat to crop growth and reducing cultivated land areas and salt-resistant crops have been required to sustain agriculture in salinized areas....
Soil salinity is major threat to crop growth and reducing cultivated land areas and salt-resistant crops have been required to sustain agriculture in salinized areas. This original research was performed to determine the effectiveness of MgSO (MS) and CaSO (CS) for each species and assess changes in the physiology and growth of fodder crops after short and long-term salt stress. Six treatments (CON (control); NaCl (NaCl 100 mM); 1 MS (1 mM MgSO + 100 mM NaCl); 2 MS (2 mM MgSO + 100 mM NaCl); 7.5 CS (7.5 mM CaSO + 100 mM NaCl); and 10 CS (10 mM CaSO + 100 mM NaCl)) were applied to Red clover () and Tall fescue () under greenhouse conditions. Cultivars were evaluated based on their dry weights, physiological parameters, forage quality, and ion concentrations. The biomass of both species decreased significantly under NaCl treatments and increased under the MS and CS treatments compared to solely salinity treatments. Salinity caused a decrease in the photosynthetic rate, but compared to CON, the MS and CS treatments yielded superior results. Moreover, the Na/K ratio increased as Na concentration increased but crop quality (CP, NDF, ADF) did not show significant differences under salinity. Overall, we concluded that these and species demonstrated various responses to salinity, MS, and CS by different physiological and morphological parameters and it turned out to be efficient under salinity stress.
PubMed: 36559688
DOI: 10.3390/plants11243576