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Stroke Sep 2020Hemorrhages are a serious complication of brain surgery, and magnesium has shown hemostatic properties in hemorrhagic stroke and non-neurological surgeries. External... (Observational Study)
Observational Study
BACKGROUND AND PURPOSE
Hemorrhages are a serious complication of brain surgery, and magnesium has shown hemostatic properties in hemorrhagic stroke and non-neurological surgeries. External ventricular drain (EVD) insertion is an advantageous model of emergency neurosurgical hemorrhage risk because it is common, standardized, and the operator is blinded to the outcome during the procedure. We tested the hypothesis that low magnesium is associated with risk of hemorrhagic complications from EVD insertion.
METHODS
Patients with spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage were enrolled in a prospective, observational study. Demographic and clinical variables were prospectively recorded, including serum magnesium measurements. Catheter tract hemorrhage (CTH) was measured on postoperative head computed tomography within 48 hours of EVD insertion.
RESULTS
We observed 50 CTH among 327 EVD procedures (15.3%) distributed similarly among intracerebral hemorrhage (21/116 [18.1%]) and subarachnoid hemorrhage (29/211 [13.7%]). Magnesium was lower in patients with CTH compared with those without (median 1.8 versus 2.0 mg/dL, <0.0001). Higher magnesium was associated with lower odds of CTH (odds ratio 0.67 per 0.1 mg/dL magnesium [95% CI, 0.56-0.78], <0.0001) after adjustment for other risk factors, with similar effect in the intracerebral hemorrhage and subarachnoid hemorrhage subgroups. Preprocedural increase in magnesium (odds ratio 0.68 [0.52-0.85]) and dose of preprocedural magnesium sulfate (odds ratio 0.67 [0.40-0.97]) were associated with reduced CTH risk after adjustment for initial magnesium and other risk factors.
CONCLUSIONS
Lower magnesium at the time of EVD insertion was an independent predictor of hemorrhagic complications. Baseline risk was attenuated by preprocedural increases in magnesium, suggesting a therapeutic opportunity.
Topics: Adult; Aged; Aged, 80 and over; Catheters; Cerebral Hemorrhage; Female; Humans; Magnesium Deficiency; Magnesium Sulfate; Male; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Complications; Prospective Studies; Subarachnoid Hemorrhage; Tomography, X-Ray Computed; Ventriculostomy
PubMed: 32772685
DOI: 10.1161/STROKEAHA.120.030128 -
Cureus Dec 2021Persistent pulmonary hypertension (PPHN) of the newborn is a lung parenchymal disorder that causes a wide range of hemodynamic changes in the newborn's systemic... (Review)
Review
Persistent pulmonary hypertension (PPHN) of the newborn is a lung parenchymal disorder that causes a wide range of hemodynamic changes in the newborn's systemic circulation. Arising from a multifactorial web of etiology, PPHN is one of the most common reasons for neonatal intensive care unit hospitalization and is associated with increased morbidity and mortality. Historically, multiple treatment modalities have been explored, ranging from oxygen and surfactant therapy to newer upcoming medications like magnesium sulfate and adenosine. This review article has discussed the pathogenesis of PPHN and its relationship with the clinical implications of PPHN, such as heart failure and so on. This article has also explored the diagnostic guidelines and analyzed the existing and the upcoming modalities for treating PPHN.
PubMed: 35036210
DOI: 10.7759/cureus.20377 -
Revue Medicale de Liege May 2020In this article, we will review major therapeutic advances in neonatology over the past ten years. We will discuss the antenatal administration of magnesium sulfate, the...
In this article, we will review major therapeutic advances in neonatology over the past ten years. We will discuss the antenatal administration of magnesium sulfate, the interest of hypothermia in the context of hypoxic ischaemic encephalopathy, the benefits and modalities of placental transfusion, less invasive techniques for ventilation and administration of the surfactant, possibilities to fortify breast milk and the concept of developmental care. These therapeutic advances are sometimes based on new therapeutics, sometimes on new concepts and, sometimes, on new less invasive techniques. They have made it possible to optimize the care of premature babies but also of term newborns.
Topics: Female; Humans; Hypothermia; Hypoxia-Ischemia, Brain; Infant; Infant, Newborn; Neonatology; Pregnancy; Surface-Active Agents
PubMed: 32496690
DOI: No ID Found -
Brazilian Journal of Anesthesiology... 2021Opioids have usually been used as intraoperative analgesic components, regardless of the many adverse effects they are associated with, such as nausea, vomiting,... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION AND OBJECTIVE
Opioids have usually been used as intraoperative analgesic components, regardless of the many adverse effects they are associated with, such as nausea, vomiting, respiratory depression, and hyperalgesia. Several approaches have been investigated to reduce doses used, and magnesium sulfate has been shown to be a valuable analgesic adjunct. The main objective of the present trial was to evaluate the effectiveness of magnesium sulfate as the chief intraoperative analgesic, and the secondary objectives were to assess propofol consumption, postoperative analgesia, and intraoperative hemodynamic stability.
METHODS
In this prospective, double-blind trial, 50 patients scheduled to undergo post-bariatric abdominoplasty under general intravenous anesthesia were divided into two groups, to receive remifentanil or magnesium sulfate as intraoperative analgesic. Fentanyl 1 µg kg was the rescue analgesic.
RESULTS
Among the patients in the group receiving Magnesium Sulfate (MSG), 64% did not need supplemental analgesia and none of the patients in the Remifentanil Group (RG) required fentanyl. MSG patients showed propofol consumption 36.6% higher (guided by the Bispectral Index - BIS). MSG patients consumed significantly less ephedrine (mean ± SD) than RG patients, respectively 1.52 ± 4.38 mg and 10 ± 10.39 mg, p < 0.001. Mean values of blood concentrations of magnesium were comparable to values previously described in the literature.
CONCLUSION
Magnesium sulfate is a safe and effective option for intraoperative analgesia, when avoiding or decreasing opioid use is required.
Topics: Analgesics; Analgesics, Opioid; Anesthesia, Intravenous; Double-Blind Method; Fentanyl; Humans; Magnesium Sulfate; Pain, Postoperative; Prospective Studies
PubMed: 34537125
DOI: 10.1016/j.bjane.2021.02.008 -
Pediatric Investigation Mar 2023Infantile spasm (IS) is a kind of refractory epilepsy. The first-line treatments for IS are adrenocorticotropic hormone (ACTH), oral corticosteroids, and vigabatrin.
IMPORTANCE
Infantile spasm (IS) is a kind of refractory epilepsy. The first-line treatments for IS are adrenocorticotropic hormone (ACTH), oral corticosteroids, and vigabatrin.
OBJECTIVE
This study aimed to evaluate the efficacy of magnesium sulfate and ACTH (MgSO+ACTH) combination therapy in patients with IS who failed first-line treatments.
METHODS
In this retrospective study, the clinical data of patients with IS who failed first-line treatments were collected in the Chinese PLA General Hospital. Patients received MgSO+ACTH combination therapy after first-line treatments failed. The course of treatments was 2 weeks. The therapeutic dose of ACTH and MgSO was 2.5 U·kg·d and 0.25 g·kg·d, respectively.
RESULTS
A total of 229 patients with IS who failed the first-line treatments were collected. At the end of the MgSO+ACTH combination treatment, the seizure-free rate was 48.5% (111/229), and the resolution of hypsarrhythmia on electroencephalogram (EEG) was 72.1% (165/229). About 21.4% (49/229) of patients showed side effects, including infectious diseases, hypokalemia, and diarrhea.
INTERPRETATION
For patients with IS who failed first-line treatments, in terms of the seizure-free rate and resolution of hypsarrhythmia on EEG, MgSO+ACTH combination therapy can be considered.
PubMed: 36967744
DOI: 10.1002/ped4.12368 -
Biomedicine Hub 2022The study aimed to evaluate the impact of antenatal exposure of magnesium sulfate (MgSO) on short- and long-term outcomes in preterm neonates born less than 32 weeks...
OBJECTIVES
The study aimed to evaluate the impact of antenatal exposure of magnesium sulfate (MgSO) on short- and long-term outcomes in preterm neonates born less than 32 weeks gestation.
METHODS
Single-center retrospective cohort study of 229 neonates born between 24 and 32 weeks gestation was conducted from January 2018 through December 2018 in a level III neonatal care unit in Kuwait. Antenatal MgSO exposure was collected from the medical records, and the indication was for neuroprotection effect. Brain MRI was done on 212 neonates (median gestational age 36 weeks), and brain injury was assessed using the Miller's score. Neurodevelopmental outcome was assessed by Bayley-III scales of infant development at 36 months corrected age ( = 146). The association of exposure to MgSO4 with brain injury and neurodevelopmental outcomes was examined using multivariable regression analysis adjusting for gestational age at MRI and variables with value <0.05 on univariate analysis.
RESULTS
Among the 229 neonates, 47 received antenatal MgSO. There were no differences between the groups in gestational age and birth weight. MgSO exposure was not associated with an increased risk of necrotizing enterocolitis, chronic lung disease, retinopathy of prematurity, and mortality. The incidence of cerebellar hemorrhage was significantly less in the MgSO group (0% vs. 16%, value = 0.002). Neonates who received MgSO had lower risks of grade 3-4 intraventricular hemorrhage (IVH) adjusted OR 0.248 (95% CI: 0.092, 0.66), = 0.006; moderate-severe white matter injury (WMI) adjusted odd ratio 0.208 (95% CI: 0.044, 0.96), = 0.046; and grade 3-4 IVH and/or moderate-severe WMI adjusted OR 0.23 (95% CI: 0.06, 0.84), = 0.027. Neurodevelopmental assessment at 36 months corrected age showed better motor (adjusted beta coefficient 1.08 [95% CI: 0.099, 2.06]; = 0.031) and cognitive composite scores (adjusted beta coefficient 1.29 [95% CI: 0.36, 2.22]; = 0.007) in the MgSO group.
CONCLUSION
Antenatal exposure to MgSO in preterm neonates less than 32 weeks was independently associated with lower risks of brain injury and better motor and cognitive outcomes.
PubMed: 35950015
DOI: 10.1159/000525431 -
Turkish Journal of Medical Sciences 2023This study investigated the possible degeneration in cochlear morphology induced by preeclampsia (PE) and the therapeutic/preventive effect of vitamin D (Vit D) and...
BACKGROUND/AIM
This study investigated the possible degeneration in cochlear morphology induced by preeclampsia (PE) and the therapeutic/preventive effect of vitamin D (Vit D) and magnesium sulfate (MgSO) used separately and together on feto-maternal outcomes.
MATERIALS AND METHODS
We created PE in rats using a reduced uterine perfusion pressure (RUPP) animal model and recorded blood pressure (BP), embryonic survival (ES), and embryonic weight (EW) and evaluated cochlear morphology by electron microscopy.
RESULTS
The PE group had elevated BP, a decreased number and weight of live pups, and significant degeneration in the cochlea compared to the sham group. In the PEV group, we observed significant beneficial effects of Vit D supplementation at 14.5 and 19.5 dpc in terms of BP (p < 0.05), EW (p < 0.001), and cochlear degeneration compared to the PE group. In the PEM group, BP (p < 0.05) and cochlear degeneration nearly reached the level found in the sham group. However, although the EW was statistically different in the PE group, it did not reach sham group levels. We also observed that BP returned to sham level (p < 0.01) and noticed significant increases in the EW (p < 0.0001) and ES (p = 0.017) in the PEMV group compared to the PE group. According to the scanning electron microscope results, combined administration of VitD and MgSO is more effective than separate administration in improving cochlear degeneration induced by PE.
CONCLUSION
The administration of Vit D and MgSO during pregnancy has beneficial effects on PE pathology and may play a significant role in preventing PE-related complications, including cochlear degeneration.
Topics: Animals; Magnesium Sulfate; Pre-Eclampsia; Female; Pregnancy; Cochlea; Vitamin D; Rats; Disease Models, Animal; Rats, Sprague-Dawley
PubMed: 38813514
DOI: 10.55730/1300-0144.5730 -
International Journal of General... 2022Perioperative shivering is a common problem faced in anesthesia practice. Unless it is properly managed and prevented, it causes discomfort and devastating problems,... (Review)
Review
BACKGROUND
Perioperative shivering is a common problem faced in anesthesia practice. Unless it is properly managed and prevented, it causes discomfort and devastating problems, especially in patients with cardiorespiratory problems. Surgery, anesthesia, exposure of skin in a cool operating theater, and administration of unwarmed fluids are some of the major causes for the development of shivering among surgical patients. Currently, a variety of non-pharmacological and pharmacological techniques are available to prevent and manage this problem. The available options to prevent and treat shivering include but are not limited to pre-warming the patient for 15 minutes before anesthesia administration, administration of low dose ketamine, dexamethasone, pethidine, clonidine, dexmedetomidine, tramadol, and magnesium sulfate.
OBJECTIVE
To develop evidence-based recommendations for the prevention and management of shivering after spinal anesthesia in a resource-limited settings.
METHODS
The kinds of literature are searched from Google Scholar, PubMed, Cochrane library, and HINARI databases to get access to current and update evidence on the prevention and management of shivering after spinal anesthesia. The keywords for the literature search were (shivering or prevention) AND (shivering or management) AND (anesthesia or shivering).
CONCLUSION
Pre-warming the patient with cotton, blanket, gown warming, and administering warm IV fluid 15 minutes before spinal anesthesia are possible non-pharmacologic options for the prevention of shivering. Furthermore, pharmacological medications like low dose ketamine, dexamethasone, magnesium sulfate, ad tramadol can be used as alternative options for the prevention and management strategies for shivering of different degrees in resource-limited areas.
PubMed: 36090703
DOI: 10.2147/IJGM.S370439 -
International Journal of Molecular... Mar 2023Mast cell degranulation impacts the development of pain and inflammation during tissue injury. We investigated the antinociceptive effect of a combination of...
Mast cell degranulation impacts the development of pain and inflammation during tissue injury. We investigated the antinociceptive effect of a combination of cromoglycate and magnesium in the orofacial model of pain and the histological profile of the effect of magnesium in orofacial pain. In male Wistar rats, formalin (1.5%, 100 µL) was injected subcutaneously into the right upper lip of rats after cromoglycate and/or magnesium. Pain was measured as the total time spent on pain-related behavior. Toluidine blue staining was used to visualize mast cells under the light microscope. In the formalin test, in phase 1, magnesium antagonized the antinociceptive effect of cromoglycate, while in phase 2, it potentiated or inhibited its effect. Magnesium significantly reduced mast cell degranulation in the acute phase by about 23% and in the second phase by about 40%. Pearson's coefficient did not show a significant correlation between mast cell degranulation and pain under treatment with magnesium. The cromoglycate-magnesium sulfate combination may prevent the development of inflammatory orofacial pain. The effect of a combination of cromoglycate-magnesium sulfate depends on the nature of the pain and the individual effects of the drugs. Magnesium reduced orofacial inflammation in the periphery, and this effect did not significantly contribute to its analgesic effect.
Topics: Rats; Animals; Male; Magnesium Sulfate; Magnesium; Cromolyn Sodium; Rats, Wistar; Cell Degranulation; Neuroinflammatory Diseases; Mast Cells; Facial Pain; Inflammation; Analgesics
PubMed: 37047214
DOI: 10.3390/ijms24076241 -
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