-
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 -
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 -
The Journal of Maternal-fetal &... Dec 2022Pregnant women diagnosed with preeclampsia are at increased risk of eclampsia. Magnesium sulfate is the standard of care for maternal seizure prophylaxis. Traditional... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Pregnant women diagnosed with preeclampsia are at increased risk of eclampsia. Magnesium sulfate is the standard of care for maternal seizure prophylaxis. Traditional regimens of magnesium sulfate have continued infusions for 24 h postpartum. More recent evidence suggests shortened courses of postpartum magnesium sulfate. The purpose of this systematic review is to evaluate whether the duration of postpartum magnesium sulfate for seizure prophylaxis in women with preeclampsia affects the incidence of seizures postpartum.
DATA SOURCE
MEDLINE, Cochrane Library, and clinicaltrials.gov were reviewed from inception until 1 May 2020.
METHODS OF STUDY SELECTION
Two hundred and fifty-three studies were reviewed by three individual authors. Inclusion criteria were as follows: published, randomized controlled trials (RCTs) that included pregnant women diagnosed with preeclampsia who received a maintenance infusion of magnesium sulfate in the postpartum period. Studies were excluded if either arm did not provide maintenance dosing of magnesium sulfate in the postpartum period. We also excluded ongoing, unpublished, and non-randomized trials.
RESULTS
Nine RCTs ( = 1369) were included in the systematic review. Data were abstracted and reviewed by three authors, then entered into Review Manager data software. The primary outcome of eclampsia was reported in all nine studies. An eclamptic event occurred in 2/696 women who received <24 h of postpartum magnesium compared to 0/673 events in women who received ≥24 h of postpartum magnesium (RD 0.00, 95% CI -0.01, 0.01; =.71). Women who received <24 h of postpartum magnesium sulfate had a significantly faster time to ambulation postpartum (MD -10.57, 95% CI -17.43, -3.71; =.003) and shorter durations of indwelling urinary catheter placement (MD -18.97, 95% CI -34.64, -3.29; =.02).
CONCLUSIONS
As eclampsia is a rare occurrence, this review was not powered to show a difference in the rate of eclampsia. However, the two cases of eclampsia that were reported occurred in the group of women who received <24 h of postpartum magnesium sulfate. Therefore, the results of this systematic review support continued use of 24 h of postpartum magnesium sulfate for seizure prophylaxis.
Topics: Pregnancy; Female; Humans; Magnesium Sulfate; Eclampsia; Pre-Eclampsia; Magnesium; Seizures; Postpartum Period; Anticonvulsants
PubMed: 34187284
DOI: 10.1080/14767058.2021.1946505 -
Cureus Dec 2020Stroke is a leading cause of death, disability, and dementia worldwide. Strokes can be divided into ischemic strokes and hemorrhagic strokes. At the moment, tissue... (Review)
Review
Stroke is a leading cause of death, disability, and dementia worldwide. Strokes can be divided into ischemic strokes and hemorrhagic strokes. At the moment, tissue plasminogen activator (tPA) is the only FDA-approved drug for ischemic stroke. Minocycline (MC) and Magnesium (Mg) are promising therapies for ischemic stroke, especially in the pre-hospital setting. These drugs are readily available, inexpensive, and generally safe. We decided to investigate these drugs' neuroprotective effects in treating ischemic stroke in the acute and chronic setting. We conducted a systematic review of the published literature on MC and Mg's functional outcome in ischemic stroke. This paper's methodology included only clinical trials published in the last 15 years, using PubMed as a database. The systematic review demonstrated that MC infusion in the pre-hospital and hospital setting improved functional outcomes and disability scores. Furthermore, MC also decreased matrix metalloproteinase 9 (MMP-9) levels. MC might have a more significant effect on men than women because different molecular pathways of cerebral ischemia seem to be involved between both genders. The systematic review showed that patients with ischemic stroke did not benefit from magnesium sulfate infusion in the pre-hospital and hospital setting. Nevertheless, patients with lacunar strokes and patients who supplemented their meals with potassium-magnesium salt in the diet had better functional outcomes. Future studies would need a more significant sample of participants and a better selection to increase the study's power and avoid selection bias, respectively. Further publications could benefit from subcategorizing strokes and investigating the gender role in stroke treatment. These directives could give a more robust conclusion regarding the neuroprotective effects of these drugs.
PubMed: 33520535
DOI: 10.7759/cureus.12339 -
Paediatric Respiratory Reviews Feb 2024Asthma is the most prevalent chronic disease in children and constitutes a significant healthcare burden. First-line therapy for acute asthma exacerbations is well... (Review)
Review
BACKGROUND
Asthma is the most prevalent chronic disease in children and constitutes a significant healthcare burden. First-line therapy for acute asthma exacerbations is well established. However, secondary treatments, including intravenous magnesium sulfate (IV-MgSO4), remain variable due to scarcity of data on its efficacy and safety.
OBJECTIVE
To assess the effectiveness and safety of IV-MgSO4 as a second line of treatment in managing children with asthma exacerbations.
METHODS
We searched five databases from inception until April 2023 on randomized clinical trials of IV-MgSO4 in children with acute asthma exacerbations. The primary outcomes were hospitalization rate and length, and change in the severity score. Secondary outcomes included percentage increase in peak expiratory flow rate (PEFR), hospital re-admission rate, need and length for pediatric intensive care unit (PICU) treatment, and adverse effects. Meta-analysis was performed for three outcomes with estimated odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs).
RESULTS
Eleven studies met the final criteria. In comparison to control, administration of IV-MgSO4 was associated with a reduced hospitalization risk (OR 0.15; 95%CI: 0.03, 0.73) in four studies, and improvement of lung function (MD 26.77% PEFR; 95%CI: 18.41, 54.79) in two studies. There were no significant differences in the length of stay between groups. Due to heterogeneity, a narrative synthesis of other outcomes was performed.
CONCLUSION
The use of IV-MgSO4 demonstrated a reduction in the hospitalization rate and PEFR improvement in children with asthma exacerbations. Adverse effects were rare. Further well-designed studies are needed to better determine the efficacy and safety profile of IV-MgSO4.
PubMed: 38395640
DOI: 10.1016/j.prrv.2024.01.003 -
Frontiers in Neurology 2023The use of magnesium sulfate for treating aneurysmal subarachnoid hemorrhage (aSAH) has shown inconsistent results across studies. To assess the impact of magnesium...
INTRODUCTION
The use of magnesium sulfate for treating aneurysmal subarachnoid hemorrhage (aSAH) has shown inconsistent results across studies. To assess the impact of magnesium sulfate on outcomes after aSAH, we conducted a systematic review and meta-analysis of relevant randomized controlled trials.
METHODS
PubMed, Embase, and the Cochrane Library were searched for relevant literature on magnesium sulfate for aSAH from database inception to March 20, 2023. The primary outcome was cerebral vasospasm (CV), and secondary outcomes included delayed cerebral ischemia (DCI), secondary cerebral infarction, rebleeding, neurological dysfunction, and mortality.
RESULTS
Of the 558 identified studies, 16 comprising 3,503 patients were eligible and included in the analysis. Compared with control groups (saline or standard treatment), significant differences were reported in outcomes of CV [odds ratio (OR) = 0.61, = 0.04, 95% confidence interval (CI) (0.37-0.99)], DCI [OR = 0.57, = 0.01, 95% CI (0.37-0.88)], secondary cerebral infarction [OR = 0.49, = 0.01, 95% CI (0.27-0.87)] and neurological dysfunction [OR = 0.55, = 0.04, 95% CI (0.32-0.96)] after magnesium sulfate administration, with no significant differences detected in mortality [OR = 0.92, = 0.47, 95% CI (0.73-1.15)] and rebleeding [OR = 0.68, = 0.55, 95% CI (0.19-2.40)] between the two groups.
CONCLUSION
The superiority of magnesium sulfate over standard treatments for CV, DCI, secondary cerebral infarction, and neurological dysfunction in patients with aSAH was demonstrated. Further randomized trials are warranted to validate these findings with increased sample sizes.
PubMed: 38020616
DOI: 10.3389/fneur.2023.1249369 -
Frontiers in Pediatrics 2022Magnesium sulfate is a second-tier therapy for asthma exacerbations in children; guidelines recommend a single-dose to improve pulmonary function and decrease the odds...
OBJECTIVES
Magnesium sulfate is a second-tier therapy for asthma exacerbations in children; guidelines recommend a single-dose to improve pulmonary function and decrease the odds of admission to the in-patient setting. However, many clinicians utilize prolonged magnesium sulfate infusions for children with refractory asthma. The purpose of this review is to describe the efficacy and safety of magnesium sulfate infusions administered over ≥ 1 h in children with status asthmaticus.
METHODS
Medline was searched using the keywords "magnesium sulfate" and "children." Articles evaluating the use of magnesium sulfate infusions for ≥1 h published between 1946 and August 2021 were included. Published abstracts were not included because of lack of essential details. All articles were screened by two reviewers.
RESULTS
Eight reports including 447 children were included. The magnesium regimens evaluated included magnesium delivered over 1 h ( = 148; 33.1%), over 4-5 h ( = 105; 23.5%), and over >24 h ( = 194; 43.4%). Majority of patients received a bolus dose of 25-75 mg/kg/dose prior to initiation of a prolonged infusion ( = 299; 66.9%). For the patients receiving magnesium infusions over 4-5 h, the dosing regimen varied between 40 and 50 mg/kg/h. For those receiving magnesium infusions >24 h, the dosing varied between 18.4 and 25 mg/kg/h for a duration between 53.4 and 177.5 h. Only three reports including 186 patients (41.6%) included an evaluation of clinical outcomes including evaluation of lung function parameters, reduction in PICU transfers, and/or decrease in emergency department length of stay. Five reports including 261 patients (58.4%) evaluated magnesium serum concentrations. In most reports, the goal concentrations were between 4 and 6 mg/dL. Only 3 (1.1%) out of the 261 patients had supratherapeutic magnesium concentrations. The only reports finding adverse events attributed to magnesium were noted in those receiving infusions for >24 h. Clinically significant adverse events included hypotension ( = 74; 16.6%), nausea/vomiting ( = 35; 7.8%), mild muscle weakness ( = 22; 4.9%), flushing ( = 10; 2.2%), and sedation ( = 2; 0.4%).
CONCLUSION
Significant variability was noted in magnesium dosing regimens, with most children receiving magnesium infusions over >4 h. Most reports did not assess clinical outcomes. Until future research is conducted, the use of prolonged magnesium sulfate infusions should be reserved for refractory asthma therapy.
PubMed: 35391743
DOI: 10.3389/fped.2022.853574 -
Journal of Clinical Anesthesia Jun 2017Magnesium sulfate displays numerous characteristics that make it a useful drug in anesthesiology (N-methyl-d-aspartate receptor antagonist, vasodilator, antiarrhythmic,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Magnesium sulfate displays numerous characteristics that make it a useful drug in anesthesiology (N-methyl-d-aspartate receptor antagonist, vasodilator, antiarrhythmic, inhibitor of catecholamine release and of acetylcholine in the terminal motor plate). The perioperative use of this drug as an adjuvant capable of decreasing the required dose of anesthetics, has been proposed.
OBJECTIVES
To assess the influence of intravenous magnesium sulfate administration during general anesthesia on the overall dose of required anesthetics.
DESIGN
A systematic review of controlled randomized trials and meta-analysis.
DATA SOURCES
An electronic bibliography search in MEDLINE and in the Cochrane Database of Controlled trials (CENTRAL) up to 2015.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS
Randomized, double-blind trials relating to general anesthesia in elective surgery using intravenous magnesium sulfate that provide information about the anesthetic requirements in ASA I and II patients.
RESULTS
20 clinical trials were selected for the qualitative analysis and 19 for the quantitative one. The use of perioperative intravenous magnesium sulfate reduces the requirement of the anesthetic, propofol during induction (-28.52mg; CI 95% -35.22-1.82; p<0.001) and maintenance (-213.56mg; CI 95% -322.93, -104.18; p<0.001) of anesthesia. Additionally, magnesium sulfate reduces the requirement of neuromuscular non-despolarizing blocking agents (-2.99mg; CI 95% -44.47, -1.99; p<0.001) and the intraoperative consumption of fentanile(-53.57 mcg; CI 95% -75.01, -32.12; p<0.001).
CONCLUSIONS
We conclude that perioperative magnesium sulfate acts as a coadjuvant drug capable of reducing anesthetic requirements.
Topics: Anesthesia, General; Anesthetics, Intravenous; Dose-Response Relationship, Drug; Humans; Magnesium Sulfate; Perioperative Care; Propofol; Randomized Controlled Trials as Topic
PubMed: 28494889
DOI: 10.1016/j.jclinane.2017.03.038 -
The Journal of Pediatrics Nov 2023To assess magnesium sulfate (MgSO) as a neuroprotective agent in hypoxic-ischemic encephalopathy. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess magnesium sulfate (MgSO) as a neuroprotective agent in hypoxic-ischemic encephalopathy.
STUDY DESIGN
For this systematic review, PubMed, EMBASE, the Cochrane Library, EMCARE, and MedNar were searched in November 2022 for randomized controlled trials (RCTs). Meta-analysis was conducted using Stata 16.0 and RevMan 5.3.
RESULTS
Twenty RCTs with a total sample size of 1485 were included, of which 16 were from settings where therapeutic hypothermia (TH) was not offered. Regarding MgSO in settings where TH was not offered, only 1 study evaluated composite outcome of death or disability at ≥18 months and reported such poor outcome in 8 of 14 control infants and 4 of 8 in the MgSO group. MgSO was not associated with mortality (RR, 0.86; 95% CI, 0.72-1.03; 13 RCTs) or hypotension (RR, 1.02; 95% CI, 0.88-1.18; 5 RCTs). Thirteen studies reported that MgSO improved in-hospital outcomes, such as reduced seizure burden and improved neurological status at discharge. MgSO reduced the risk of poor suck feeds (RR, 0.52; 95% CI, 0.40-0.68; 6RCTs) and abnormal electroencephalogram (RR, 0.64; 95% CI, 0.45-0.93; 5 RCTs). Certainty of evidence was moderate for mortality and low or very low for other outcomes. For studies with MgSO as an adjunct to TH, none reported on death or neurodevelopmental disability at ≥18 months. MgSO was not associated with mortality (RR, 0.65; 95% CI, 0.34-1.27; 3 RCTs) or hypotension (RR, 1.0; 95% CI, 0.71-1.40; 3 RCTs).
CONCLUSIONS
Evidence around long-term outcomes of MgSO when used with or without TH was scant. MgSO therapy may improve in-hospital neurological outcomes without affecting mortality in settings where TH is not offered. Well-designed RCTs for neuroprotection are needed, especially in low-resource settings.
TRIAL REGISTRATION
"Open Science Forum" (https://doi.org/10.17605/OSF.IO/FRM4D).
Topics: Infant, Newborn; Infant; Humans; Magnesium Sulfate; Hypoxia-Ischemia, Brain; Seizures; Hypotension
PubMed: 37468038
DOI: 10.1016/j.jpeds.2023.113610 -
JBI Evidence Synthesis Mar 2021The purpose of this systematic review and meta-analysis was to determine the effectiveness of intravenous magnesium sulfate when used to attenuate hemodynamic... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this systematic review and meta-analysis was to determine the effectiveness of intravenous magnesium sulfate when used to attenuate hemodynamic fluctuations associated with the creation of pneumoperitoneum in adults undergoing laparoscopic surgery.
INTRODUCTION
Laparoscopic surgery has gained popularity as a result of improved patient outcomes postoperatively, but pneumoperitoneum alters the patient's physiology and hemodynamic profile during the intraoperative period. Magnesium sulfate is a nonopioid agent known for its ability to blunt the physiologic sympathetic response associated with exposure to noxious stimuli. Magnesium sulfate may be efficacious in promoting anesthetic management that optimizes a patient's cardiopulmonary function while minimzing opioid use.
INCLUSION CRITERIA
Studies with participants at least 18 years old undergoing any elective laparoscopic surgery using pneumoperitoneum with CO2 insufflation were included. Studies were excluded if patients were being treated for pheochromocytoma. Studies eligible for inclusion employed any intravenous dosing strategy of magnesium sulfate, administered at any point in the perioperative period for the purpose of blunting the sympathetic response to creation of a pneumoperitoneum. The comparator utilized was normal saline.
METHODS
A systematic search of MEDLINE, CINAHL, Cochrane Library, Google Scholar, Trip Database, MedNar, Grey Literature Report, ClinicalTrials.gov, and ProQuest Dissertations and Theses was conducted to identify both published and unpublished studies. The search was limited to studies written in the English language and performed on human subjects. Studies were selected for review based on inclusion criteria and were appraised by two reviewers using the appropriate JBI standardized appraisal tool. Data extraction was performed for all outcome variables. Data were pooled using the JBI System for the Unified Management, Assessment and Review of Information. Mean differences (95% confidence interval) were calculated for all continuous variables. Meta-analysis using a fixed effects model was performed at various time points for heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure. Standard GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) evidence assessment was also reported.
RESULTS
A total of six randomized controlled trials were included in the review. Meta-analysis of data for biophysical parameters (heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure) at five minutes, 10 to 15 minutes, 30 minutes after pneumoperitoneum, and at the end of surgery showed a consistent reduction in the magnesium groups compared to placebo. Support for all outcome variables was determined to be high using the GRADE criteria.
CONCLUSION
The administration of magnesium sulfate consistently demonstrated improved hemodynamic measurements during laparoscopic surgery. All doses administered in the included studies proved beneficial compared to placebo. Magnesium sulfate should be considered as an adjunct agent in laparoscopic surgery to blunt the sympathetic nervous system response to surgical stimulation. The quality of the included studies was high, but small sample sizes and selection of healthy participants may limit the generalizability of the results. The use of magnesium sulfate may have improved effects on patients with significant health comorbidities, but the limitations of the included studies related to sample demographics make the evidence inconclusive.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO (CRD42019139991).
Topics: Administration, Intravenous; Adolescent; Adult; Hemodynamics; Humans; Insufflation; Laparoscopy; Magnesium Sulfate
PubMed: 33074990
DOI: 10.11124/JBISRIR-D-19-00414