-
Best Practice & Research. Clinical... Dec 2017The role of ketamine and magnesium in improving postoperative pain and diminish opioid consumption has been largely described. Synthetic opioids are known to provide... (Review)
Review
Stable anesthesia with alternative to opioids: Are ketamine and magnesium helpful in stabilizing hemodynamics during surgery? A systematic review and meta-analyses of randomized controlled trials.
INTRODUCTION
The role of ketamine and magnesium in improving postoperative pain and diminish opioid consumption has been largely described. Synthetic opioids are known to provide hemodynamic stability when given for major noncardiac surgery. Definitive evidence on the role of ketamine and/or magnesium on intraoperative hemodynamic control would support their potential as alternatives to opioids during surgery.
METHODS
The available literature published on PubMed/Medline and EMBASE was reviewed systematically to perform meta-analyses of randomized controlled trials (RCTs) assessing the effect of ketamine and/or magnesium on hemodynamic response to surgery as the primary outcome.
RESULTS
From 352 studies, we identified 19 RCTs, and after exclusion of eight studies (seven for inappropriate data reporting and one in non-English language), we analyzed 11 RCTs (five for ketamine and six for magnesium sulfate) including, in total, 371 patients, of whom 94 vs. 95 received ketamine vs. placebo and 147 vs. 145 received magnesium vs. placebo, respectively. Results show that in quantitative analyses, ketamine vs. placebo did not show a significant effect on heart rate (+0.71 bpm; 95% CI [-1.52 to +2.93], P = 0.53) but significantly reduced variability of blood pressure (-8.4 mmHg; 95% CI [-15.1 to -1.8], P = 0.0005). In contrast, magnesium vs. placebo reduced variability of heart rate (-3.7 bpm; 95% CI [-6.5 to 0.9], P = 0.01) without a significant effect on systemic blood pressure (+4.2 mmHg; 95% CI [-3.6 to +12.03], P = 0.29).
CONCLUSION
In conclusion, these meta-analyses of nine trials confirm that ketamine and magnesium, differently but consistently, reduce hemodynamic variability during surgery and may be seen as complementary not only for pain control but also to provide stable anesthesia. This study supports the use of those drugs to control the sympathetic response to surgery in the context of opioid-free anesthesia.
Topics: Analgesics; Analgesics, Opioid; Anesthesia; Hemodynamics; Humans; Intraoperative Care; Ketamine; Magnesium; Monitoring, Intraoperative; Pain, Postoperative; Randomized Controlled Trials as Topic
PubMed: 29739541
DOI: 10.1016/j.bpa.2017.07.001 -
BMJ Clinical Evidence Jan 2016About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an... (Review)
Review
INTRODUCTION
About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an increased risk of death, but patients with mild to moderate disease are also at risk of exacerbations. Most guidelines about the management of asthma follow stepwise protocols. This overview does not endorse or follow any particular protocol, but presents the evidence about a specific intervention, magnesium sulfate.
METHODS AND OUTCOMES
We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of magnesium sulfate for acute asthma? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS
At this update, searching of electronic databases retrieved 50 studies. After deduplication and removal of conference abstracts, 24 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 10 studies and the further review of 14 full publications. Of the 14 full articles evaluated, one systematic review was updated and one systematic review was added at this update. We performed a GRADE evaluation for five PICO combinations.
CONCLUSIONS
In this systematic overview, we categorised the efficacy for two comparisons based on information about the effectiveness and safety of magnesium sulfate (iv) versus placebo and magnesium sulfate (nebulised) plus short-acting beta2 agonists (inhaled) versus short-acting beta2 agonists (inhaled) alone.
Topics: Acute Disease; Administration, Inhalation; Adrenergic beta-2 Receptor Antagonists; Adult; Anti-Asthmatic Agents; Asthma; Humans; Magnesium Sulfate
PubMed: 26761432
DOI: No ID Found -
Australian Critical Care : Official... Aug 2013The value of magnesium for the prevention of cerebral arterial vasospasm in patients with aneurysmal subarachnoid haemorrhage (SAH) is debatable. We performed a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The value of magnesium for the prevention of cerebral arterial vasospasm in patients with aneurysmal subarachnoid haemorrhage (SAH) is debatable. We performed a systematic review to collate the available evidence to evaluate the effects of intravenous magnesium for the prevention of cerebral arterial vasospasm.
MATERIALS AND METHODS
An electronic search of MEDLINE (Ovid), ProQuest, CINAHL and the Cochrane Database of Systematic Reviews was undertaken up to 1st October 2012 for randomised controlled trials (RCTs) of intravenous magnesium for the prevention of vasospasm in adult patients with aneurysmal SAH. Primary outcome measures were risk of vasospasm, functional outcomes and mortality. Results are presented as risk ratios (RR) and 95% confidence intervals (CI).
RESULTS
Nine of 38 trials were included in this review. Not all trials could be combined for analyses due to differences in reported outcomes and outcome definitions. Of the trials that could be combined we found a statistically significant reduction on the incidence of vasospasm with magnesium (RR 0.83; 95% CI 0.71, 0.98; P=0.03). No statistical difference for the last reported favourable functional outcome (RR 1.00; 95% CI 0.96, 1.05; P=0.84); or mortality (RR 0.95; 95% CI 0.77, 1.18; P=0.67) between magnesium treated and standard care/control groups was found.
CONCLUSION
We identified a benefit in the role of magnesium to reduce the incidence of cerebral vasospasm in patients with an aneurysmal SAH. However no benefit was found regarding improved favourable functional outcome or a reduction of mortality.
Topics: Adult; Humans; Infusions, Intravenous; Magnesium; Magnesium Sulfate; Subarachnoid Hemorrhage; Vasodilator Agents; Vasospasm, Intracranial
PubMed: 23806874
DOI: 10.1016/j.aucc.2013.05.002 -
Stroke Apr 2019Background and Purpose- Acute stroke treatment is challenging, and stroke remains a major cause of death and disability. The purpose of this meta-analysis is to... (Meta-Analysis)
Meta-Analysis
Background and Purpose- Acute stroke treatment is challenging, and stroke remains a major cause of death and disability. The purpose of this meta-analysis is to investigate the effects of postacute stroke intravenous administration of the neuroprotectant magnesium sulfate (MgSO) on global outcome, functional outcome, and mortality 90 days poststroke (ischemic and nonischemic). Methods- We searched in Pubmed, Science Direct, CENTRAL, and ClinicalTrials.gov, up to November 11, 2017, and we conducted a systematic review and meta-analysis of randomized controlled trials. We synthesized results by using random-effects model, weighted mean differences, standardized mean differences, and odds ratios. Results- Seven randomized controlled trials (4347 patients) met our criteria. Compared with placebo, treatment did not improve functional outcome defined as Barthel Index >60 (odds ratio =1.05; 95% CI, 0.92-1.19) and >95 (odds ratio =0.95; 95% CI, 0.76-1.20), 90 days poststroke. It also did not improve global outcome measured with modified Rankin Scale (standardized mean difference =-0.01; 95% CI, -0.12 to 0.10), 90 days poststroke. In an additional subgroup meta-analysis that exclusively included ischemic stroke patients, intravenous MgSO resulted in lower modified Rankin Scale score (improved global outcome; weighted mean difference =-0.96; 95% CI, -1.34 to -0.58; I=0%], 90 days poststroke. Finally, mortality stayed unaltered (odds ratio =1.10; 95% CI, 0.94-1.29). Conclusions- The findings of our meta-analysis showed that intravenous MgSO generally did not improve global/functional outcomes and mortality at 90 days after stroke (combined ischemic stroke and nonischemic stroke). The finding of favorable neurological outcome, selectively in ischemic stroke patients, should be viewed with extreme caution given the limited number of patients included in this subgroup meta-analysis.
Topics: Administration, Intravenous; Brain Ischemia; Humans; Intracranial Hemorrhages; Magnesium Sulfate; Neuroprotective Agents; Stroke; Survival Rate; Treatment Outcome
PubMed: 30852968
DOI: 10.1161/STROKEAHA.118.021916 -
Indian Journal of Anaesthesia Jul 2019Post-operative sore throat (POST) is a common undesirable consequence of tracheal intubation. Magnesium, an N-methyl-D-aspartate receptor antagonist, has... (Review)
Review
BACKGROUND AND AIMS
Post-operative sore throat (POST) is a common undesirable consequence of tracheal intubation. Magnesium, an N-methyl-D-aspartate receptor antagonist, has anti-nociceptive and anti-inflammatory properties, and has been found to be useful in POST prevention in various trials. We conducted this systematic review and meta-analysis to study the efficacy of topical magnesium in preventing POST in adult patients undergoing surgery under general anaesthesia with single lumen tracheal tube.
METHODS
Comprehensive literature search was performed in PubMed, Google Scholar, EMBASE, Scopus and the Cochrane central registers of controlled trial databases through July, 2018 and data were pooled using fixed effect modelling followed by random-effect methods (after assessing heterogeneity with fixed modelling). The primary outcome was the incidence of POST at 24 h after surgery/extubation. Comparative results were deliberated as pooled mean difference for continuous variables and Mantel-Haenszel (MH) odds ratio for dichotomous variables. Statistical analysis was done using Comprehensive Meta-Analysis-Version 3 (Biostat Inc., USA).
RESULTS
Seven trials involving 726 study participants were included in the final analysis. Incidence of POST at 24 hours was significantly lower in magnesium group (26/363) in comparison to active and non-active control group (89/363); = 0.00- RR 0.22 (95%CI = 0.12-0.39, I = 0%). No significant adverse events were reported with the use of topical magnesium.
CONCLUSION
Prophylactic use of topical magnesium before the induction of general anaesthesia seems to be an effective measure to decrease the incidence of POST.
PubMed: 31391614
DOI: 10.4103/ija.IJA_856_18 -
Journal of Obstetrics and Gynaecology :... Feb 2012Premature birth increases a child's risk of cerebral palsy and death. The aim of this work is to investigate the association between treatment with magnesium sulphate... (Meta-Analysis)
Meta-Analysis Review
Premature birth increases a child's risk of cerebral palsy and death. The aim of this work is to investigate the association between treatment with magnesium sulphate during premature deliveries and infants' cerebral palsy and mortality through a meta-analysis of observational studies. A comprehensive search of the Cochrane Library, EMBASE and the PubMed database from their inceptions to 1 October, 2010 using the keywords 'magnesium sulphate, children/infant/pre-term/premature and cerebral palsy/mortality/morbidity/adverse effects/outcome' identified 11 reports of observational studies. Two authors working independently extracted the data. A meta-analysis of the data found an association between magnesium sulphate treatment and a significantly reduced risk of mortality (RR 0.73; 95% CI 0.61-0.89) and cerebral palsy (OR 0.64; 95% CI 0.47-0.89). Antenatal treatment with magnesium sulphate during premature deliveries seems to be associated with health benefits for the infants. The effective dose and timing, however, is not defined and given the lack of mechanistic understanding of the effect of MgSO(4), a reasonable alternative is a large-scale pragmatic clinical trial.
Topics: Cerebral Palsy; Female; Humans; Infant, Newborn; Magnesium Sulfate; Obstetric Labor, Premature; Pregnancy
PubMed: 22296422
DOI: 10.3109/01443615.2011.638999 -
Journal of Obstetrics and Gynaecology... Feb 2014To review systematically the magnesium sulphate (MgSO4) dosing regimens tested in low and middle income countries (LMICs) for women with preeclampsia (prevention) and/or... (Review)
Review
OBJECTIVE
To review systematically the magnesium sulphate (MgSO4) dosing regimens tested in low and middle income countries (LMICs) for women with preeclampsia (prevention) and/or eclampsia (treatment).
DATA SOURCES
We searched Medline, EMBASE, IPA, CINAHL, CDSR, and CENTRAL databases for relevant English language publications.
STUDY SELECTION
Our search yielded 753 publications, of which 26 (10 randomized controlled trials and 16 observational studies) evaluated MgSO4 for preeclampsia and/or eclampsia in World Bank-classified LMICs.
DATA EXTRACTION
Independent, by two authors.
DATA SYNTHESIS
Twenty-five studies were conducted in hospital settings and one in the community. Rates of eclampsia were usually < 5% (median 3.0%, range 0.0% to 26.5%) even when MgSO4 was administered for eclampsia. When dosage varied from the standard Pritchard or Zuspan regimens, almost all (n = 22) reduced the dose or duration of treatment, most commonly because of concerns about maternal safety, cost, or resource availability. Four trials of a loading dose only (4 g IV + 10 g IM) versus loading plus maintenance dosing of 5 g/4 hr IM found no difference in eclampsia recurrence (RR 1.64; 95% CI 0.48 to 5.65, n = 396). One study documented less eclampsia recurrence associated with community administration of a MgSO4 loading dose before referral to a care facility versus treatment in a care facility (RR 0.23; 95% CI 0.11 to 0.49, n = 265).
CONCLUSION
Use of MgSO4 for eclampsia treatment and prevention has been well-studied in LMICs, but concern remains about potential toxicity. Further studies are needed to identify the minimum effective dosage of MgSO4 for management of preeclampsia and eclampsia and whether MgSO4 loading can be safely administered in the community.
Topics: Africa South of the Sahara; Asia; Eclampsia; Female; Humans; Income; MEDLINE; Magnesium Sulfate; Poverty; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Recurrence; Treatment Outcome
PubMed: 24518915
DOI: 10.1016/S1701-2163(15)30662-9 -
Developmental Medicine and Child... Nov 2022We performed a systematic review and network meta-analysis (NMA) to obtain comparative effectiveness estimates and rankings of non-surgical interventions used to treat... (Meta-Analysis)
Meta-Analysis Review
AIM
We performed a systematic review and network meta-analysis (NMA) to obtain comparative effectiveness estimates and rankings of non-surgical interventions used to treat infantile spasms.
METHOD
All randomized controlled trials (RCTs) including children 2 months to 3 years of age with infantile spasms (with hypsarrhythmia or hypsarrhythmia variants on electroencephalography) receiving appropriate first-line medical treatment were included. Electroclinical and clinical remissions within 1 month of starting treatment were analyzed.
RESULTS
Twenty-two RCTs comparing first-line treatments for infantile spasms were reviewed; of these, 17 were included in the NMA. Both frequentist and Bayesian network rankings for electroclinical remission showed that high dose adrenocorticotropic hormone (ACTH), methylprednisolone, low dose ACTH and magnesium sulfate (MgSO ) combination, low dose ACTH, and high dose prednisolone were most likely to be the 'best' interventions, although these were not significantly different from each other. For clinical remission, low dose ACTH/MgSO combination, high dose ACTH (with/without vitamin B ), high dose prednisolone, and low dose ACTH were 'best'.
INTERPRETATION
Treatments including ACTH and high dose prednisolone are more effective in achieving electroclinical and clinical remissions for infantile spasms.
WHAT THIS PAPER ADDS
Adrenocorticotropic hormone and high dose prednisolone are more effective than other medications for infantile spasms. Symptomatic etiology decreases the likelihood of remission even after adjusting for treatment lag.
Topics: Adrenocorticotropic Hormone; Anticonvulsants; Child; Humans; Infant; Magnesium Sulfate; Methylprednisolone; Network Meta-Analysis; Spasms, Infantile; Treatment Outcome; Vitamins
PubMed: 35765990
DOI: 10.1111/dmcn.15330 -
BMJ Clinical Evidence Mar 2007Acute organophosphorus poisoning occurs after dermal, respiratory, or oral exposure to either low-volatility pesticides (e.g. chlorpyrifos, dimethoate) or... (Review)
Review
INTRODUCTION
Acute organophosphorus poisoning occurs after dermal, respiratory, or oral exposure to either low-volatility pesticides (e.g. chlorpyrifos, dimethoate) or high-volatility nerve gases (e.g. sarin, tabun). Most cases occur in resource-poor countries as a result of occupational or deliberate exposure to organophosphorus pesticides.
METHODS AND OBJECTIVES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute organophosphorus poisoning? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 22 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: activated charcoal, alpha2 adrenergic receptor agonists, atropine, benzodiazepines, butyrylcholinesterase replacement therapy, cathartics, extracorporeal clearance, gastric lavage, glycopyrronium bromide, ipecacuanha, magnesium sulphate, milk or other home remedies, N-methyl-D-aspartate receptor antagonists, organophosphorus hydrolases, oximes, sodium bicarbonate, washing the poisoned person and removing contaminated clothing.
Topics: Acute Disease; Administration, Oral; Charcoal; Gastric Lavage; Humans; Organophosphate Poisoning; Oximes; Pesticides; Receptors, N-Methyl-D-Aspartate; Sodium Bicarbonate
PubMed: 19454054
DOI: No ID Found -
BMJ Clinical Evidence Apr 2011About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an... (Review)
Review
INTRODUCTION
About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an increased risk of death, but patients with mild to moderate disease are also at risk of exacerbations. Most guidelines about the management of asthma follow stepwise protocols. This review does not endorse or follow any particular protocol, but presents the evidence about specific interventions.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute asthma? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 100 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: beta(2) agonists (plus ipratropium bromide, pressured metered-dose inhalers, short-acting continuous nebulised, short-acting intermittent nebulised, short-acting iv, and inhaled formoterol); corticosteroids (inhaled); corticosteroids (single oral, combined inhaled, and short courses); education about acute asthma; generalist care; helium-oxygen mixture (heliox); magnesium sulphate (iv and adding isotonic nebulised magnesium to inhaled beta(2) agonists); mechanical ventilation; oxygen supplementation (controlled 28% oxygen and controlled 100% oxygen); and specialist care.
Topics: Acute Disease; Administration, Inhalation; Administration, Oral; Adrenal Cortex Hormones; Adult; Asthma; Humans; Ipratropium; Magnesium Sulfate; Nebulizers and Vaporizers
PubMed: 21463536
DOI: No ID Found