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Revista Brasileira de Anestesiologia 2010Magnesium is predominantly an intracellular ion. Its blocking effects on NMDA receptors are responsible for the analgesic and sedative characteristics of this ion. The... (Review)
Review
BACKGROUND AND OBJECTIVES
Magnesium is predominantly an intracellular ion. Its blocking effects on NMDA receptors are responsible for the analgesic and sedative characteristics of this ion. The objective of this study was to review the physiology, pharmacology, and decreased plasma levels of magnesium, as well as its applications in obstetrics and anesthesia.
CONTENTS
Magnesium is an intracellular cation with multiple functions: it is a cofactor for enzymes of the glucose metabolism and those that participate in the degradation of nucleic acids, proteins, and fatty acids; it regulates the movements of transmembrane ions; and it intervenes in the activity of several enzymes. Critical patients have a tendency to develop hypomagnesemia, and the treatment consists in correcting the cause, whenever possible, and replacement of magnesium. A reduction in the minimum alveolar concentration (MAC) of inhalational agents in animals and the use of opioids in humans under anesthesia has been demonstrated.
CONCLUSIONS
Magnesium sulfate has been used in obstetrics with good results, inhibiting premature labor and in the treatment of eclampsia-associated seizures. It is potentially analgesic and sedative, and could be used as adjuvant during general anesthesia, attenuating the blood pressure response to tracheal intubation and decreasing the need of anesthetics.
Topics: Anesthesia, Obstetrical; Female; Humans; Magnesium; Magnesium Sulfate; Pregnancy
PubMed: 20169270
DOI: 10.1016/s0034-7094(10)70013-1 -
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 -
Drugs in R&D Sep 2020The pharmacokinetic basis of magnesium sulphate (MgSO) dosing regimens for preeclampsia (PE) prophylaxis and treatment is not clearly established. The aim of study is to... (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVE
The pharmacokinetic basis of magnesium sulphate (MgSO) dosing regimens for preeclampsia (PE) prophylaxis and treatment is not clearly established. The aim of study is to develop a population pharmacokinetic (PK) model of MgSO in PE, and to determine key covariates having an effect in MgSO pharmacokinetics in preeclampsia (PE) and to determine key covariates having an effect in MgSO PK.
METHODS
A prospective cohort study was conducted from June 2016 to February 2018 in patients with PE administered MgSO as a 4-g bolus followed by continuous infusion at a rate of 1 g/h. Serum magnesium concentrations were obtained before treatment administration and 2, 6, 12, and 18 h after the initial dose. The software Monolix was used to estimate population PK parameters of MgSO [clearance (CL), volume of distribution (V), half-life] and to develop a PK model with baseline patient demographic, clinical, and laboratory covariates.
RESULTS
The study population consisted of 109 patients. The PK profile of MgSO was adequately described by a one-compartment PK model. The model estimate of the population CL was 1.38 L/h; for V, it was 13.3 L; and the baseline magnesium concentration was 0.77 mmol/L (1.87 mg/dL). The baseline body weight and serum creatinine statistically influenced MgSO CL and V, respectively. The model was parameterized as CL and V.
CONCLUSION
The PK of MgSO in pregnant women with PE is significantly affected by creatinine and body weight. Pregnant women with PE and higher body weight have a higher V and, consequently, a lower elimination rate of MgSO. Pregnant women with PE and a higher serum creatinine value show lower CL and, therefore, lower MgSO elimination rate.
Topics: Adolescent; Adult; Anticonvulsants; Clinical Protocols; Cohort Studies; Female; Humans; Infusions, Intravenous; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Prospective Studies; Young Adult
PubMed: 32642964
DOI: 10.1007/s40268-020-00315-2 -
Medicine Jan 2016To evaluate the evidence of effects and safety of magnesium sulfate on neuroprotection for preterm infants who had exposure in uteri. We searched electronic databases... (Meta-Analysis)
Meta-Analysis Review
To evaluate the evidence of effects and safety of magnesium sulfate on neuroprotection for preterm infants who had exposure in uteri. We searched electronic databases and bibliographies of relevant papers to identify studies comparing magnesium sulfate (MgSO4) with placebo or other treatments in patients at high risk of preterm labor and reporting effects and safety of MgSO4 for antenatal infants. Then, we did this meta-analysis based on PRISMA guideline. The primary outcomes included fatal death, cerebral palsy (CP), intraventricular hemorrhage, and periventricular leukomalacia. Secondary outcomes included various neonatal and maternal outcomes. Ten studies including 6 randomized controlled trials and 5 cohort studies, and involving 18,655 preterm infants were analyzed. For the rate of moderate to severe CP, MgSO4 showed the ability to reduce the risk and achieved statistically significant difference (odd ratio [OR] 0.61, 95% confidence interval [CI] 0.42-0.89, P = 0.01). The comparison of mortality rate between the MgSO4 group and the placebo group only presented small difference clinically, but reached no statistical significance (OR 0.92, 95% CI 0.77-1.11, P = 0.39). Summarily, the analysis of adverse effects on babies showed no margin (P > 0.05). Yet for mothers, MgSO4 exhibited obvious side-effects, such as respiratory depression, nausea and so forth, but there exited great heterogeneity. MgSO4 administered to women at high risk of preterm labor could reduce the risk of moderate to severe CP, without obvious adverse effects on babies. Although there exit many unfavorable effects on mothers, yet they may be lessened through reduction of the dose of MgSO4 and could be tolerable for mothers. So MgSO4 is both beneficial and safety to be used as a neuroprotective agent for premature infants before a valid alternative was discovered.
Topics: Cerebral Palsy; Female; Humans; Infant, Newborn; Infant, Premature; Magnesium Sulfate; Mothers; Neuroprotective Agents; Obstetric Labor, Premature; Pregnancy
PubMed: 26735551
DOI: 10.1097/MD.0000000000002451 -
Cirugia Y Cirujanos 2022Postoperative intraabdominal adhesions are obvious cause of postoperative morbidity. In this experimental study, our aim is to compare the effects of 4% icodextrin...
OBJECTIVE
Postoperative intraabdominal adhesions are obvious cause of postoperative morbidity. In this experimental study, our aim is to compare the effects of 4% icodextrin produced for adhesion prevention, magnesium sulfate used as an anticonvulsant in obstetrics and also as a thickening lubricant in the detergent industry, and saline, which we use most frequently in abdominal irrigation, on adhesion formation.
MATERIALS AND METHODS
A total of 4 groups were formed, 8 in the control group (K), 8 in the icodextrin group (I), 8 in the magnesium sulfate group (M), and 8 in the saline group (SF). Adhesions were quantitatively evaluated with the classification defined by Nair and microscopic grading defined by Zuhlke.
RESULTS
The macroscopic staging degree was statistically significantly lower in Group M, I, and SF compared to Group K. Again, the degree of microscopic staging was significantly lower in Group M and I compared to Group K.
CONCLUSIONS
Three different materials were used in our study. It was observed that they significantly reduced adhesions. This study once again demonstrates the limited ability of these materials to prevent adhesion, despite the wide variety of materials used, and the need for careful adherence to tissue-respectful surgical techniques.
Topics: Humans; Icodextrin; Magnesium Sulfate; Postoperative Complications; Sodium Chloride; Tissue Adhesions
PubMed: 35349560
DOI: 10.24875/CIRU.21000162 -
Seizure Nov 2015Our goal was to perform a systematic review of the literature on the use of intravenous magnesium sulfate (MgSO4) for non-eclamptic status epilepticus (SE) and... (Review)
Review
BACKGROUND
Our goal was to perform a systematic review of the literature on the use of intravenous magnesium sulfate (MgSO4) for non-eclamptic status epilepticus (SE) and refractory status epilepticus (RSE).
METHODS
Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to June 2015), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers.
RESULTS
We identified 19 original articles. A total of 28 patients were described in these articles with 11 being adult, 9 being pediatric, and 8 of unknown age. Seizure reduction/control with IV MgSO4 occurred in 14 of the 28 patients (50.0%), with 2 (7.1%) and 12 (42.9%) displaying partial and complete responses respectively. Seizures recurred upon withdrawal of MgSO4 therapy in 50% of the patients whom had reduction/control of their SE/RSE. Three patients had recorded adverse events related to MgSO4 therapy.
CONCLUSIONS
Oxford level 4, GRADE D evidence exists to suggest a trend towards improved seizure control with the use of intravenous MgSO4 for non-eclamptic RSE. Routine use of IV MgSO4 in non-eclamptic SE/RSE cannot be recommended at this time. Further prospective study of this drug is required in order to determine its efficacy as an anti-epileptic in this setting.
Topics: Administration, Intravenous; Anticonvulsants; Humans; Magnesium Sulfate; Status Epilepticus
PubMed: 26552572
DOI: 10.1016/j.seizure.2015.09.017 -
Jornal de Pediatria 2017To describe the role of intravenous magnesium sulfate (MgSO) as therapy for acute severe asthma in the pediatric emergency department (ED). (Review)
Review
OBJECTIVES
To describe the role of intravenous magnesium sulfate (MgSO) as therapy for acute severe asthma in the pediatric emergency department (ED).
SOURCE
Publications were searched in the PubMed and Cochrane databases using the following keywords: magnesium AND asthma AND children AND clinical trial. A total of 53 publications were retrieved using this criteria. References of relevant articles were also screened. The authors included the summary of relevant publications where intravenous magnesium sulfate was studied in children (age <18 years) with acute asthma. The NAEPP and Global Initiative for Asthma expert panel guidelines were also reviewed.
SUMMARY OF THE DATA
There is a large variability in the ED practices on the intravenous administration of MgSO for severe asthma. The pharmacokinetics of MgSO is often not taken into account with a consequent impact in its pharmacodynamics properties. The cumulative evidence points to the effectiveness of intravenous MgSO in preventing hospitalization, if utilized in a timely manner and at an appropriate dosage (50-75mg/kg). For every five children treated in the ED, one hospital admission could be prevented. Another administration modality is a high-dose continuous magnesium sulfate infusion (HDMI) as 50mg/kg/h/4h (200mg/kg/4h). The early utilization of HDMI for non-infectious mediated asthma may be superior to a MgSO bolus in avoiding admissions and expediting discharges from the ED. HDMI appears to be cost-effective if applied early to a selected population. Intravenous MgSO has a similar safety profile than other asthma therapies.
CONCLUSIONS
Treatment with intravenous MgSO reduces the odds of hospital admissions. The use of intravenous MgSO in the emergency room was not associated with significant side effects or harm. The authors emphasize the role of MgSO as an adjunctive therapy, while corticosteroids and beta agonist remain the primary acute therapeutic agents.
Topics: Acute Disease; Asthma; Child; Emergency Service, Hospital; Hospitalization; Humans; Infusions, Intravenous; Magnesium Sulfate; Severity of Illness Index
PubMed: 28754601
DOI: 10.1016/j.jped.2017.06.002 -
Acta Obstetricia Et Gynecologica... Feb 2016The optimal dosing regimen of magnesium sulfate for treating preeclampsia and eclampsia is unclear. Evidence from the Cochrane review of randomized controlled trials... (Review)
Review
INTRODUCTION
The optimal dosing regimen of magnesium sulfate for treating preeclampsia and eclampsia is unclear. Evidence from the Cochrane review of randomized controlled trials (RCTs) was inconclusive due to lack of relevant data.
MATERIAL AND METHODS
To complement the evidence from the Cochrane review, we assessed available data from non-randomized studies on the comparative efficacy and safety of alternative magnesium sulfate regimens for the management of preeclampsia and eclampsia. Sources included Medline, EMBASE, Popline, CINAHL, Global Health Library, African Index Medicus, Biological abstract, BIOSIS and reference lists of eligible studies. We selected non-randomized study designs including quasi-RCTs, cohort, case-control and cross-sectional studies that compared magnesium sulfate regimens in women with preeclampsia or eclampsia.
RESULTS
Of 6178 citations identified, 248 were reviewed in full text and five studies of low to very low quality were included. Compared with standard regimens, lower-dose regimens appeared equally as good in terms of preventing seizures [odds ratio (OR) 1.02, 95% confidence interval (CI) 0.46-2.28, 899 women, four studies], maternal morbidity (OR 0.47, 95%CI 0.32-0.71, 796 women, three studies), and fetal and/or neonatal mortality (OR 0.87, 95%CI 0.38-2.00, 800 women, four studies). Comparison of loading dose only with maintenance dose regimens showed no differences in seizure rates (OR 0.99, 95%CI 0.22-4.50, 146 women, two studies), maternal morbidity (OR 0.53, 95%CI 0.15-1.93, 146 women, two studies), maternal mortality (OR 0.63, 95%CI 0.05-7.50, 146 women, two studies), and fetal and/or neonatal mortality (OR 0.49, 95%CI 0.23-1.03, 146 women, two studies).
CONCLUSION
Lower-dose and loading dose-only regimens could be as safe and efficacious as standard regimens; however, this evidence comes from low to very low quality studies and further high quality studies are needed.
Topics: Adult; Eclampsia; Female; Humans; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Tocolytic Agents
PubMed: 26485229
DOI: 10.1111/aogs.12807 -
Nefrologia 2021The study aimed to investigate the role of magnesium sulfate prophylaxis in nephrotoxicity caused by colistin. Thirty Wistar Albino rats were divided into four groups:...
The study aimed to investigate the role of magnesium sulfate prophylaxis in nephrotoxicity caused by colistin. Thirty Wistar Albino rats were divided into four groups: control, colistin, magnesium (Mg), and Mg+colistin. The drugs were administered to the groups for seven days. Urea-creatinine values were measured at the beginning (T0) and end (T1) of the study. Malondialdehyde (MDA) levels were measured in plasma and kidney tissue, glutathione (GSH) levels were analyzed in the erythrocyte and kidney tissues. At the end of the study, the semiquantitative score (SQS) was calculated by the histopathological examination of the kidneys. Urea values significantly decreased in Mg and Mg+colistin groups compared to the baseline (p=0.013 and p=0.001). At the time of T1, these groups had significantly lower urea values than the colistin and control groups. Creatinine value was significantly increased in the colistin group compared to baseline (p=0.005), the creatinine value in the colistin group was significantly higher than the Mg+colistin group (p=0.011). Plasma MDA levels were significantly higher in the colistin group compared to the other groups at the time of T1 (p<0.001). The Mg+colistin group had lower renal MDA levels than the colistin group. The colistin group had significantly higher renal tubular grade (p=0.035), renal affected area (p<0.001), and SQS (p=0.001) than the Mg+colistin group. The results of the study suggested that Mg sulfate may have a nephrotoxicity-reducing effect on colistin.
Topics: Animals; Colistin; Creatinine; Glutathione; Humans; Magnesium; Magnesium Sulfate; Malondialdehyde; Oxidative Stress; Rats; Rats, Wistar; Renal Insufficiency; Urea
PubMed: 36165156
DOI: 10.1016/j.nefroe.2022.01.005 -
Stroke Apr 2009Magnesium sulfate is used extensively for prevention of eclamptic seizures. Empirical and clinical evidence supports the effectiveness of magnesium sulfate; however,... (Review)
Review
BACKGROUND AND PURPOSE
Magnesium sulfate is used extensively for prevention of eclamptic seizures. Empirical and clinical evidence supports the effectiveness of magnesium sulfate; however, questions remain as to its safety and mechanism. This review summarizes current evidence supporting the possible mechanisms of action and several controversies for magnesium sulfate treatment.
SUMMARY OF REVIEW
Several mechanisms are presented, including the effects of magnesium sulfate on peripheral and cerebral vasodilation, blood-brain barrier protection, and as an anticonvulsant.
CONCLUSIONS
Though the specific mechanisms of action remain unclear, the effect of magnesium sulfate in the prevention of eclampsia is likely multi-factorial. Magnesium sulfate may act as a vasodilator, with actions in the peripheral vasculature or the cerebrovasculature, to decrease peripheral vascular resistance or relieve vasoconstriction. Additionally, magnesium sulfate may also protect the blood-brain barrier and limit cerebral edema formation, or it may act through a central anticonvulsant action.
Topics: Anticonvulsants; Blood-Brain Barrier; Eclampsia; Epilepsy; Female; Humans; Magnesium Sulfate; Pregnancy; Vasodilation
PubMed: 19211496
DOI: 10.1161/STROKEAHA.108.527788