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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 -
Korean Journal of Anesthesiology Dec 2023Respiratory mechanics are often significantly altered in morbidly obese patients and magnesium sulfate (MgSO4) is a promising agent for managing several respiratory... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of magnesium sulfate on oxygenation and lung mechanics in morbidly obese patients undergoing bariatric surgery: a prospective double-blind randomized clinical trial.
BACKGROUND
Respiratory mechanics are often significantly altered in morbidly obese patients and magnesium sulfate (MgSO4) is a promising agent for managing several respiratory disorders. This study aimed to examine the effects of MgSO4 infusions on arterial oxygenation and lung mechanics in patients with morbid obesity undergoing laparoscopic bariatric surgery.
METHODS
Forty patients with morbid obesity aged 21-60 years scheduled for laparoscopic bariatric surgery under general anesthesia were randomly allocated to either the control (normal saline infusion) or MgSO4 group (30 mg/kg lean body weight [LBW] of 10% MgSO4 in 100 ml normal saline intravenously over 30 min as a loading dose, followed by 10 mg/kg LBW/h for 90 min). The primary outcome was intraoperative arterial oxygenation (ΔPaO2/FiO2). Secondary outcomes included intraoperative static and dynamic compliance, dead space, and hemodynamic parameters.
RESULTS
At 90 min intraoperatively, the Δ PaO2/FiO2 ratio and the Δ dynamic lung compliance were statistically significantly higher in the MgSO4 group (mean ± SE: 16.1 ± 1.0, 95% CI [14.1, 18.1] and 8.4 ± 0.5 ml/cmH2O, 95% CI [7.4, 9.4]), respectively), and the Δ dead space (%) was statistically significantly lower in the MgSO4 group (mean ± SE: -8.0 ± 0.3%, 95% CI [-8.6, -7.4]) (P < 0.001). No significant differences in static compliance were observed.
CONCLUSIONS
Although MgSO4 significantly preserved arterial oxygenation and maintained dynamic lung compliance and dead space in patients with morbid obesity, the clinical relevance is minimal. This study failed to adequately reflect the clinical importance of these results.
Topics: Humans; Obesity, Morbid; Magnesium Sulfate; Prospective Studies; Saline Solution; Lung; Bariatric Surgery
PubMed: 36539925
DOI: 10.4097/kja.22446 -
American Family Physician Feb 2021
Review
Topics: Acute Disease; Administration, Intravenous; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Asthmatic Agents; Asthma; Child; Child, Preschool; Curriculum; Education, Medical, Continuing; Female; Humans; Infant; Magnesium Sulfate; Male; Middle Aged; Young Adult
PubMed: 33587577
DOI: No ID Found -
Acta Obstetricia Et Gynecologica... Apr 2023Preterm delivery and its complications are among the biggest challenges and health risks in obstetrical practice. Several tocolytic agents are used in clinical practice,...
INTRODUCTION
Preterm delivery and its complications are among the biggest challenges and health risks in obstetrical practice. Several tocolytic agents are used in clinical practice, although the efficacy and side effect profiles of these drugs are not satisfying. The aim of this study was to investigate the uterus relaxant effect of the coadministration of β -mimetic terbutaline and magnesium sulfate (MgSO ) in an isolated organ bath and to perform in vivo smooth muscle electromyographic (SMEMG) studies in pregnant rats. In addition, we also investigated whether the tachycardia-inducing effect of terbutaline can be reduced by the presence of magnesium, due to the opposite heart rate modifying effects of the two agents.
MATERIAL AND METHODS
In the isolated organ bath studies, rhythmic contractions of 22-day- pregnant Sprague-Dawley rats were stimulated with KCl, and cumulative dose-response curves were constructed in the presence of MgSO or terbutaline. The uterus-relaxing effects of terbutaline were also investigated in the presence of MgSO in both normal buffer and Ca -poor buffer. The in vivo SMEMG studies were carried out under anesthesia with the subcutaneous implantation of an electrode pair. The animals were treated with MgSO or terbutaline alone or in combination in a cumulative bolus injection. The implanted electrode pair also detected the heart rate.
RESULTS
Both MgSO and terbutaline reduced uterine contractions in vitro and in vivo, furthermore, the administration of a small dose of MgSO significantly enhanced the relaxant effect of terbutaline, especially in the lower range. However, in Ca -poor environment, MgSO was not able to increase the effect of terbutaline, indicating the role of MgSO as a Ca channel blocker. In the cardiovascular studies, MgSO significantly decreased the tachycardia-inducing effect of terbutaline in late pregnant rats.
CONCLUSIONS
The combined application of MgSO and terbutaline may have clinical significance in tocolysis, which must be confirmed in clinical trials. Furthermore, MgSO could substantially reduce the tachycardia-inducing side effect of terbutaline.
Topics: Pregnancy; Female; Rats; Animals; Terbutaline; Magnesium Sulfate; Rats, Sprague-Dawley; Tocolytic Agents; Uterus
PubMed: 36808376
DOI: 10.1111/aogs.14532 -
Journal of Clinical Pharmacology Nov 2019Magnesium sulfate is the anticonvulsant of choice for eclampsia prophylaxis and treatment; however, the recommended dosing regimens are costly and cumbersome and can be...
Magnesium sulfate is the anticonvulsant of choice for eclampsia prophylaxis and treatment; however, the recommended dosing regimens are costly and cumbersome and can be administered only by skilled health professionals. The objectives of this study were to develop a robust exposure-response model for the relationship between serum magnesium exposure and eclampsia using data from large studies of women with preeclampsia who received magnesium sulfate, and to predict eclampsia probabilities for standard and alternative (shorter treatment duration and/or fewer intramuscular injections) regimens. Exposure-response modeling and simulation were applied to existing data. A total of 10 280 women with preeclampsia who received magnesium sulfate or placebo were evaluated. An existing population pharmacokinetic model was used to estimate individual serum magnesium exposure. Logistic regression was applied to quantify the serum magnesium area under the curve-eclampsia rate relationship. Our exposure-response model-estimated eclampsia rates were comparable to observed rates. Several alternative regimens predicted magnesium peak concentration < 3.5 mmol/L (empiric safety threshold) and eclampsia rate ≤ 0.7% (observed response threshold), including 4 g intravenously plus 10 g intramuscularly followed by either 8 g intramuscularly every 6 hours × 3 doses or 10 g intramuscularly every 8 hours × 2 doses and 10 g intramuscularly every 8 hours × 3 doses. Several alternative magnesium sulfate regimens with comparable model-predicted efficacy and safety were identified that merit evaluation in confirmatory clinical trials.
Topics: Adult; Anticonvulsants; Eclampsia; Female; Humans; Magnesium Sulfate; Pre-Eclampsia; Pregnancy
PubMed: 31157410
DOI: 10.1002/jcph.1448 -
Archives of Razi Institute Jun 2020Clostridium septicum, the anaerobic toxigenic bacterium is the agent that causes dangerous disease in man and animals. There is a lethal toxin of the bacterium namely...
Clostridium septicum, the anaerobic toxigenic bacterium is the agent that causes dangerous disease in man and animals. There is a lethal toxin of the bacterium namely alpha toxin. The ɑ-toxin has hemolytic, necrotic and lethal activities. Today, Razi Vaccine and Serum Research Institute of Iran produced the C. septicum vaccine in the form of bacterin/toxoid. Because of some problems, the vaccine needs to improve on an industrial scale. The study is going to find an appropriate supplement to improve growth and ɑ-toxin production. Three strains of C. septicum (vaccine, NH1 and NH8 strains) were cultured in the basic vaccine media. Magnesium sulfate, Copper, Ferrous, yeast extract, and trace elements plus vitamins' solution were added to the basic vaccine media in different cultures. The effect of the ingredients on the growth was measured by a spectrophotometer and the α-toxin secretion was assayed by hemolysin test. Growth of the bacterium and α-toxin secretion were increased by Magnesium (80 mg/l) in NH8 and vaccine strains significantly. The black precipitate was difficult to dissolve in magnesium media that must be solved. Trace elements plus vitamins solution mildly influence on NH1strain growth and toxin secretion. Other supplements (Cu, Fe, yeast extract) were not showen any significant changes in the growth and α-toxin production of C. septicum. Overflowing peptone (4%) in the vaccine media, fixes essentials of proteolysis activity, allows the sufficient growth and toxin production without Cu, Fe, and yeast extract. Due to essentially of Mg for growth, extra magnesium was added for improvement of media culture. The study suggests for Magnesium addition in the C. septicum vaccine media during production procedure after precipitation solving problem.
Topics: Bacterial Toxins; Bacterial Vaccines; Clostridium septicum; Magnesium Sulfate
PubMed: 32621451
DOI: 10.22092/ari.2019.124567.1284 -
Emergency Medicine Journal : EMJ Dec 2007To estimate the effect of intravenous and nebulised magnesium sulphate upon hospital admissions and pulmonary function in adults and children with acute asthma. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To estimate the effect of intravenous and nebulised magnesium sulphate upon hospital admissions and pulmonary function in adults and children with acute asthma.
METHODS
We undertook a systematic review and meta-analysis of randomised and quasi-randomised trials of intravenous or nebulised magnesium sulphate in acute asthma. Trials were identified by searches of the electronic literature, relevant journal websites and conference proceedings, and contact with authors and experts. Data were pooled using random effects meta-analysis of the relative risk (RR) of hospital admission and the standardised mean difference (SMD) in pulmonary function.
RESULTS
24 studies (15 intravenous, 9 nebulised) incorporating 1669 patients were included. Intravenous treatment was associated in adults with weak evidence of an effect upon respiratory function (SMD 0.25, 95% confidence interval (CI) -0.01 to 0.51; p = 0.05), but no significant effect upon hospital admission (RR 0.87, 95% CI 0.70 to 1.08; p = 0.22), and in children with a significant effect upon respiratory function (SMD 1.94, 95% CI 0.80 to 3.08; p<0.001) and hospital admission (RR 0.70, 95% CI 0.54 to 0.90; p = 0.005). Nebulised treatment was associated in adults with weak evidence of an effect upon respiratory function (SMD 0.17, 95% CI -0.02 to 0.36; p = 0.09), and hospital admission (RR 0.68, 95% CI 0.46 to 1.02; p = 0.06), and in children with no significant effect upon respiratory function (SMD -0.26, 95% CI -1.49 to 0.98; p = 0.69) or hospital admission (RR 2.0, 95% CI 0.19 to 20.93; p = 0.56).
CONCLUSION
Intravenous magnesium sulphate appears to be an effective treatment in children. Further trials are needed of intravenous and nebulised magnesium sulphate in adults and nebulised magnesium sulphate in children.
Topics: Acute Disease; Administration, Inhalation; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Asthmatic Agents; Asthma; Child; Female; Hospitalization; Humans; Injections, Intravenous; Magnesium Sulfate; Male; Middle Aged; Nebulizers and Vaporizers; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 18029512
DOI: 10.1136/emj.2007.052050 -
Anaesthesia Dec 2012Uncontrolled studies suggest that magnesium sulphate controls spasms in patients with established tetanus. We performed a meta-analysis of controlled trials that... (Meta-Analysis)
Meta-Analysis Review
Uncontrolled studies suggest that magnesium sulphate controls spasms in patients with established tetanus. We performed a meta-analysis of controlled trials that compared magnesium sulphate with placebo or diazepam for the treatment of patients with tetanus. We searched PubMed, Scopus, Embase and the Cochrane clinical trials registry. Three studies met the inclusion criteria, containing 275 participants (199 male patients, 72.4%). Magnesium sulphate did not reduce mortality, relative risk (95% CI): vs placebo, 0.80 (0.41-1.58); vs diazepam, 1.11 (0.70-1.75). The data on duration of total intensive care unit stay, total hospital stay and the need for ventilatory support were conflicting and pooling of results could not be done due to methodological differences of individual trials. More controlled trials are needed to assess the effect of magnesium sulphate on reducing autonomic instability, spasms, duration of intensive care and hospital stays and the need for mechanical ventilation.
Topics: Anticonvulsants; Diazepam; Female; Humans; Magnesium Sulfate; Male; Randomized Controlled Trials as Topic; Spasm; Tetanus
PubMed: 23033859
DOI: 10.1111/anae.12020 -
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 -
Acta Obstetricia Et Gynecologica... Aug 2022Magnesium sulfate is used world-wide to treat pregnant women at imminent risk of preterm delivery in order to protect the brain of the premature infant. Previous...
INTRODUCTION
Magnesium sulfate is used world-wide to treat pregnant women at imminent risk of preterm delivery in order to protect the brain of the premature infant. Previous research has shown that magnesium sulfate decreases the risk of cerebral palsy by ~30% in infants born preterm. Despite this, the dosage required for optimal neuroprotection remains unknown. We aimed to investigate whether 6 g magnesium sulfate given as a single bolus dose was tolerable for the women and infants and whether the desired target concentration in the mother's blood was reached and non-toxic level in the infant could be ensured.
MATERIAL AND METHODS
In total, 49 women who were at risk of delivery prior to 32 weeks of gestation were recruited. They received a bolus dose of 6 g magnesium sulfate intravenously between 1 and 24 h prior to giving birth and were closely monitored during and after infusion. Blood samples from the patients were analyzed at different time-points (20-30 min after start of infusion, 1, 2, 6 and 24 h) post-administration. Blood samples from the umbilical cord were also taken directly after birth to assess the concentration of magnesium in the infant.
RESULTS
None of the women who received magnesium sulfate reached serum magnesium concentrations >3.3 mmol/L. In all, 72% of the women showed serum magnesium levels within the therapeutic interval (2.0-3.5 mmol/L) and no adverse events were observed during the infusion. The serum magnesium levels in the mothers declined to pre-bolus-levels within 24 h after delivery. Serum magnesium levels in the umbilical cord samples ranged from 0.87 to 1.4 mmol/L, which means that all but two were within the normal expected range for a newborn premature infant.
CONCLUSIONS
A bolus dose of 6 g magnesium sulfate was well tolerated and without any serious side effects in either mother or infant. Most of our women reached the targeted concentration range of serum magnesium levels after infusion was completed. Their infants had magnesium levels within acceptable levels, regardless of gestational week or mother's body mass index.
Topics: Cerebral Palsy; Female; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Magnesium; Magnesium Sulfate; Neuroprotective Agents; Pregnancy; Premature Birth; Prenatal Care
PubMed: 35501953
DOI: 10.1111/aogs.14372