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Journal of Medical Case Reports Nov 2017In the present study, we used Doppler velocimetry in the ophthalmic artery to evaluate the hemodynamic status of the intracranial vasculature. This is the first time in...
BACKGROUND
In the present study, we used Doppler velocimetry in the ophthalmic artery to evaluate the hemodynamic status of the intracranial vasculature. This is the first time in the literature that indices of ophthalmic artery Doppler sonography of women with preeclampsia were evaluated before and after the use of magnesium sulfate to prevent eclampsia.
CASE PRESENTATION
Indices of ophthalmic artery Doppler sonography of six women with severe preeclampsia at 27 to 33 weeks of gestational age were evaluated before and after the use of magnesium sulfate (10 minutes, 30 minutes, and 60 minutes after the magnesium sulfate loading dosage. The patients' ages were 26 years (patient 01), 29 years (patient 02), 20 years (patient 03), 21 years (patient 04), 20 years (patient 05), and 19 years (patient 06). The ethnic group of patients 01 and 04 was white and the ethnic group of patients 02, 03, 05 and 06 was mulatto.
CONCLUSIONS
The apparent increase in resistance index and pulsatility index values, although there is no statistical significance in this series of cases, and the decrease in peak ratio values after the administration of magnesium sulfate reflect an increase in the impedance to flow in the ophthalmic artery and consequently a reduction in cerebral perfusion after the use of magnesium sulfate. This may explain how magnesium sulfate protects women with severe preeclampsia against cerebral damage and prevents acute convulsions in these patients. We believe that this case series report may have a broader clinical impact across medicine because the mechanism of how magnesium sulfate can protect patients and prevent acute convulsions is controversial.
Topics: Administration, Intravenous; Adult; Analysis of Variance; Female; Gestational Age; Humans; Magnesium Sulfate; Ophthalmic Artery; Pre-Eclampsia; Pregnancy; Rheology; Severity of Illness Index; Tocolytic Agents; Ultrasonography, Doppler; Young Adult
PubMed: 29151361
DOI: 10.1186/s13256-017-1490-1 -
BMC Pediatrics Jan 2019Although therapeutic hypothermia improves the outcome of neonatal hypoxic-ischemic encephalopathy (HIE), its efficacy is still limited. This preliminary study evaluates...
Combination therapy with erythropoietin, magnesium sulfate and hypothermia for hypoxic-ischemic encephalopathy: an open-label pilot study to assess the safety and feasibility.
BACKGROUND
Although therapeutic hypothermia improves the outcome of neonatal hypoxic-ischemic encephalopathy (HIE), its efficacy is still limited. This preliminary study evaluates the safety and feasibility of the combination therapy with erythropoietin (Epo), magnesium sulfate and hypothermia in neonates with HIE.
METHODS
A combination therapy with Epo (300 U/kg every other day for 2 weeks), magnesium sulfate (250 mg/kg for 3 days) and hypothermia was started within 6 h of birth in neonates who met the institutional criteria for hypothermia therapy. All patients received continuous infusion of dopamine. Vital signs and adverse events were recorded during the therapy. Short-term and long-term developmental outcomes were also evaluated.
RESULTS
Nine patients were included in the study. The mean age at first intervention was 3.9 h (SD, 0.5). Death, serious adverse events or changes in vital signs likely due to intervention were not observed during hospital care. All nine patients completed the therapy. At the time of hospital discharge, eight patients had established oral feeding and did not require ventilation support. Two patients had abnormal MRI findings. At 18 months of age, eight patients received a follow-up evaluation, and three of them showed signs of severe neurodevelopmental disability.
CONCLUSION
The combination therapy with 300 U/kg Epo every other day for 2 weeks, 250 mg/kg magnesium sulphate for 3 days and therapeutic hypothermia is feasible in newborn patients with HIE.
TRIAL REGISTRATION
ISRCTN33604417 retrospectively registered on 14 September 2018.
Topics: Combined Modality Therapy; Drug Administration Schedule; Erythropoietin; Feasibility Studies; Female; Humans; Hypothermia, Induced; Hypoxia-Ischemia, Brain; Infant, Newborn; Magnesium Sulfate; Male; Pilot Projects; Prospective Studies
PubMed: 30621649
DOI: 10.1186/s12887-018-1389-z -
Canadian Family Physician Medecin de... Sep 2009Magnesium is considered adjuvant therapy for moderate to severe asthma exacerbations in adults, but can it be used to treat children? (Review)
Review
QUESTION
Magnesium is considered adjuvant therapy for moderate to severe asthma exacerbations in adults, but can it be used to treat children?
ANSWER
Magnesium seems to be beneficial in the treatment of moderate to severe asthma in children. It is a safe drug to administer, but there have been minor side effects reported, such as epigastric or facial warmth, flushing, pain and numbness at the infusion site, dry mouth, malaise, and hypotension. Owing to its bronchodilating and anti-inflammatory effects, magnesium is an encouraging adjuvant therapy for pediatric patients who do not respond to conventional treatment in acute severe exacerbations. Future studies should focus on establishing the optimal dosage for maximal benefits and the best route of administration. Magnesium should also be considered as a prophylactic treatment.
Topics: Administration, Inhalation; Asthma; Calcium Channel Blockers; Child; Humans; Magnesium; Magnesium Sulfate; Nebulizers and Vaporizers; Treatment Outcome
PubMed: 19752254
DOI: No ID Found -
Developmental Medicine and Child... Jan 2019Cerebral palsy (CP) remains the most significant neurological disorder associated with preterm birth. It disrupts quality of life and places huge cost burdens on... (Review)
Review
Cerebral palsy (CP) remains the most significant neurological disorder associated with preterm birth. It disrupts quality of life and places huge cost burdens on society. Antenatal magnesium sulphate administration to females before 32 weeks' gestation has proven to be an effective intervention to reduce the rate of CP. In models of hypoxia, hypoxia-ischemia, inflammation, and excitotoxicity in various animal species, magnesium sulphate preconditioning decreased the resulting lesion sizes and inflammatory cytokine levels, prevented cell death, and improved long-term cognitive and motor behaviours. In humans, meta-analyses of five randomized controlled trials using magnesium sulphate as a neuroprotectant showed prevention of CP at 2 years. The benefit remained consistent regardless of gestational age, cause of preterm birth, and total dose received. Antenatal magnesium sulphate treatment is now recommended by the World Health Organization and by many obstetric societies. Its cost-effectiveness further justifies its widespread implementation. WHAT THIS PAPER ADDS: Neuroprotective effect of magnesium sulphate to reduce cerebral palsy in infants born preterm when administered to females at risk of imminent preterm birth. Neuroprotection regardless of gestational age, cause of preterm birth, and total dose. Antenatal magnesium sulphate treatment has good cost-effectiveness.
Topics: Animals; Brain; Female; Humans; Infant, Newborn; Infant, Premature; Magnesium Sulfate; Neuroprotective Agents; Pregnancy; Prenatal Care
PubMed: 30294845
DOI: 10.1111/dmcn.14038 -
Anaesthesia Jan 2013Intravenous magnesium has been reported to improve postoperative pain; however, the evidence is inconsistent. The objective of this quantitative systematic review is to... (Meta-Analysis)
Meta-Analysis Review
Intravenous magnesium has been reported to improve postoperative pain; however, the evidence is inconsistent. The objective of this quantitative systematic review is to evaluate whether or not the peri-operative administration of intravenous magnesium can reduce postoperative pain. Twenty-five trials comparing magnesium with placebo were identified. Independent of the mode of administration (bolus or continuous infusion), peri-operative magnesium reduced cumulative intravenous morphine consumption by 24.4% (mean difference: 7.6 mg, 95% CI -9.5 to -5.8 mg; p < 0.00001) at 24 h postoperatively. Numeric pain scores at rest and on movement at 24 h postoperatively were reduced by 4.2 (95% CI -6.3 to -2.1; p < 0.0001) and 9.2 (95% CI -16.1 to -2.3; p = 0.009) out of 100, respectively. We conclude that peri-operative intravenous magnesium reduces opioid consumption, and to a lesser extent, pain scores, in the first 24 h postoperatively, without any reported serious adverse effects.
Topics: Acute Pain; Analgesics, Opioid; Bradycardia; Endpoint Determination; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Magnesium Sulfate; Male; Morphine; Pain Measurement; Pain, Postoperative; Perioperative Care; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 23121612
DOI: 10.1111/j.1365-2044.2012.07335.x -
Poultry Science May 1975Potential for increasing contamination of water supplies with such materials as dissolved inorganic solids suggests more precise water quanlity standards for poultry....
Potential for increasing contamination of water supplies with such materials as dissolved inorganic solids suggests more precise water quanlity standards for poultry. Commercial strain S.C.W.L. hens were supplied water containing sodium sulfate (Na2SO4) or magnesium sulfate (MgSO4) (250, 1,000, 4,000, or 16,000 p.p.m.) on a total sulfate basis in Exp. 1 and on a total salt basis in Exp. 2. All data are expressed as percentages deviated from pre-treatment performance. Four thousand p.p.m. of total sulfate as Na2SO4 or MgSO4 significantly depressed feed consumption and hen-day production. Magnesium sulfate (4,000 p.p.m.) had a more depressing effect than Na2SO4 (4,000 p.p.m.) on hen-day production (-80.4 vs. -24.4%). At that level, Na2SO4 significantly increased water consumption and fecal moisture content, while MgSO4 significantly decreased water consumption. All hens on 1l,000 p.p.m. of either salt died during the experiment. No effect on egg quality was observed before the hens died. On a total salt basis (Exp. 2) 16,000 p.p.m. of either Na2SO4 or MgSO4 significantly depressed hen-day production, body weight, and feed comsumption, but increased water consumption. Hens receiving 16,000 p.p.m. Na2SO4 increased water consumption more than those receiving 16,000 p.p.m. MgSO4(146.7 and 24.6%). No significant differences between treatments were observed for mortality (Exp. 2). Mortality data suggest that lethal levels of Na2SO4 and MgSO4 are between 16,000 and 20,032 or 23,680 p.p.m. total salt, respectively.
Topics: Administration, Oral; Animal Feed; Animals; Body Weight; Chickens; Drinking; Eating; Eggs; Feces; Female; Magnesium Sulfate; Oviposition; Poultry Diseases; Sodium; Sulfates; Water
PubMed: 1153372
DOI: 10.3382/ps.0540707 -
BMC Public Health Apr 2011Pre-eclampsia and Eclampsia are relatively common complications of pregnancy, leading to considerable maternal and fetal mortality and morbidity. We sought to review the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pre-eclampsia and Eclampsia are relatively common complications of pregnancy, leading to considerable maternal and fetal mortality and morbidity. We sought to review the effect of aspirin, calcium supplementation, antihypertensive agents and magnesium sulphate on risk stillbirths.
METHODS
A systematic literature search was conducted to identify studies evaluating the above interventions. We used a standardized abstraction and grading format and performed meta-analyses where data were available from more than one studies. The estimated effect on stillbirths was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules for multiple outcomes. For interventions with insufficient evidence for overall effect, a Delphi process was undertaken to estimate effectiveness.
RESULTS
We identified 82 relevant studies. For aspirin, maganesium sulphate and use of antihypertensive we found an insignificant decrease in stillbirth and perinatal mortality. For calcium supplementation, there was a borderline significant reduction in stillbirths (RR 0.81, 95 % CI 0.63-1.03). We undertook a Delphi consultation among experts to assess the potential impact of a package of interventions for the management of pre-eclampsia and eclampsia (antihypertensive, magnesium sulphate and C-section if needed). The Delphi process suggested 20% reduction each in both antepartum and intrapartum stillbirths with the use of this package.
CONCLUSIONS
Despite promising benefits of calcium supplementation and aspirin use cases on maternal morbidity and eclampsia in high risk cases, further work is needed to ascertain their benefits in relation to stillbirths. The Delphi process undertaken for assessing potential impact of a package of interventions indicated that this could be associated with 20% reduction in stillbirths, for input into LiST.
Topics: Antihypertensive Agents; Aspirin; Calcium; Dietary Supplements; Eclampsia; Female; Humans; Magnesium Sulfate; Pre-Eclampsia; Pregnancy; Stillbirth
PubMed: 21501457
DOI: 10.1186/1471-2458-11-S3-S6 -
Clinical Gastroenterology and... Aug 2014Little is known about the effects of natural mineral water on constipation in adults. We assessed the effect of a magnesium sulfate-rich natural mineral water (Hépar;... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND & AIMS
Little is known about the effects of natural mineral water on constipation in adults. We assessed the effect of a magnesium sulfate-rich natural mineral water (Hépar; Nestlé Waters, Issy-les-Moulineaux, France) on gastrointestinal transit in constipated women.
METHODS
We performed a randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of Hépar in outpatients with functional constipation (based on the Rome III criteria). The study included 244 female patients, age 18 to 60 years, identified by 62 general practitioners throughout France. After a washout period, subjects drank 1.5 L natural low-mineral water daily (control, n = 77), 0.5 L Hépar and 1 L natural low-mineral water daily (Hépar 0.5 group, n = 85), or 1 L Hépar and 0.5 L natural low-mineral water daily (Hépar 1 group, n = 82) for 4 weeks. We collected information on the number and types of stools, abdominal pain, rescue medications, adverse events, and volume of water consumed.
RESULTS
We observed no significant effect at week 1. At week 2, constipation was reduced in 21.1% of patients in the control group, in 30.9% in the Hépar 0.5 group (P = .099 vs controls), and in 37.5% in the Hépar 1 group (P = .013 vs controls). The Hépar 1 group also had a decreased number of hard or lumpy stools (Bristol scale, P = .030 vs baseline) and a substantial decrease in the use of rescue medication (P = .034 vs controls). Patient responses correlated with magnesium sulfate concentrations. Safety was very good; there were no serious adverse events among patients who drank Hépar.
CONCLUSIONS
In a controlled trial, daily consumption of 1 L Hépar reduced constipation and hard or lumpy stools in a greater percentage of women with functional constipation than natural low-mineral water, as early as the second week of treatment.
Topics: Adolescent; Adult; Constipation; Female; France; Humans; Magnesium Sulfate; Middle Aged; Mineral Waters; Treatment Outcome; Young Adult
PubMed: 24342746
DOI: 10.1016/j.cgh.2013.12.005 -
Minerva Anestesiologica Nov 2015The effectiveness of combining magnesium (Mg) administration with both general and spinal anesthesia to reduce postoperative pain and analgesic consumption is still... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The effectiveness of combining magnesium (Mg) administration with both general and spinal anesthesia to reduce postoperative pain and analgesic consumption is still debated. We evaluated the effects of an intravenous (IV) infusion of Mg sulphate on analgesic consumption and postoperative pain score after total knee arthroplasty performed under spinal anesthesia.
METHODS
We studied 40 patients who underwent spinal anesthesia with bupivacaine plus morphine. Patients were randomly assigned to two groups, each of 20 patients, who received either treatment (i.e., intravenous Mg sulphate 40 mg kg(-1) followed by an infusion of 10 mg kg(-1) h(-1)), or the same amounts of isotonic saline (controls). Irrespective of the group of randomization, all patients received postoperative paracetamol, ketorolac, and patient-controlled analgesia with morphine.
RESULTS
The Mg postoperative blood level was 0.85 ± 0.02 mmol/L and 1.25 ± 0.11 mmol/L for C and Mg groups, respectively (P<0.001). Sensory level of the spinal block, height of spinal block, mean time to first pain and incidence of PONV were similar in the two groups. Morphine consumption did not show any statistically significant difference between the two groups. The pain score was not significantly different between the two groups. No severe adverse effects were recorded after Mg infusion.
CONCLUSION
IV perioperative administration of Mg did not influence postoperative pain control and analgesic consumption after total knee arthroplasty. More studies should be performed with different intra and postoperative pain protocols to enhance the potential anti-nociceptive effect of Mg.
Topics: Aged; Analgesia, Patient-Controlled; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthesia, Spinal; Arthroplasty, Replacement, Knee; Calcium; Female; Humans; Magnesium; Magnesium Sulfate; Male; Middle Aged; Pain, Postoperative
PubMed: 25616206
DOI: No ID Found -
Archives of Disease in Childhood. Fetal... Jul 2023To evaluate the effectiveness and cost-effectiveness of the National PReCePT Programme (NPP) in increasing use of magnesium sulfate (MgSO) in preterm births.
National PReCePT Programme: a before-and-after evaluation of the implementation of a national quality improvement programme to increase the uptake of magnesium sulfate in preterm deliveries.
OBJECTIVE
To evaluate the effectiveness and cost-effectiveness of the National PReCePT Programme (NPP) in increasing use of magnesium sulfate (MgSO) in preterm births.
DESIGN
Before-and-after study.
SETTING
Maternity units (N=137) within NHS England and the Academic Health Science Network (AHSN) in 2018.
PARTICIPANTS
Babies born ≤30 weeks' gestation admitted to neonatal units in England.
INTERVENTIONS
The NPP was a quality improvement (QI) intervention including the PReCePT (Preventing Cerebral Palsy in Pre Term labour) QI toolkit and materials (preterm labour proforma, staff training presentations, parent leaflet, posters for the unit and learning log), regional AHSN-level support, and up to 90 hours funded backfill for a midwife 'champion' to lead implementation.
MAIN OUTCOME MEASURES
MgSO uptake post implementation was compared with pre-NPP implementation uptake. Implementation and lifetime costs were estimated.
RESULTS
Compared with pre-implementation estimates, the average MgSO uptake for babies born ≤30 weeks' gestation, in 137 maternity units in England, increased by 6.3 percentage points (95% CI 2.6 to 10.0 percentage points) to 83.1% post implementation, accounting for unit size, maternal, baby and maternity unit factors, time trends, and AHSN. Further adjustment for early/late initiation of NPP activities increased the estimate to 9.5 percentage points (95% CI 4.3 to 14.7 percentage points). From a societal and lifetime perspective, the health gains and cost savings associated with the NPP effectiveness generated a net monetary benefit of £866 per preterm baby and the probability of the NPP being cost-effective was greater than 95%.
CONCLUSION
This national QI programme was effective and cost-effective. National programmes delivered via coordinated regional clinical networks can accelerate uptake of evidence-based therapies in perinatal care.
Topics: Infant, Newborn; Humans; Pregnancy; Female; Magnesium Sulfate; Quality Improvement; Infant, Premature; Parturition; England
PubMed: 36617442
DOI: 10.1136/archdischild-2022-324579