Magnesium sulfate as an anesthetic adjuvant for children undergoing adenotonsillectomy

Abstract

Background This randomized, double-blind, prospective-controlled study was designed to assess magnesium sulfate, an N -methyl-D-aspartate receptor blocker, as an anesthetic adjuvant decreasing emergence delirium/agitation, pain, postoperative analgesic requirement, and adverse events. Patients and methods Forty-seven patients undergoing an adenotonsillectomy were included in two parallel groups: the magnesium group received magnesium sulfate 40 mg/kg intravenously after induction of anesthesia, followed by 15 mg/kg/h by a continuous intravenous infusion during the operation. The same volume of isotonic solution was administered to the control group. Primary outcome measures were emergence delirium/agitation assessed by pediatric anesthesia emergence delirium scale. Secondary measures included intraoperative sevoflurane concentration, recovery time, pain assessed by objective pain score, time to first postoperative rescue analgesic, the total dose of rescue fentanyl required, need for rescue antiemetic, postanesthetic care unit (PACU) stay, postoperative total analgesic required, and postoperative adverse events. Results In the magnesium group, there was a reduction in the incidence and severity of pediatric anesthesia emergence delirium [(13 vs. 39%) and (8 vs. 14)], objective pain score (1 vs. 3), sevoflurane concentration (0.0001), time to discharge from the PACU ( P = 0.04), postoperative analgesic requirement, and adverse events compared with the control group. Conclusion Magnesium sulfate as an anesthetic adjuvant decreased the incidence and severity of postoperative emergence agitation and pain, intraoperative sevoflurane concentration, time in PACU, and postoperative analgesic requirement.