Administration Of Magnesium Sulfate Research Articles

Changes in Blood Brain-Derived Neurotrophic Factor (BDNF) Levels in Experimental Animals with Traumatic Brain Injury after Magnesium Sulfate Administration: An Experimental Study

Changes in Blood Brain-Derived Neurotrophic Factor (BDNF) Levels in Experimental Animals with Traumatic Brain Injury after Magnesium Sulfate Administration: An Experimental Study

Clinical Study of Eclampsia Patients in Early Age Group of Women Admitted into DMCh between July 2023 to December 2023

Background: Eclampsia, characterized by the onset of seizures in women with preeclampsia, is a significant cause of maternal and neonatal mortality, especially in low-resource settings like Bangladesh. Young women, particularly those in their teenage years, are especially vulnerable to this life-threatening condition due to socio-economic and health factors. Objective: This study aims to assess the clinical outcomes of eclampsia patients aged 15 to 20 years admitted to Dhaka Medical College Hospital (DMCh) between July 2023 and December 2023. Method: A cross-sectional study was conducted at DMCh, focusing on young women diagnosed with eclampsia. Patients admitted with symptoms of preeclampsia or eclampsia after 20 weeks of gestation were included. Detailed clinical evaluations and sociodemographic data were collected, including obstetric history and predisposing factors. Diagnostic tests were performed, and management protocols were followed, including the administration of magnesium sulfate. Maternal and neonatal outcomes were monitored, including mode of delivery and complications. Results: The majority of eclampsia patients (39.13%) were aged 17-18 years, followed by 35% aged 15-16 years, with a significant proportion being primigravida (55%). Most cases occurred between 36-38 weeks of gestation (35%). Antepartum eclampsia accounted for 90% of cases, and 80% of deliveries were via cesarean section. Maternal outcomes revealed a 77% improvement rate, while neonatal outcomes showed an 80% survival rate, despite a 15% stillbirth rate. Conclusion: The findings indicate that eclampsia predominantly affects young, primigravida women in late gestation, with significant implications for maternal and neonatal health. The high incidence of cesarean deliveries and notable stillbirth rates highlight the need for improved prenatal care and postnatal monitoring in this vulnerable population. Addressing these gaps could help reduce the burden of eclampsia in young women in Bangladesh.

A “Strange” Hypocalcemia

Background: Gitelman syndrome is a rare salt-losing tubulopathy (A), autosomal recessive genetic disorder that causes reduced reabsorption of NaCl in the distal convoluted tubule (Figure 1). It is characterized by metabolic alkalosis, hypocalcemia, hypomagnesemia and low levels of calcium in the urine. Case History: M. C. aged 77, suffering from chronic ischemic heart disease, systemic arterial hypertension, pulmonary emphysema, renal lithiasis; following dizziness, headache and tremors he repeatedly enters the emergency room and performs several specialists visits that place diagnosis of “Epileptic seizures in the course of hypocalcemia”. He returns to the emergency room again for the onset of unspecified tremors, dizziness and nausea. CT brain scan, CT abdomen scan, neurological and nephrological consultation are performed. Clinically presents generalized convulsions; blood chemistry tests show calcium 5.6 mg/dl, magnesium 0.4 mg/dl, urinary calcium <60 mg/24h, pH 7.50. Following intravenous administration of calcium gluconate and magnesium sulfate and normalization of blood levels of serum electrolytes, does not present additional convulsive manifestations. Discussion: Reduced sodium reabsorption generates an increase in aldosterone secretion and onset of metabolic alkalosis, the contraction of plasma volume causes hypocalciuria. Hypocalcemia is a consequence of hypomagnesemia which is itself the cause of reduced functionality of parathormone and vitamin D [1].

Unraveling the Magnesium Connection: The Cincinnati PPG's Pioneering Work on Mineral Metabolism in Diabetes and Pregnancy.

This study aimed to review the Cincinnati PPG's contribution to the understanding and treatment of neonatal hypocalcemia (NHC) in infants of diabetic mothers. This study is a retrospective review of the NIH-funded Program Project Grant (PPG) works related to mineral metabolism in type 1 diabetic pregnant women. The PPG investigators first described the epidemiology and the additional risk factors for NHC, namely prematurity and neonatal asphyxia, but also recognized the independent effect of maternal diabetes mellitus. They explored the link between NHC and maternal/neonatal hypomagnesemia. They finally conducted a randomized control trial of prevention of NHC by early administration of magnesium sulfate soon after birth to prevent NHC. The PPG in its various phases has allowed to reveal the important role that magnesium plays in the regulation of mineral metabolism in pregnancy and in particular the pregnancy complicated by pregestational diabetes. KEY POINTS: · Poor glycemic control during pregnancy leads to maternal magnesium deficiency.. · Maternal magnesium deficiency leads to fetal and neonatal magnesium deficiency.. · Neonatal magnesium deficiency leads to functional hypoparathyroidism and parathyroid hormone resistance..

Magnesium sulphate to prevent perioperative atrial fibrillation in cardiac surgery: a randomized clinical trial

BackgroundPostoperative atrial fibrillation (POAF) is a common and potentially serious complication post cardiac surgery. Hypomagnesaemia is common after cardiac surgery and recent evidence indicates that supplementation of magnesium may prevent POAF. We aim to investigate the effectiveness of continuous intravenous magnesium sulphate administration in the perioperative period to prevent POAF as compared to placebo.MethodsThe (POMPAE) trial is a phase 2, single-center, double-blinded randomized superiority clinical study. It aims to assess the impact of perioperative continuous intravenous magnesium administration on the occurrence of cardiac surgery-related POAF. A total of 530 patients will be included. Eligible patients will be randomized in 1:1 ratio to the intervention or placebo group with stratification based on the presence of valvular surgery. The objective of the infusion is to maintain ionized magnesium levels between 1.5 and 2.0 mmol/L.DiscussionThe primary outcome measure is the incidence of de novo POAF within the first 7 days following surgery, with censoring at hospital discharge. This trial may generate crucial evidence for the prevention of POAF and reduce clinical adverse events in patients following cardiac surgery.Trial registrationThe POMPAE trial was registered at ClinicalTrials.gov under the following identifier NTC05669417, https://clinicaltrials.gov/ct2/show/NCT05669417. Registered on December 30, 2022.Protocol versionVersion 3.3, dated 13–01-2023.

Effect of intra-operative Magnesium sulphate on the occurrence of post-operative delirium and insomnia in patients undergoing lumbar fixation: a randomized controlled trial

BackgroundOver the last two decades, a large body of literature has focused on studying the prevalence and outcome of the postoperative delirium and sleep disturbance. The aim of this work was to evaluate the effect of intraoperative administration of Magnesium sulphate on the occurrence of post-operative delirium and insomnia in patients undergoing lumbar fixation.MethodsThis prospective randomized controlled trial was carried out on 80 patients indicated for lumbar fixation; 40 of them received conventional general anesthesia with extra administration of intraoperative magnesium sulphate (Mg sulphate group), and the other 40 received conventional general anesthesia only (control group). Both groups were submitted to pre-operative assessment of depression using Beck Depression inventory (BDI) scale, pre-operative assessment of fatigue using a fatigue questionnaire, pre- and post-operative assessment of insomnia using Insomnia severity index (ISI), post-operative assessment of delirium using Memorial delirium assessment scale (MDAS), post-operative assessment of pain using Visual Analogue Scale (VAS), and pre- and post-operative Quantitative electroencephalography (QEEG).ResultsMg sulphate administration, age, pre-operative BDI, pre-operative ISI, and post-operative VAS were independent predictors of post-operative ISI (P-value < 0.001, 0.047, 0.021, < 0.001, and < 0.001 respectively). Age and post-operative VAS were independent predictors of post-operative MDAS (P-value = 0.008, 0.013 respectively). Mg sulphate administration and pre-operative ISI were independent predictors of post-operative VAS (P-value = 0.010, 0.006 respectively).ConclusionThere was a significant relationship between intraoperative Mg sulphate administration and both post-operative insomnia and pain in unadjusted and adjusted analysis.

Magnesium sulfate for fetal neuroprotection in preterm pregnancy: a meta-analysis of randomized controlled trials

BackgroundIntravenous administration of magnesium sulfate (MgSO4) to expectant individuals before childbirth, has been evaluated to reduce the likelihood of mortality and occurrence cerebral palsy in their offspring. Therefore, this systematic review and meta-analysis conducted to determine if were the prophylactic use of magnesium sulfate in women at risk for preterm delivery leads to decrease in the incidence of death or cerebral palsy.MethodsA comprehensive search of electronic databases was done to identify relevant studies. Selection of eligible studies was based on predetermined inclusion criteria. Data extraction was performed, and the methodological quality of the selected studies was assessed using appropriate evaluative tools. A meta-analysis was carried out to estimate the overall effect of intravenous administration of magnesium sulfate on the incidence of death or cerebral palsy.ResultsA total of 7 studies met the inclusion criteria and were included in the final analysis. No significant publication bias was observed. The risk of fetal neurological impairment was significantly lower in the MgSO4 group compared to the control group relative risk (RR = 0.70, 95% CI: 0.56 to 0.87; I20%). However, neonatal mortality was not significantly associated with MgSO4 injection. (RR = 1.03, 95% CI: 0.88 to 1.21; I2 = 42%). Subgroup analysis was done based on the bolus dosage of MgSO4 and the duration of the trial follow-up. revealing a non-significant differences between-group.ConclusionThis study demonstrated that MgSO4 administration can improve fetal neurological impairment and cerebral palsy but is not linked to reducing mortality. Further studies are necessary to strengthen the evidence and clarify the underlying mechanisms.

Effect of Magnesium Sulfate with Propofol on Hemodynamic Stability during Tracheal Intubation in Patients Undergoing Coronary Artery Bypass Grafting: A Single-Center Study

Objectives: This study aimed to assess the hemodynamic response of magnesium sulfate (MGS) with propofol during tracheal intubation in patients undergoing coronary artery bypass grafting (CABG). Methodology: A cross-sectional study was conducted at a tertiary cardiac center in Pakistan, involving 100 patients undergoing elective CABG. Hemodynamic parameters were recorded before and after intubation, following the administration of MGS with propofol. Results: The mean systolic blood pressure was 114.9±9.4 mmHg, 120.3±3.4 mmHg and 111.1±6.4 mmHg before intubation, after 2 minutes and 5minutes respectively, with p-value of &lt;0.001. The mean diastolic blood pressure was 66.2±10.3 mmHg, 67.8±6.1 mmHg, and 62±7.2 mmHg before intubation, after 2 minutes and 5minutes respectively, with p-value of &lt;0.001. The mean arterial blood pressure was 82.5±9.2 mmHg, 85.3±4.5, mmHg and 78.4±6.4 mmHg before intubation, after 2 minutes and 5minutes respectively, with p-value of &lt;0.001. The mean heart rate was 65.1±8.8 bpm, 69.7±5.2 bpm and 71.3±4.6 bpm before intubation, after 2 minutes and 5minutes respectively, with p-value of &lt;0.001. Conclusion: The study concludes that the addition of MGS to propofol contributes to hemodynamic stability during tracheal intubation in patients undergoing CABG. Further research is needed to validate these findings and explore optimal dosing regimens.

Magnesium sulfate for postoperative pain in orthopedic surgery: A narrative review.

Magnesium Sulfate (MgSO4) is a widely used adjuvant in anesthesia. Often administered with local anesthetics, it is known to reduce analgesic and opioid consumption while extending the duration of analgesia. MgSO4 applications extend to orthopedic surgeries, cardiovascular and urogenital procedures, offering extended postoperative pain relief. While commonly administered through various routes, there is a research gap concerning the comparative efficacy of intrathecal (IT) and intravenous (IV) MgSO4 administration. This narrative review aims to provide a comparison between IT and IV administration of MgSO4 particularly following orthopedic procedures, where pain management is paramount. A comprehensive literature search was conducted across several electronic databases, trial registries, and gray literature from inception to 2023. Inclusion criteria encompassed studies investigating the effects of perioperative IT administration of magnesium compared to perioperative IV administration of MgSO4 in patients undergoing surgery, with no language restrictions. Our search identified 4326 articles, of which 9 randomized controlled trials met our inclusion criteria. We summarized these selected articles. Four studies discussed IT magnesium sulfate (MgSO4) administration, 2 focused on IT administration in orthopedic surgeries, and 3 explored both IV and IT administration of MgSO4 in orthopedic surgery. IT MgSO4 shows promise in postoperative pain management, delaying block onset and extending duration. Personalized administration choice, considering patient factors and surgery type, is crucial. Further research is needed to refine strategies for better patient outcomes, particularly following orthopedic surgeries.

Randomized trial to compare acceptability of magnesium sulphate administration for preeclampsia and eclampsia: Springfusor pump versus standard of care.

In low-resource settings, magnesium sulphate (MgSO4) for preeclampsia is administered majorly through an injection into the gluteal muscles 4-hourly for 24 hours. The repeated injections are very painful and may lead to infection, abscess formation, and reduced compliance. To determine the acceptability of Springfusor® pump for the administration of Magnesium Sulphate in preeclampsia and eclampsia. Randomized Open Label Clinical Trial. The study was conducted at Kawempe National Referral Hospital. Eligible women had a systolic blood pressure of ≥140mmHg and or diastolic blood pressure >90mmHg, proteinuria ≥+1, and the physician's decision to start on MgSO4. Four-hundred-ninety-six participants were randomized to a Springfusor® pump group (n = 248) or control (standard of care) (n = 248) administration of MgSO4. Intervention group had a loading dose (4gm of 50% MgSO4 intravenously over 20 minutes) and maintenance therapy (1gm of 50% MgSO4 intravenously per hour for 24 hours) administered using the Springfusor®. The standard of care (SOC) group received a loading dose of 4gm of 20% MgSO4 IV over 15-20 minutes, followed by 10gm of 50% MgSO4 intramuscular (5gm in each buttock) and a maintenance dose of 5gm of 50% MgSO4 was administered IM every 4 hours for 24 hours. Both arms received the rest of the care for preeclampsia/eclampsia as per the hospital guidelines. Acceptability of the method of administration was assessed using a Likert scale (1-5; 1 and 2: acceptable and 3-5: unacceptable). Pain at the site of MgSO4 administration was assessed using a Visual Analogue Scale 1-7, (1 minimal pain and 7 worst pain). Comparisons were assessed with the Chi-square test, Mann Whitney-Wilcoxon test, and Students' t-test. Intervention arm; was more acceptable than the standard of care arm, (95.3% vs70.3%; p<0.001), had a lower median pain score, (2(CI: 2-2), vs 4(CI: 4-5) p<0.001), and fewer side effects. Maternal mortality was comparable between groups (0.8% in the intervention arm vs 1.2% in the IM arm). Trial No PACTR201712002887266 (https://pactr.samrc.ac.za/).

DETERMINANTS OF MORTALITY AND COMPLICATIONS IN HYPERTENSIVE DISORDERS OF PREGNANCY : A SINGLE CENTER EXPERIENCE

Our retrospective cohort study set out to identify the determinants of adverse maternal and perinatal outcome in patients admitted to intensive care (ICU) with severe features of Hypertensive Disorders of Pregnancy(HDP).Case files of patients with severe pre-eclampsia and eclampsia (including HELLP syndrome) were analyzed.The prevalence of HDP was 6.01% and eclampsia 0.99%. Parity did not affect the severity of disease nor survival. The incidence of chronic hypertension was 15.38% and 12.5% in survivors and non-survivors respectively. There was a high number of patients who did not receive any antenatal care prior to admission in both the groups [69% and 87%]. Severe anemia was significantly higherin non-survivors (42%) than in survivors (13%). Symptoms such as blurred vision, respiratory distress, oliguria, altered sensorium and absent fetal movements were prognostic markers. Multiple seizures and a time lapse between the onset of symptoms and administration of magnesium sulfate produced an increased mortality. The stillbirth rate, as expected, was high is those who demised (62.5%).We conclude that complications due to hypertension in pregnancy should be considered as a failure to provide quality antenatal care and represent a missed opportunity to detect and treat raised blood pressure.

The effect of long-term magnesium treatment on changes in hepatic autophagic and apoptotic ability of type 2 diabetic female rats and their offspring

AimWe investigated the role of magnesium sulfate (MgSO4) and insulin administration on improved autophagy and apoptosis to prevent diabetes in high-fat diet (HFD)-diabetic parents and their offspring. MethodsA HFD and a low dose of streptozotocin (STZ) were used to induce diabetes. Animals were assigned to four groups: non-diabetic control (NDC), diabetic control (DC), the diabetic group received insulin (INS), and the diabetic group received magnesium (MG). The duration of the research was 6 months, and offspring were fed a normal diet for 4 months. Blood glucose was determined weekly in rats (parents and offspring). The gene expression of adenosine monophosphate-activated protein kinase (AMPKα1), Bcl-2-interacting myosin-like coiled-coil protein (Becline-1), P62, Microtubule-associated protein 1 light chain 3 (LC3-II), and caspase-9 of liver tissues were assessed using Real-time PCR. ResultThe analysis of maternal gene expression data showed that treatment with MG and INS considerably augmented the AMPKα1 and LC3-II genes expression and diminished P62 and caspase-9 expression. Also, a significant decrease in the expression of AMPKα1, LC3-II, P62, and Becline-1 was observed in the female offspring in the MG and INS groups. Significant alterations in levels of AMPKα1, Beclin-1, P62, and caspase-9 mRNA were not observed between groups in male offspring, but the expression of LC3-II considerably diminished in the groups compared with the DC group. DiscussionOur data demonstrated that MG supplementation strengthened the mother's autophagy and reduced the transmission of damage to the female offspring. In the male offspring, the transmission of damage was generally less, and MG improved the autophagy condition in the male offspring. Our findings support the presence of a link between autophagy induction and MG-modified biomaterials and determine a potential mechanism of MG-mediated diabetes and autophagy.

Efficacy and Safety of Intravenous Magnesium Sulfate in Spinal Surgery: A Systematic Review and Meta-Analysis.

Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal surgery because of its analgesic properties and modulation of neurotransmitters and autonomic nervous system. Existing evidence regarding the use of magnesium sulfate is partial and controversial, necessitating a comprehensive meta-analysis to evaluate its efficacy and safety. The aim of this study was to conduct a comprehensive meta-analysis to evaluate the efficacy and safety of magnesium sulfate in spinal surgery compared to other available options. This meta-analysis adhered to the PRISMA guidelines. Patients undergoing spinal surgery were included, with the intervention group receiving intravenous magnesium sulfate (MS) at various doses or combinations, whereas the comparison group received other alternatives or a placebo. The efficacy and safety outcomes were assessed. Data were collected from multiple databases and analyzed using Review Manager version 5.4. Heterogeneity was assessed and fixed- or random-effects models were applied. The meta-analysis included eight studies (n = 541). Magnesium sulfate demonstrated significant reductions in pain at 24 h (MD -0.20, 95% CI: -0.39 to -0.02) and opioid consumption (SMD -0.66, 95% CI: -0.95 to -0.38) compared to placebo. Additionally, a decrease in the use of muscle relaxants (SMD -0.91, 95% CI: -1.65 to -0.17) and remifentanil (SMD -1.52, 95% CI: -1.98 to -1.05) was observed. In contrast, an increase in extubation time (MD 2.42, 95% CI: 1.14 to 3.71) and verbal response (MD 1.85, 95% CI: 1.13 to 2.58) was observed compared to dexmedetomidine. In conclusion, magnesium sulfate administration in spinal surgery reduced pain and opioid consumption, and prolonged orientation and verbal response. No significant differences in blood pressure or heart rate were observed between the groups.

A COMPARISON BETWEEN THE TWO METHODS OF MAGNESIUM SULFATE ADMINISTRATION FOR DURATION OF 12 VERSUS 24 H AFTER DELIVERY IN PATIENTS WITH SEVERE PREECLAMPSIA

Objective: Preeclampsia is one of the very serious and important complications of pregnancy which may culminate in serious maternal mortality and morbidity. For preventing eclampsia and convulsions, magnesium sulfate (Mg So4) is the medication of choice. As a standard method, it will be continued up to 24 hours after delivery of the baby. Shortening the duration of its administration can reduce the duration of hospital stay, risk of magnesium sulfate (Mg sulfate) toxicity and adverse effects, cost, duration of treatment, and patient satisfaction. The purpose of the present study was to compare the 2 methods of magnesium sulfate administration for a duration of 12 VS 24 hours after delivery in patients with severe preeclampsia. Design and method: The study was performed as a randomized clinical trial on 182 cases of severe preeclampsia. They were randomly assigned into the 2 groups. In one group, Mg sulfate was prescribed for 12 hours after delivery and in the other group, it was prescribed for 24 hours after delivery. The dosage of Mg sulfate was similar in both groups and only the duration of administration was different. Both groups were compared for the occurrence of convulsions and other adverse effects. Results: The women of the 2 groups did not have significant differences according to age, BMI, Parity, gravidity, or gestational age at the time of delivery. Also, systolic blood pressure, diastolic blood pressure, antihypertensive use, previous diabetes and renal disorders, gestational diabetes, and proteinuria were similar in both groups before treatment. One woman had a convulsion in the 12 hours group and Mg SO4 was continued for 24 hours in this case. Blood pressure, urine volume, and laboratory indexes did not show significant differences between the 2 groups before and after treatment. Also, adverse effects were similar in both groups. Pain at the injection site was less in the 12-hour group (P=0.048). Conclusions: Administration of Mg sulfate for 12 hours after delivery should be considered somehow as effective as 24 24-hour prescription for preventing convulsion after delivery.

Timing of administration of antenatal magnesium sulphate and correlation with umbilical cord blood magnesium levels in preterm babies

BackgroundThe effectiveness of MgSO4 for foetal neuroprotection is acknowledged, but the best time to provide it in relation to birth is a conundrum, and dose schedule is yet unknown. Understanding the determinants of the magnesium levels in cord blood aids in determining the appropriate timing and length of administration. Aim and objectiveTo assess the cord blood magnesium concentration in relation to the timing of MgSO4 and delivery. To achieve ROC in relation to optimum level of cord blood magnesium concentration in relation to neonatal outcome variables. Study designA prospective observational study conducted in a tertiary care hospital over 2 years in women having preterm delivery from 26 weeks to 33 + 6 weeks, who received Neuroprophylaxis. Cord blood was collected for magnesium level estimation. Baby followed 24 h after delivery. ROC analysis performed for predicting an optimal cut-off for a continuous predictor predicting binary outcome. Results85 recruited cases divided into bolus group, bolus + infusion group. The mean cord blood magnesium (n = 85) was 3.8 mg/dl. The AUROC for Gestational Age at Administration predicting Baby Outcome: 0.699, It was statistically significant (p = 0.034). The AUROC for Cord Blood Mg predicting Baby Outcome: 0.606, It was not statistically significant (p = 0.262). ConclusionMean cord blood magnesium levels served as a tool to determine the timing and duration of Neuroprophylaxis. Mean cord blood magnesium of 3.8 mg/dl should be achieved to serve the purpose of Neuroprotection. To achieve this, Bolus followed by Infusion should be administered for at-least 6 h prior to delivery.

Effects of intra-operative magnesium sulfate infusion on orthognathic surgery: A prospective and randomized controlled trial

PurposeTo comprehensively understand the effects of intra-operative infusion of magnesium sulfate on patients who underwent orthognathic surgery, including remifentanil consumption, postoperative pain, postoperative nausea and vomiting (PONV), inflammatory response, and serum magnesium levels. MethodsSeventy-five adult patients undergoing orthognathic surgery under general balanced anesthesia were randomly divided into two groups. One group (Group M) received 50 mg/kg of magnesium sulfate in 20 mL 0.9 % saline after intubation, followed by a continuous infusion at a rate of 15 mg/kg/h until 30 min before the anticipated end of surgery. The other group (Group C) received an equal volume of isotonic saline as a placebo. (Clinical trial registration number: chiCTR2100045981). ResultsThe primary outcome was remifentanil consumption. The secondary outcomes included the pain score assessed using the verbal numerical rating scale (VNRS) and PONV assessed using a Likert scale. Remifentanil comsumption in Group M was lower than Group C (mean ± SD: 0.146 ± 0.04 μg/kg/min vs. 0.173 ± 0.04 μg/kg/min, P = 0.003). At 2 h after surgery, patients in Group C suffered more severe PONV than those in Group M (median [interquartile range, IQR]: 1 [3] vs. 1 [0], mean rank: 31.45 vs. 42.71, P = 0.040). At post-anesthesia care unit (PACU), postoperative pain in Group C was severe than Group M (3 [1] vs. 3 [0], mean rank: 31.45 vs. 42.71, P = 0.013). Changes in haemodynamics and surgical field scores did not differ between the groups (all P > 0.05). The levels of cytokines (IL-4, IL-6, IL-8, IL-10, TNF-a, and MIP-1β) were not significantly different between the groups after surgery (all P > 0.05). Postoperative serum magnesium levels in Group C were lower than those in Group M (0.74 ± 0.07 mmol/L vs. 0.91 ± 0.08 mmol/L, P = 0.000) and the preoperative level (0.74 ± 0.07 mmol/L vs. 0.83 ± 0.06 mmol/L, P = 0.219). ConclusionsIn orthognathic surgery, magnesium sulfate administration can reduce remifentanil requirement and relieve PONV and postoperative pain in the early postoperative phase.

Local Magnesium Sulfate Administration Ameliorates Nociception, Peripheral Inflammation, and Spinal Sensitization in a Rat Model of Incisional Pain

ObjectivePostoperative pain remains one of the most common complaints after surgery, and appropriate treatments are limited. MethodsWe therefore investigated the effect of the anti-nociceptive properties of magnesium sulfate (MgSO4), an N-methyl-D-aspartate (NMDA) receptor antagonist, on incision-induced postoperative pain and peripheral and central nervous system inflammation. ResultsWe found that local MgSO4 administration dose-dependently increases paw withdrawal latency, indicating reduced peripheral postoperative pain. Furthermore, MgSO4 inhibited the expression of interleukin-1β (IL-1β) and inducible nitric oxide synthase (iNOS) and phosphorylation of the NMDA receptor NR1 subunit in injured paw tissue and significantly attenuated microglial and astrocytic activation in the ipsilateral lumbar spinal cord dorsal horn. ConclusionLocally administered MgSO4 has potential for development as an adjunctive therapy for preventing central nociceptive sensitization.

The Effect of Magnesium Sulfate on Contraction of Pregnant Women with Cases of Partus Premature Imminent in District General Hospitals Mentawai Islands

In 2020, it was recorded that the number of neonatal deaths in West Sumatra was 104, with 18 cases being the cause of prematurity, where the Mentawai Islands district had the highest ranking of neonate deaths with 44 deaths and 10 cases being the cause of prematurity. This research aims to determine the effect of administering magnesium sulfate therapy on contractions of pregnant women in cases of imminent premature labour at the Mentawai Islands District Hospital in 2021. This type of research is pre-experimental with a Grup Pretest-Post Test design because in this study a random sample was not carried out by taking samples from secondary data retrospectively. Data taken came from medical records of inpatients who had a diagnosis of premature labour (ICD Total sampling was taken with a total sample size of 48, and statistical data analysis using the McNemar test. Data from 48 research subjects experienced contractions and received magnesium sulfate therapy. During monitoring after administering magnesium sulfate, 3 subjects still experienced contractions and 45 subjects did not experience contractions. Uterine contractions occurred significantly more before magnesium sulfate therapy than after magnesium sulfate therapy (P&lt;0.005). There is a significant relationship between administering magnesium sulfate to patients with preterm labour to stop uterine contractions at the Mentawai Islands District Hospital. Apart from being a tocolytic therapy, magnesium sulfate also has a neuroprotectant effect so it is highly recommended for therapy in cases of premature parturition.

Survival and morbidity in very preterm infants in Shenzhen: a multi-center study.

To analyze survival and morbidity among very preterm infants (VPIs) in Shenzhen and explore factors associated with survival without major morbidity. Between January 2022 and December 2022, 797 infants were admitted to 25 neonatal intensive care units in Shenzhen with gestational age (GA) < 32 weeks, excluded discharged against medical advice, insufficient information, and congenital malformation, 742 VPIs were included. Comparison of maternal and neonate characteristics, morbidities, survival, and survival without major morbidities between groups used Mann Whitney U test and X2 test, multivariate logistic regression was used to analyze of risk factors of survival without major morbidities. The median GA was 29.86 weeks (interquartile range [IQR], 28.0-31.04), and the median birth weight was 1,250 g (IQR, 900-1,500). Of the 797 VPIs, 721 (90.46%) survived, 53.52% (38 of 71) at 25 weeks' or less GA, 86.78% (105 of 121) at 26 to 27 weeks' GA, 91.34% (211 of 230) at 28 to 29 weeks' GA, 97.86% (367 of 375) at 30 to 31 weeks' GA. The incidences of the major morbidities were moderate-to-severe bronchopulmonary dysplasia,16.52% (113 of 671); severe intraventricular hemorrhage and/or periventricular leukomalacia, 2.49% (17 of 671); severe necrotizing enterocolitis, 2.63% (18 of 671); sepsis, 2.34% (16 of 671); and severe retinopathy of prematurity, 4.55% (27 of 593), 65.79% (450 of 671) survived without major morbidities. After adjustment for GA, birth weight, and 5-min Apgar score, antenatal steroid administration (OR = 2.397), antenatal magnesium sulfate administration (OR = 1.554) were the positivity factors to survival without major morbidity of VPIs, however, surfactant therapy (OR = 0.684,), and delivery room resuscitation (OR = 0.626) that were the negativity factors. The present results indicate that survival and the incidence of survival without major morbidities increased with GA. Further, antenatal administration of steroids and magnesium sulfate, surfactant therapy, and delivery room resuscitation were pronounced determinants of survival without morbidities.

Translation of mechanistic advances in preeclampsia to the clinic: Long and winding road.

As one of the leading causes of premature birth and maternal and infant mortality worldwide, preeclampsia remains a major unmet public health challenge. Preeclampsia and related hypertensive disorders of pregnancy are estimated to cause >75 000 maternal and 500 000 infant deaths globally each year. Because of rising rates of risk factors such as obesity, invitro fertilization and advanced maternal age, the incidence of preeclampsia is going up with rates ranging from 5% to 10% of all pregnancies worldwide. A major discovery in the field was the realization that the clinical phenotypes related to preeclampsia, such as hypertension, proteinuria, and other adverse maternal/fetal events, are due to excess circulating soluble fms-like tyrosine kinase-1 (sFlt-1, also referred to as sVEGFR-1). sFlt-1 is an endogenous anti-angiogenic protein that is made by the placenta and acts by neutralizing the pro-angiogenic proteins vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). During the last decade, this work has spawned a new era of molecular diagnostics for early detection of this condition. Antagonizing sFlt-1 either by reducing production or blocking its actions has shown salutary effects in animal models. Further, in early-stage human studies, the therapeutic removal of sFlt-1 from maternal circulation has shown promise in delaying disease progression and improving outcomes. Recently, the FDA approved the first molecular test for preterm preeclampsia (sFlt-1/PlGF ratio) for clinical use in the United States. Measuring serum sFlt-1/PlGF ratio in the acute hospital setting may aid short-term management, particularly regarding step-up or step-down of care, decision to transfer to settings better equipped to manage both the mother and the preterm neonate, appropriate timing of administration of steroids and magnesium sulfate, and in expectant management decisions. The test itself has the potential to save lives. Furthermore, the availability of a molecular test that correlates with adverse outcomes has set the stage for interventional clinical trials testing treatments for this disorder. In this review, we will discuss the role of circulating sFlt-1 and related factors in the pathogenesis of preeclampsia and specifically how this discovery is leading to concrete advances in the care of women with preeclampsia.