Administration Of Magnesium Sulfate Research Articles

Pulmonary oedema in the course of severe maternal outcome in South Africa: A cohort study combined with clinical audit.

To describe the incidence and outcomes of pulmonary oedema in women with severe maternal outcome during childbirth and identify possible modifiable factors through audit. All women with severe maternal outcome (maternal deaths or near misses) who were referred to Tygerberg referral hospital from health facilities in Metro East district, South Africa, during 2014-2015 were included. Women with severe maternal outcome and pulmonary oedema during pregnancy or childbirth were evaluated using three types of critical incident audit: criterion-based case review by one consultant gynaecologist, monodisciplinary critical incident audit by a team of gynaecologists, multidisciplinary audit with expert review from anaesthesiologists and cardiologists. Of 32,161 pregnant women who gave birth in the study period, 399 (1.2%) women had severe maternal outcome and 72/399 (18.1%) had pulmonary oedema with a case fatality rate of 5.6% (4/72). Critical incident audit demonstrated that pre-eclampsia/HELLP-syndrome and chronic hypertension were the main conditions underlying pulmonary oedema (44/72, 61.1%). Administration of volumes of intravenous fluids in already sick women, undiagnosed underlying cardiac illness, administration of magnesium sulphate as part of pre-eclampsia management and oxytocin for augmentation of labour were identified as possible contributors to the pathophysiology of pulmonary oedema. Women-related factors (improved antenatal care attendance) and health care-related factors (earlier diagnosis and management) would potentially have improved maternal outcome. Although pulmonary oedema in pregnancy is rare, among women with severe maternal outcome a considerable proportion had pulmonary oedema (18.1%). Audit identified options for prevention of pulmonary oedema and improved outcome. These included early detection and management of preeclampsia with close monitoring of fluid intake and cardiac evaluation in case of suspected pulmonary oedema. Therefore, a multidisciplinary clinical approach is recommended.

Administration of magnesium sulphate does not prevent post-reperfusion syndrome but is necessary during living donor liver transplantation.

Severe hemodynamic instability is observed during portal vein de-clamping in the form of post-reperfusion syndrome in liver transplantation. The protective effect of magnesium on inflammation and ischemia-reperfusion injuries of various organs is evident, but its role in the prevention of post-reperfusion syndrome in liver transplantation is not clear. We investigated the effect of magnesium sulphate on the incidence of post-reperfusion syndrome during living donor liver transplantation. The secondary outcomes were the requirement of vasopressor boluses and levels of serum magnesium, lactate and serum C-reactive protein. Seventy living donor liver transplant recipients were randomized into a magnesium (M) group (n=35) or normal saline (N) group (n=35). The patients in group M received 35mg/kg of magnesium sulphate, 30 minutes after the beginning of the anhepatic phase, and patients in group N received normal saline. The incidence of post-reperfusion syndrome in group M and group N was 34.29% and 40%, respectively, with no significant difference. The requirement for rescue vasopressor boluses and levels of C-reactive protein and lactate were also comparable between the two groups. However, the incidence of hypomagnesemia at the end of surgery was significantly higher in group N (37.1% vs. 14.28%, p=0.027). Magnesium does not appear to prevent post-reperfusion syndrome. However, hypomagnesemia is more frequently seen during liver transplantation. Hence, serum magnesium should be routinely monitored and administered during liver transplantation.

Scaling up an intervention to protect preterm infants from neurodevelopmental disabilities — findings from a qualitative process evaluation comparing standard with enhanced quality improvement support packages for maternity units in England

BackgroundA quality improvement strategy (PReCePT) was used in a standard and enhanced format to scale up a clinical intervention (administering magnesium sulphate to women in preterm labour) across all maternity units in England to protect prematurely born infants from neurodevelopmental disabilities. Formal evaluations reported the effectiveness of the standard package alone in increasing the administration of magnesium sulphate. In this paper, we focus on the findings of the process evaluations, using normalisation process theory to explain how different implementation contexts generated the observed outcomes relating to normative and relational restructuring and sustainment.MethodsInterviews were conducted with key individuals in implementation of leadership positions nationally and locally. Interviews were analysed initially using the framework method. We then engaged recursively with NPT constructs to generate generalisable insights with pragmatic applicability in other settings.ResultsIn total, 72 interviews were conducted with good representation from units across England and staff from the National Academic Health Science Network. We found that all units irrespective of whether they received a standard or enhanced QI package were successful in the ‘normative restructuring’ of their setting to enable magnesium sulphate to be administered. This suggests that this implementation outcome is necessary to achieve improvements. However, it may not be sufficient to sustain the changes once additional resources have been withdrawn. Sustainment, our findings suggest, required ‘relational restructuring’ to accommodate altered workflows and facilitate the sharing of responsibilities and tasks in daily practice. Relational restructuring was more likely to have been achieved units receiving enhanced QI support but also happened in units with standard QI support, especially in those where perinatal team working was already well established.ConclusionUnlike other large QI-focused spread-and-scale programmes which failed to show any impact on outcomes, the PReCePT programme in both the enhanced and standard support packages led to improvements in the uptake of magnesium sulphate. The findings suggest that QI programmes interact with the enabling factors, such as strong interprofessional team working, already present in the setting. A standard package with minimal support was therefore sufficient in settings with enabling factors, but enhanced support was required in units where these were absent.

Laparoscopy in Pregnancy: A Comparative Review of National Guidelines.

Gynecological and general surgical conditions requiring surgical management during pregnancy constitute a medical challenge, which often entailsthe collaboration of numerous medical specialties. In recent years, laparoscopy in pregnancy has been accepted as a safe alternative to open surgery. This has led gynecological societies to conduct studies and issue guidelines related to laparoscopy in pregnancy, with a view to assisting and guiding clinicians and surgeons. The aim of this study was to review and compare the recommendations from various published national guidelines on laparoscopy in pregnant women. To that end, a descriptive review of guidelines fromthe British Society for Gynaecological Endoscopy (BSGE), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the Society of Obstetricians and Gynaecologists of Canada (SOCG), and the Collège National des Gynécologues et Obstétriciens Français (CNGOF) was conducted. Regarding diagnosis, the SAGES andSOCG societies recommend ultrasound as the preferred and safe imaging technique during pregnancy. In terms of the optimal timing for laparoscopic intervention,BSGE andSAGES do not restrict the laparoscopic approach based on safety, depending on the gestation week, whereasSOCG and CNGOF proposeearly second trimester and first and second quarter of pregnancy respectively. There is an overall consensus regarding patient positioning, initial port placement, insufflation pressure during the operation, venous thromboembolic (VTE) prophylaxis, fetal heart monitoring, and tocolysis among the reviewed guidelines. Moreover, only the BSGE mentions the need for corticosteroids, magnesium sulfate, and anti-D prophylactic administration.

Antenatal magnesium sulfate and the need for mechanical ventilation in the first three days of life

Antenatal administration of magnesium sulfate (MgSO4) to women in preterm labor has gained widespread use. This study examined the relationship between MgSO4 exposure with neonatal respiratory outcomes. Very low birth weight (VLBW) infants exposed to antenatal MgSO4 were included. Infants who were intubated anytime during the first three days of life were compared to those who were not intubated regarding their demographic and clinical characteristics, MgSO4 therapy, immediate respiratory outcomes, and occurrence of intraventricular hemorrhage (IVH) using student t-test, chi square testing and logistic regression analysis to control for confounding variables. Correlation coefficient of MgSO4 cumulative dose given and duration of infusion with delivery room resuscitation and need for mechanical ventilation in the first 3 days of life were also calculated. Multilinear regression analysis was used to control for confounding factors. Intubated group included 96 infants while non-intubated group included 171 infants. Although, intubated group has younger gestational age (26 vs. 29 weeks, p<0.01) and lower birth weight (786 vs. 1115g (g), p<0.01), there were no significant differences between groups in regard to MgSO4 cumulative dose (24 vs. 27g, p=0.29), infusion time (14.6 vs. 18h, p=0.19) or infants' serum magnesium level (2.6 vs. 2.8 milliequivalents (mEq)/L p=0.86). There was no correlation between cumulative MgSO4 dose with endotracheal intubation or cardiac resuscitation in the delivery room (cc: -0.03, p=0.66; and 0.02, p=0.79, respectively) or the need for mechanical ventilation in the first 3 days of life (cc: -0.04 to -0.07, p=0.21-0.51). In addition, there was no relationship between MgSO4 dose, duration of infusion, or infant's serum magnesium level and occurrence of IVH. Regardless of dose or duration of infusion, antenatal MgSO4 exposure is not associated with increased intubation or mechanical ventilation early in life.

Potential Missed Opportunities for Antenatal Corticosteroid Exposure and Outcomes Among Periviable Births: Observational Cohort Study

ABSTRACT Antenatal corticosteroid (ANCS) exposure reduces preterm infant death and morbidities, such as intracranial hemorrhage. Although observational studies suggest periviable infants may benefit from this treatment, many eligible women do not receive ANCSs due to unclear policies, lack of opportunity, or inconsistent care. Professional societies and the Eunice Kennedy Shriver National Institute of Child Health and Human Development recommend administering ANCSs at 24 weeks' gestation for all at-risk pregnancies and as early as 22 weeks with planned postnatal treatment. The aim of this study was to assess whether potential missed opportunities for ANCSs increase as gestational age decreases and are associated with higher rates of hospital mortality or severe brain injury. This was an observational cohort study of infants born at 24 National Institute of Child Health and Human Development Neonatal Research Network centers from 2006 to 2018. Included were infants at 220/7 to 256/7 weeks of gestation, without major birth defects, and a birth weight of 401 to 1000 g. Data were collected prospectively from birth to discharge, transfer, death, or 120 days. Antenatal corticosteroid exposure was defined as infants who received partial, complete, or repeat courses of the treatment. Potential missed opportunities for exposure were defined as infants who received no ANCSs, despite potentially having sufficient time to receive prenatal antibiotics, were administered magnesium sulfate, or experience prolonged rupture of membranes. Severe brain injury was defined as intracranial hemorrhage or periventricular leukomalacia on cranial imaging. The primary outcome was the rate of ANCS exposure and potential missed opportunities at each gestational age. Secondary outcomes included death and severe brain injury. A total of 7957 infants who were actively treated postnatally were included in the primary analysis. Of these, 87.6% had ANCS exposure, 5.7% had no exposure but potential missed opportunities for exposure, and 6.7% had no exposure and no potential missed opportunities. Potential missed opportunities for exposure were more common in infants born at 22 and 23 weeks versus 25 weeks (22 weeks: adjusted risk ratio [aRR], 11.06; 95% confidence interval [CI], 7.52–16.27; P &lt; 0.001); 23 weeks: aRR, 3.24; 95% CI, 2.44–4.29; P &lt; 0.001). No difference was observed between 24 and 25 weeks (24 weeks: aRR, 1.08; 95% CI, 0.82–1.42). From 2006 to 2018, infants at 22 weeks saw the largest increase in exposure to ANCSs (12.5%–87.2%) and a decrease in the rate of potential missed opportunities (68.8%–2.6%). Overall, the rate of mortality was 23% lower among infants in the exposure group than for those in the missed opportunities group (31% vs 54.8%; aRR, 0.77; 95% CI, 0.70–0.84; P &lt; 0.001). Infants in the exposure group had lower risk of severe brain injury than those in the missed opportunities group (25% vs 44.5%; aRR, 0.64; 95% CI, 0.55–0.73; P &lt; 0.001), with no significant variation by gestational age. In conclusion, the potential for missed opportunities for ANCS exposure was more common among periviable infants at 22 and 23 weeks compared with those at 25 weeks of gestation. Moreover, exposure to ANCSs was associated with lower rates of mortality and severe brain injury.

Does Antenatal MgSO 4 Administration to the Mother in the Event of Imminent Premature Birth Reduce the Occurrence of Infantile Cerebral Palsy in the Child? - An Umbrella Review.

Introduction Premature births have a significantly increased risk of developing cerebral palsy. This clinical picture involves great restrictions and impairments in the lives of the children and their families. Its prevention is therefore of great importance. One method of neuroprotection to reduce the rate of infantile cerebral palsy is the antenatal administration of magnesium sulfate to the mother. The aim of this paper is to present the current state of research of existing reviews and meta-analyses on the topic and to review the evidence for this intervention. Material and Methods A literature search was conducted within the framework of an umbrella review in the electronic database PubMed in February 2022 to identify all relevant publications on the topic. The search was structured using the PRISMA statement. The important methodological characteristics and the results of the studies were then extracted. In addition, a quality assessment of the studies was performed using the AMSTAR score. Results Two systematic reviews with meta-analysis, one systematic review, and one individual participant data meta-analysis were included in this study. The total number of subjects was n=6178. The publications conclude that the antenatal administration of magnesium sulfate to the mother significantly reduces the risk of cerebral palsy in preterm infants. Due to the high quality of 3 of the 4 studies, a high level of evidence can be assumed. Conclusion The evidence for antenatal magnesium sulfate administration for the prophylaxis of cerebral palsy in preterm infants is high. However, further research is needed to determine which doses of magnesium and up to which gestational age the administration is useful.

COMPARISION OF DEXAMETHASONE AND MAGNESIUM SULPHATE AS ADJUVANTS TO BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINAL SURGERIES USING TRANSVERSUS ABDOMINIS PLANE BLOCK

Background:Transversus abdominis plane block is regional anaesthesia technique that provides analgesia to the parietal peritoneum as well as skin and muscles of the anterior abdominal wall.Magnesium is N-methyl D-aspartate receptor and physiological calcium antagonist.Dexamethasone is a potent glucocorticoid,has anti-inflammatory as well as analgesic properties. Objectives: To compare the duration of postoperative analgesia,time of administration of first rescue analgesia,systemic side effects of Bupivacaine with Magnesium sulphate and Dexamethasone using Transversus abdominis plane block. Methods: After approval of ethical committee and informed written consent A total of Sixty ASA grade I and II patients aged between 18-60 years undergoing lower abdominal surgeries were randomnly allocated to receive TAP block and divided into two groups of 30 each . Group BD received 20ml of 0.25% Bupivacaine +2ml(8mg) Dexamethasone , Group BM received 20ml 0f 0.25% Bupivacaine+1ml of 25% Magnesium sulphate(250mg)+1ml of normal saline respectively.Heart rate,mean arterial pressure,VAS score,time for first rescue analgesia and side effects were recorded postoperatively. Analgesia was given when VAS score was more than 4. Results: The postoperative visual analogue scale scores was significantly less in group BM.Time for first rescue analgesia was more in group BM compared to group BD without any systemic side effects . Conclusion:Administration of Magnesium sulphate with Bupivacaine reduces postoperative pain scores, prolongs the postoperative analgesia compared with Dexamethasone without any systemic side effects.

Management of preterm birth using protocols in a low resource setting.

Preterm birth is the leading cause of neonatal deaths and the second leading cause of death in children under five after pneumonia. The study aimed at improving the management of preterm birth through the development of protocols for standardization of care. The study was conducted in Mulago National Referral Labor ward in two phases. A total of 360 case files were reviewed and mothers whose files had missing data interviewed for clarity for both the baseline audit and the re-audit. Chi squares were used to compare results for the baseline and the re-audit. There was significant improvement in four parameters out of the six that were used to assess quality of care and these were 32% increase in administration of Dexamethasone for fetal lung maturity, 27% increase in administration of Magnesium Sulphate for fetal neuroprotection and 23% increase in anti-biotic administration. A 14% reduction noted in patients who received no intervention. However, there was no change in the administration of Tocolytic. The results of this study have shown that protocols standardize care and improve the quality of care in preterm delivery to optimize outcomes.

Investigation of Intrapartum Parenteral Magnesium Sulfate as an Independent Risk Factor for Postpartum Hemorrhage Using Quantitative Blood Loss Assessment

Magnesium sulfate is used for seizure prophylaxis in preeclampsia and for fetal neuroprotection when delivery is anticipated before 32 weeks of gestation. Existing risk assessment tools for postpartum hemorrhage often identify the use of magnesium sulfate as an intrapartum risk factor. Previous studies examining the association between the use of magnesium sulfate and postpartum hemorrhage have relied largely on qualitative estimates of blood loss rather than quantitative estimates of blood loss. This study aimed to determine whether intrapartum administration of magnesium sulfate is associated with an increased risk of postpartum hemorrhage using a quantitative blood loss assessment via the use of graduated drapes and weight differences in surgical supplies. This case-control study was conducted to test the hypothesis that intrapartum parenteral administration of magnesium sulfate is not independently associated with postpartum hemorrhage. All deliveries at our tertiary-level academic medical center between July 2017 and June 2018 were reviewed. Of note, 2 categories of postpartum hemorrhage were defined: the traditional definition (>500 mL for vaginal delivery and >1000 mL for cesarean delivery) and the contemporary definition (>1000 mL regardless of delivery mode). Statistical analyses using the chi-square test, Fisher exact test, t test, or Wilcoxon rank-sum test were performed to compare the patients who did and did not receive magnesium sulfate concerning the rates of postpartum hemorrhage, pre- and postdelivery hemoglobin level, and rates of blood transfusion. A total of 1318 deliveries were included, with postpartum hemorrhage rates of 12.2% (traditional definition) and 6.2% (contemporary definition). Multivariate logistic regression did not find the use of magnesium sulfate as an independent risk factor by either definition (odds ratio, 1.44 [95% confidence interval, 0.87-2.38] and 1.34 [95% confidence interval, 0.71-2.54]). The only significant independent risk factor was cesarean delivery, by both definitions (odds ratio, 2.71 [95% confidence interval, 1.85-3.98] and 19.34 [95% confidence interval, 8.55-43.72]). In our study population, intrapartum administration of magnesium sulfate was not found to be an independent risk factor for postpartum hemorrhage. Cesarean delivery was determined as an independent risk factor, consistent with previous reports.

Cerebral palsy as a public health indicator.

Cerebral palsy as a public health indicator.

Trends in Perioperative Magnesium Sulfate Use in Patients Who Underwent Major Cancer Surgery: A Retrospective Population-Based Cohort Study in South Korea.

Magnesium sulfate is a potential anesthetic adjunct in cancer surgery. However, no definite consensus exists on the use of magnesium sulfate in patients undergoing major cancer surgery. This study aimed to examine the trends and factors associated with magnesium sulfate administration in patients who underwent major cancer surgery in South Korea. In this retrospective and population-based cohort study, we used 5-year health data that were extracted from the National registration database in South Korea from January 1, 2016 to December 31, 2020. All adult patients who underwent major cancer surgery during 2016-2020 in South Korea were included. In total, 253,538 patients were included. Among these patients, 6.6% (16,708/253,538) were administered magnesium sulfate during major cancer surgery. In multivariable logistic regression modeling, older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.02-1.02; P < .001), esophageal cancer surgery (vs lung cancer surgery [OR, 3.04; 95% CI, 2.80-3.30; P < .001]), increased Charlson comorbidity index score (OR, 1.03; 95% CI, 1.02-1.03; P < .001), mild-to-moderate disability (OR, 1.08; 95% CI, 1.03-1.14; P = .003), and severe disability (OR, 1.16; 95% CI, 1.05-1.27; P = .003) were associated with a higher incidence of perioperative magnesium sulfate administration for major cancer surgery. Video-assisted thoracoscopic surgery or laparoscopy (OR, .57; 95% CI, .55-.59; P < .001) and propofol-based total intravenous anesthesia (OR, .86; 95% CI, .82-.89; P < .001) were associated with a lower incidence of perioperative Mg sulfate administration for major cancer surgery. In South Korea, 6.6% of the patients who underwent major cancer surgery were administered magnesium sulfate during surgery. Certain factors, such as old age, thoracic cancer surgery, open laparotomy or thoracotomy, greater comorbid status, and inhalation anesthesia, were potentially associated with magnesium sulfate administration in patients undergoing major cancer surgery.

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND MAGNESIUM SULPHATE AS AN ADJUVANT TO BUPIVACAINE FOR POSTOPERATIVE EPIDURAL ANALGESIA IN LOWER LIMB SURGERIES

Background:Pain is pathologic entity,noxious stimulus and a most common problems challenging the anaesthetist.Regional anaesthesia is a safe,inexpensive technique that inhibits the nerve transmission to relieve pain and also provide postoperative analgesia.Magnesium is N-methyl D-aspartate receptor and physiological calcium antagonist.Dexmedetomedine is α2 receptor antagonist with analgesic and sedative properties. Objectives: To compare the duration of postoperative analgesia,time of administration of first rescue analgesia,systemic side effects of epidural bupivacaine with Magnesium sulphate and dexmedetomidine. Methods: After approval of ethical committee and informed written consent A prospective randomised study was conducted with Sixty ASA grade I and II patients aged between 18-60 years undergoing lower limb surgeries were divided into two groups of 30 each .Group BM and Group BD received 10ml of 0.125% bupivacaine with 100mg of 20%MgSo4 and 12.5mcg of dexmedetomidine respectively.Heart rate,mean arterial pressure,VAS score,time for first rescue analgesia were recorded postoperatively.Epidural analgesia was given when VAS score was more than 4. Results:VAS was significantly less in group BM,time for first rescue analgesia was more in group BM compared to group BD without any systemic side effects . Conclusion:Administration of Magnesium sulphate with bupivacaine provides prolonged postoperative analgesia compared with Dexmedetomidine without any systemic side effects.

Maternal magnesium sulfate administration increases early-onset hyperkalemia risk in premature infants: A propensity score-matched, case-control study.

Magnesium sulfate (MgSO4) is a common substance administered to pregnant women with preeclampsia or eclampsia to prevent and treat seizures or gestational hypertension. This study aimed to evaluate whether administering maternal magnesium sulfate increased the risk of early-onset hyperkalemia in preterm infants. This single-center, propensity score-matched, case-control study examined preterm infants born within 24-36 weeks of gestation using electronic medical records between January 2015 and June 2019, in the Saitama City Hospital, Japan. We categorized infants according to their maternal MgSO4 administration status. After adjusting for perinatal information and maternal treatment, we compared the incidence of the variables, including neonatal hyperkalemia, within 24h after birth between the matched cohorts. All infants in Model 1 were analyzed separately, while in Model 2 infants with birth weight of less than 1000g were excluded. We enrolled 421 infants (maternal MgSO4 group, 124; control group, 297). Ninety-five infants in Model 1 and 86 in Model 2 were matched in each group using propensity scores, respectively. In the matched cohorts of both models, infants in the maternal MgSO4 group had a higher hyperkalemia incidence than did those in the control group (42.1% vs. 7.4% in Model 1, 44.2% vs. 5.8% in Model 2, respectively; p<0.0001). However, there was no relationship between the duration of intrauterine exposure to MgSO4 and early-onset neonatal hyperkalemia incidence. Our study demonstrated that maternal MgSO4 administration, even for a short period of time, may increase the risk of early-onset hyperkalemia in preterm infants. Accordingly, physicians should be cautious when administering serum potassium to infants born to mothers administered MgSO4, especially within 24h after birth.

Targeting the Endoplasmic Reticulum Stress-Linked PERK/GRP78/CHOP Pathway with Magnesium Sulfate Attenuates Chronic-Restraint-Stress-Induced Depression-like Neuropathology in Rats.

Magnesium sulfate has demonstrated marked neuroprotection in eclampsia, hypoxia, stroke, and post-traumatic brain injury rodent models. However, its potential impact against chronic-restraint-stress (CRS)-induced depression-like neuropathology and associated alterations in endoplasmic reticulum (ER) stress have not been adequately examined. The present study aimed to investigate the neuroprotective potential of magnesium sulfate in a rat model of CRS-triggered depression-like behavioral disturbance and the underlying molecular mechanisms. Herein, CRS was induced by placing rats into restraining tubes for 6 h/day for 21 days and the animals were intraperitoneally injected with magnesium sulfate (100 mg/kg/day) during the study period. After stress cessation, the depression-like behavior was examined by the open-field test, sucrose preference test, and forced swimming test. The present data demonstrated that CRS triggered typical depression-like behavioral changes which were confirmed by the Z-normalization scores. Mechanistically, serum circulating corticosterone levels spiked, and the hippocampi of CRS-exposed animals demonstrated a significant decline in serotonin, norepinephrine, and dopamine neurotransmitters. At the molecular level, the hippocampal pro-inflammatory TNF-alpha and IL-1β cytokines and the oxidative stress marker 8-hydroxy-2'-deoxyguanosine (8-HG) increased in stressed animals. In tandem, enhancement of hippocampal ER stress was evidenced by the activation of iNOS/PERK/GRP78/CHOP axis seen by increased protein expression of iNOS, PERK, GRP78, and CHOP signal proteins in the hippocampi of stressed rats. Interestingly, magnesium sulfate administration attenuated the depression-like behavioral outcomes and the histopathological changes in the brain hippocampi. These favorable actions were driven by magnesium sulfate's counteraction of corticosterone spike, and hippocampal neurotransmitter decline, alongside the attenuation of neuroinflammation, pro-oxidation, and ER stress. In conclusion, the current results suggest the promising neuroprotective/antidepressant actions of magnesium sulfate in CRS by dampening inflammation, ER stress, and the associated PERK/GRP78/CHOP pathway.

Impact of magnesium sulfate therapy in improvement of renal functions in high fat diet-induced diabetic rats and their offspring

The role of magnesium sulfate (MgSO4) administration to prevent diabetic nephropathy (DN) by reducing insulin resistance (IR) and the relationship of this action with gender and the expression of NOX4 and ICAM1 genes in the parents and their offspring were studied. Males and females rat, and their pups were used. Type 2 diabetes induced by high-fat diet (HFD) administration and a low dose of streptozotocin. Animals were divided into the: non-treated diabetic (DC), the diabetic group received insulin (Ins), and the diabetic group received MgSO4. Two groups of parents received just a normal diet (NDC). Following each set of parents for 16 weeks and their pups for 4 months, while eating normally. We assessed the amount of water consumed, urine volume, and blood glucose level. The levels of glucose, albumin, and creatinine in the urine were also measured, as well as the amounts of sodium, albumin, and creatinine in the serum. Calculations were made for glomerular filtration rate (GFR) and the excretion rates of Na and glucose fractions (FE Na and FE G, respectively). The hyperinsulinemic-euglycemic clamp was done. NOX4 and ICAM1 gene expressions in the kidney were also measured. MgSO4 or insulin therapy decreased blood glucose, IR, and improved GFR, FE Na, and FE G in both parents and their offspring compared to D group. MgSO4 improved NOX4 and ICAM1 gene expressions in the parents and their offspring compared to D group. Our results indicated that MgSO4 could reduce blood glucose levels and insulin resistance, and it could improve kidney function.

Early Intravenous Magnesium Sulfate Administration in the Emergency Department for Severe Asthma Exacerbations.

Severe asthma exacerbations in pediatric patients occur frequently and can require pediatric intensive care unit (PICU) admission. To determine if early administration of intravenous magnesium sulfate (IVMg) to pediatric patients experiencing severe asthma exacerbations, defined as a respiratory clinical score (RCS) of 9 to 12, resulted in fewer PICU admissions. Retrospective chart review of pediatric patients aged from 2 to 17 years presenting with a severe asthma exacerbation to a single tertiary care pediatric emergency department. Univariable and multivariable logistic regression analyses were used to determine if admission to the PICU was associated with early IVMg treatment, within 60 minutes of registration. A total of 1911 patients were included in the study, of which 1541 received IVMg. The average time to IVMg was 79 minutes, with 35% of the patients receiving it within 60 minutes of arrival. Two hundred forty-eight (13%) were admitted to the PICU, 641 (34%) were admitted to the general inpatient floor, and 1022 (53%) were discharged home. Factors associated with increased odds ratio (OR) of PICU admission were: early IVMg (OR, 1.63; 95% CI: 1.16-2.28), arrival mode to the emergency department via ambulance (OR, 2.23; 95% CI: 1.45-3.43), history of PICU admission for asthma (OR, 1.73; 95% CI: 1.22-2.44), and diagnosis of status asthmaticus (OR, 8.88; 95% CI: 3.49-30.07). Calculated OR of PICU admission subcategorized by RCS for early IVMg patients, after controlling for PICU risk factors, are as follows: RCS 9 (reference), RCS 10 (OR, 2.52; 95% CI: 0.89-2.23), RCS 11 (OR, 2.19; 95% CI: 1.3-3.70), and RCS 12 (OR, 4.12; 95% CI: 2.13-7.95). Early administration of IVMg to pediatric patients experiencing severe asthma exacerbations does not result in fewer PICU admissions.

Factors associated with appropriate administration of magnesium sulfate for neuroprotection prior to early preterm birth

To evaluate factors associated with appropriate administration of magnesium sulfate (MgSO4) for fetal neuroprotection prior to preterm birth (PTB) in a large United States university-based health system. Multicenter retrospective cohort of all PTBs between 23 0/7-31 6/7 weeks’ gestation from 1/1/2019 to 12/31/21. Exclusion criteria included patients with hypertensive disorders of pregnancy (to assure only indication for MgSO4 administration was fetal neuroprotection and not maternal seizure prophylaxis), stillbirths, higher-order multiple gestations, and extramural deliveries. Cases were stratified into two groups based on whether MgSO4 was administered prior to PTB or not. Maternal characteristics were compared between the two groups using Chi-squared or Mann-Whitney U test with statistical significance set at P < 0.05. A subgroup analysis evaluating reasons for lack of administration in those who did not receive MgSO4 prior to delivery was also performed. Of the 527 patients included, 438 (83.1%) received MgSO4 prior to delivery. Baseline characteristics and delivery outcomes compared between the two groups are displayed in Table 1. Patients who did not receive MgSO4 prior to delivery were more commonly admitted for fetal status abnormalities and non-obstetric complaints, and had a significant shorter median time interval from arrival to delivery (1.5 hours vs. 59.0 hours, P = < 0.001) (Table 1). Lack of adherence to health system protocol for MgSO4 administration occurred in 16.9% (15/89, 2.8% of overall study cohort) of patients who did not receive MgSO4 prior to delivery (Table 2). The overall adherence to a protocol of MgSO4 administration for fetal neuroprotection prior to early PTB was high. Admission for fetal status abnormalities and non-obstetric complaints were more common among patients who did not receive MgSO4 prior to delivery, with most patients who did not receive MgSO4 either arrived < 2 hours from delivery or had an acute change in maternal/fetal status requiring immediate delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Comparison of adjuvant therapy with midazolam, paracetamol, tramadol, or magnesium sulfate during intravenous regional anesthesia with ropivacaine: A randomized clinical trial.

Intravenous (IV) regional anesthesia is an easy, safe, reliable, and efficient option for inducing anesthesia during surgeries but with tourniquet-related pain. This study aimed to evaluate midazolam, paracetamol, tramadol, and magnesium sulfate administration as adjuvants with ropivacaine on pain relief and hemodynamic changes in IV regional anesthesia. A randomized, double-blind, placebo-controlled trial was conducted in subjects undergoing forearm surgery with IV regional anesthesia. The block randomization method was used to assign eligible participants to each of five study groups. Hemodynamic parameters were assessed before applying the tourniquet, at prespecified time points (5, 10, 15, and 20 min), then and every subsequent 10 min until surgery completion. A Visual Analog Scale was used to assess pain severity at baseline followed by every 15 min until completion of the surgery, and after tourniquet deflation every 30 min to 2 h, and at 6, 12, and 24 h postoperative. Data were analyzed using Chi-square and analysis of variance with repeated data testing. The shortest onset and the longest duration of sensory block were observed in the tramadol group and the shortest onset of motor block in the midazolam group (P < 0.001). Pain score was estimated to be significantly lower in the tramadol group at the time of tourniquet application and release, and 15 min to 12 h after tourniquet release (P < 0.05). In addition, the lowest dose of pethidine consumption was observed in the tramadol group (P < 0.001). Tramadol appeared to be able to effectively relieve pain, shorten the onset of sensory block, prolong the duration of sensory block, and achieve the lowest consumption of pethidine.

Effect of Magnesium Sulfate in Prevention of Postoperative Atrial Fibrillation Arrhythmia among Candidates of CABG Surgery with Abnormal P-wave Duration

Background: Cardiac arrhythmias, especially atrial fibrillation, are among the most common early complications of open-heart surgery. Hypomagnesemia is one of the clinical mechanisms associated with the pathogenesis of postoperative atrial fibrillation. This study aimed to evaluate the effect of magnesium sulfate on the prevention of atrial fibrillation in patients with abnormal P-wave duration who underwent coronary artery bypass graft (CABG)surgery. Methods: In this clinical trial, 150 patients participated who had undergone CABG surgery at Imam Khomeini hospital in Ahvaz in 2014. According to the inclusion criteria, the intervention and control groups were randomly matched. The intervention group, consisting of 57 patients, received 2.4 g of magnesium sulfate daily for three days and 75 patients of the control group received a placebo. Prevention of postoperative atrial fibrillation by magnesium sulfate was evaluated in patients and data were analyzed using SPSS software. Results: The two groups did not have a significant difference in terms of gender, diabetes, hyperlipidemia, and hypertension. Also, mean P-wave duration, length of intensive care unit stay, the total length of hospitalization, left ventricular ejection fraction (LVEF), distribution of creatinine, atrial fibrillation, and aortic clamp time in intervention and control groups were not statistically significant. Only, the total pump duration difference was reported to be statistically significant between groups. Conclusion: The results of our study showed that the administration of magnesium sulfate alone cannot be helpful in the prevention of atrial fibrillation among patients with long P-wave duration. Trial Registration: https://www.irct.ir/, Identifier: IRCT2015092814190N9