Continuous Infusion Of Magnesium Sulfate Research Articles

Continuous infusion of magnesium sulfate to treat acute severe asthma in a Brazilian pediatric emergency department

Continuous infusion of magnesium sulfate to treat acute severe asthma in a Brazilian pediatric emergency department

Использование сульфата магния в виде постоянной инфузии при лечении пациентов с тяжелой черепно-мозговой травмой

Magnesium is one of the main microelements involved in the functioning of the body. In the brain, it is physiologically responsible for processes associated with intracellular homeostasis, blood-brain barrier integrity, protein synthesis, neuronal proliferation, aging and apoptosis. The article presents the experience of using continuous infusion of magnesium sulfate in the treatment of patients with severe traumatic brain injury.

Comparison of bolus administration with continuous infusion of intravenous magnesium sulfate in the prevention of Shivering following cesarean section under spinal anesthesia, a double-blind randomized clinical trial

Introduction and Objectives: Considering high prevalence of shivering in cesarean section, various methods have been used to reduce and treat it. Magnesium sulfate is a common drug used in pregnant women that has anti Shivering properties. The aim of this study was to compare the efficacy of intravenous magnesium sulfate as bolus or continuous infusion in prevention of Shivering following cesarean section.Methods: This study was an interventional clinical trial that was performed on 300 pregnant women with term pregnancies, singleton, who underwent elective cesarean section under spinal anesthesia. Patients were divided into 3 groups who immediately after spinal anesthesia received 30-minute infusion of magnesium sulfate, bolus injection of magnesium sulfate and normal saline, respectively. Vital signs and severity of shivering, along with complications such as nausea and vomiting, decreased heart rate and hypotension, and decreased arterial oxygen saturation were recorded and data analyzed.Results: Shivering at 30, 60, 75 and 90 minutes was significantly lower in the magnesium sulfate infusion group within 30 minutes than in the bolus receiving and control groups (p = 0.018).Conclusion: The prevalence of shivering was significantly reduced by continuous Infusion of magnesium sulfate. In the administration of magnesium sulfate, infusion within 30 minutes had a significant advantage in reducing the incidence of Shivering and less side effects than bolus administration.

Use of magnesium sulfate in continuous infusion in patients with severe acute asthma, in a pediatric emergency room.

Asthma is a chronic disease, of high prevalence, with important morbidity and that can lead to death in childhood. The use of intravenous magnesium sulfate has been indicated in cases refractory to the initial management with inhaled bronchodilators and corticosteroids. To evaluate the use of magnesium sulfate in continuous infusion (50 mg/kg/h in 4 h) in children with severe acute asthma in a pediatric emergency room. Ten-bed general pediatric emergency room, university hospital, tertiary, in southern Brazil. All children over 2 years old with severe acute asthma refractory to the initial treatment who received a continuous infusion of magnesium sulfate at a dose of 50 mg/kg/h in 4 h, from April 2017 to October 2019. Based on this study, the use of continuous intravenous magnesium sulfate proved to be well tolerated, leading to improved respiratory status, and can be considered as a satisfactory adjunctive therapy in the management of severe acute asthma.

The effect of intraoperative magnesium sulfate and ketamine infusion on post-operative pain in open gynecological surgeries

Background:besides an opioid analgesic, Multimodal analgesia using a non-opioid analgesic, in atrial to decrease opioid use and toincrease postoperative pain control. Objectives:To compare the effect of intra-operative infusion of ketamine and magnesium sulphate in open gynecological surgeries on post-operative pain, total morphine consumption, post-operative nausea, and vomiting inQena university hospitals. Patients and method(s):A prospective study. Conducted in Qena university hospital, South Valley University, Qena, Egypt. The study was conducted on fifty patients (ASA I or II) scheduled for open gynecological surgeries under general anesthesia: group A: Ketamine (0.2 mg/ kg) bolus than the continuous supply of ketamine (0.05 mg/kg/h), group B: Magnesium sulphate (50mg/ kg) bolus and followed by continuous infusion of magnesium sulfate(10mg/kg /h). Result(s): the visual analogue scale was found to be significantly higher in group B compared to group A in 2, 4, and 8 hrs time intervals. The mean opioid (Morphine/Pethidine) consumption doses over 24h were lower in group A compared to group B. There is no significant difference regarding adverse events between the two studied groups. Conclusion: Intraoperative magnesium sulfate and ketamine infusionin patients exposed to gynecological surgeries with general anesthesia could and decreased the post-operative opioid requirement. Ketamine showed a significant preemptive analgesic effect compared to MgSO4 at 2 and 8 h postoperatively. VAS was significantly lowered in Ketamine than MgSO4.

Interrupted versus continuous magnesium sulfate and blood loss at cesarean delivery

Objective Magnesium sulfate is standard of care for prevention of eclampsia in women with preeclampsia with severe features. The American College of Obstetrics and Gynecology endorses its use throughout labor, delivery and the immediate postpartum period. Some providers pause magnesium sulfate infusion preoperatively due to concern for increased risk of uterine atony and postpartum hemorrhage. Using a non-inferiority analysis, we investigated the effect of interrupted versus continuous infusion of magnesium sulfate on postpartum hemorrhage in women with preeclampsia with severe features undergoing cesarean delivery. Study design Retrospective non-inferiority cohort study of women with preeclampsia with severe features treated with magnesium sulfate undergoing cesarean delivery with singleton pregnancies at tertiary care hospital from 2013 to 2018. The primary outcome was postpartum hemorrhage. Secondary outcomes included estimated blood loss, change in hematocrit and a composite of postpartum hemorrhage severity, including transfusion of blood products, use of more than one uterotonic and additional surgical interventions. Results Of 249 women, magnesium sulfate infusion was interrupted in 171 (69%) and continued in 78 (31%). Women with interrupted magnesium sulfate infusion were more likely to be Caucasian (73% vs 67%, p = .024), have chronic hypertension (23% vs 1%, p < .001), labor prior to cesarean delivery (84% vs 55%, p < .001), undergo primary cesarean delivery (86% vs 67%, p = .005), and experience shorter surgical time (50 vs 55 min, p = .026). The rate of postpartum hemorrhage for those receiving interrupted magnesium sulfate infusion (9.9%) and continuous magnesium sulfate infusion (10.2%) was similar, falling within the non-inferiority margin (absolute difference 0.3%, 95% CI -7.8 to 8.4%, p = .88). There were no significant differences in the secondary outcomes. Conclusion Interrupted magnesium sulfate infusion is non-inferior to continued magnesium sulfate infusion for rates of postpartum hemorrhage in women with preeclampsia with severe features undergoing cesarean delivery.

529: Continuous versus interrupted magnesium for preeclampsia with severe features and blood loss during cesarean delivery

Magnesium sulfate is the standard of care for the prevention of eclampsia in women with preeclampsia with severe features. ACOG endorses its use throughout labor, delivery and the immediate postpartum period, even during cesarean delivery (CD). Some providers pause magnesium sulfate infusion during CD due to concern for increased risk of operative blood loss and postpartum hemorrhage. We sought to assess the effect of continuous versus interrupted infusion of magnesium sulfate on operative blood loss and postpartum hemorrhage for women with preeclampsia with severe features. Retrospective cohort study of women undergoing CD with singleton pregnancies and preeclampsia with severe features treated with magnesium sulfate infusion at a tertiary care hospital from 2013-2018. The primary outcome was a composite of postpartum hemorrhage (EBL > 1000mL), transfusion of blood products, use of other uterotonics, or additional surgical interventions. These outcomes were compared between women who received continuous versus interrupted magnesium sulfate infusion during CD. Multivariable analysis controlled for factors found to be statistically significant from baseline and delivery characteristics. Of 249 women, magnesium sulfate infusion was continuous in 78 (31%) and interrupted in 171 (69%) during CD. Women with continuous magnesium sulfate infusion were more likely to be African American (22% vs 13%, p = 0.02), experience prolonged surgical time (55 vs 50 min, p= < 0.01), have a prior cesarean delivery (28% vs 11%, p = < 0.01), and use anticoagulants prior to delivery (19% vs 6%, p < 0.01) (Table 1). There was no difference in the primary outcome (17% vs 14%, p= 0.78). Additionally, there were no significant differences for postpartum hemorrhage (10% vs 10%, p = 0.49), need for transfusion (5% vs 1%, p=0.42) or use of other uterotonics (6% vs 4%, p=0.49) (Table 2). Continuing intraoperative magnesium sulfate infusion for eclampsia prevention does not appear to be an independent risk factor for increased operative blood loss or postpartum hemorrhage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Management of severe tetanus using magnesium sulfate – The experience in a tertiary health institution in Southern Nigeria

Tetanus is a vaccine-preventable disease caused by the neurotoxin of Clostridium tetani: A motile, Gram-positive, sporeforming obligate anaerobe commonly found in the soil, dust, and alimentary canals of various animals. It remains a public health challenge in the developing countries as the morbidity and mortality rates remain high unlike in the developed world where the incidence is markedly low and no longer contributory to significant mortality. We report two male adolescents admitted in the pediatric department of a tertiary medical center of Nigeria for severe tetanus following an open injury to the limbs. Due to poor response to initial management with the combination of chlorpromazine, phenobarbitone, and diazepam, the latter was replaced with continuous infusion of magnesium sulfate after a loading dose was administered. Both the patients recovered without any prevailing complications and were discharged after 26 and 50 days of hospitalization, respectively, after receiving tetanus toxoid and were subsequently followed up. Successful severe tetanus management without the use of sophisticated medical gadgets and expensive treatment in a resource-poor economy is achievable as demonstrated by our study with the use of magnesium sulfate infusion.

The effect of perioperative magnesium sulfate on blood sugar in patients with diabetes mellitus undergoing cardiac surgery: A double-blinded randomized study.

Objective:The aim of the present study was to evaluate the perioperative effect of magnesium infusion on blood sugar level in patients with diabetes mellitus undergoing cardiac surgery.Design:This was a double-blind randomized study.Setting:The study was conducted at cardiac center.Patients:The study included 122 adult patients.Intervention:Group M – The patients received a continuous infusion of magnesium sulfate (without a loading dose) at 15 mg/kg/h. The infusion rate was started 20 min before induction maintained during surgery and the first postoperative 24 h. The medication was prepared by adding 5 g magnesium sulfate in 50 ml syringe. Group C – The patients received equal amount of normal saline.Measurements:The monitors included heart rate, mean arterial blood pressure, central venous pressure, urine output, blood levels of magnesium, sugar, and potassium.Results:The blood sugar level and the required insulin significantly decreased with Group M than Group C (P < 0.05). There were minimal changes in the potassium level in Group M, but potassium decreased in patients of Group C (P < 0.05). The amount of urine output was too much higher in Group M than Group C (P < 0.05). The pharmacological and mechanical support significantly decreased with Group M than Group C (P < 0.05). The hospital and Intensive Care Unit length of stay significantly decreased with Group M than Group C (P < 0.05).Conclusion:The magnesium sulfate produced a better-controlled effect on the blood sugar level. It decreased the requirement of insulin infusion and minimized the changes in the blood level of potassium.

Use of Magnesium Sulfate Infusion for the Management of Febrile Illness-Related Epilepsy Syndrome: A Case Series.

Febrile illness-related epilepsy syndrome is a catastrophic epileptic encephalopathy that is highly refractory to most antiepileptic drugs leading to high morbidity and mortality. The authors report the use of a pediatric infusion protocol of continuous intravenous magnesium sulfate for the control of seizures in 2 children with febrile illness-related epilepsy syndrome refractory to multiple antiepileptic drugs in a pediatric intensive care unit of a tertiary care children’s hospital. Both patients, 2 and 16 years of age, respectively, were treated with continuous magnesium sulfate infusion. Serum magnesium concentrations ranging from 2.1 to 5 mmol/L were achieved. Seizure reduction and cessation were noted in 1 patient with magnesium more than 3.0 mmol/L. No significant adverse effects were observed. Magnesium sulfate infusions can be safely used in pediatric refractory status epilepticus. Magnesium sulfate can be considered in the management of children with febrile illness-related epilepsy syndrome.

Effect of continuous magnesium sulfate infusion on spinal block characteristics: A prospective study

Background:Spinal anesthesia is an established mode of anesthesia for lower limb orthopedic surgeries. The limitations of the technique are short duration of action and limited post-operative analgesia. Concomitant use of intravenous infusion of magnesium sulfate may have an effect on the block characteristics and duration of action of intrathecal bupivacaine.Methods:A total of 80 American Society of Anesthesiologists I and II patients, either sex, 20-60 years of age scheduled for elective orthopedic fixation of fracture of long bones of lower limbs under spinal anesthesia were included. Spinal anesthesia administered with 2.5 ml heavy bupivacaine mixed with 10 mcg fentanyl. The groups were then divided to receive an infusion of injection magnesium sulfate 50 mg/kg/h over 15 min followed by 15 mg/kg/h until the end of the surgery (Group M) and 15 ml of Normal Saline over 15 min followed by 100 ml/h until the end of surgery (Group S). Onset, duration of sensory and motor block and amount of post-operative analgesic were noted.Results:A total of 6 patients (Group M) and seven patients (Group S) had inadequate block and excluded from the study. Mean block height was T6. Time required to achieve block height was 8.82 min versus 7.42 min in Groups M and S respectively (P = 0.04). Mean duration of motor block was longer in group M (160.63 ± 17.76 min) compared with Group S (130.12 ± 20.70 min) (P = 0.000). Time for regression of sensory block to T12/L1was 206.88 ± 20.96 min (Group M) and 163.88 ± 15.46 min (Group S) (P = 0.000). Hemodynamic parameters were similar and statistically not significant. Need for first analgesic requirement was after 262.88 ± 21.11 min in group M and 193.25 ± 17.74 min in the group S (P = 0.000). Mean dosage of tramadol needed in first 24 h was less in group M (190 ± 30.38 mg vs. 265 ± 48.30 mg, P = 0.000).Conclusion:Use of intravenous magnesium with spinal anesthesia reduces post-operative pain and analgesic consumption.

PP024. Effects of intravenous magnesium sulfate on the characteristics of eclamptic seizures induced by electrical stimuli in a rat preeclampsia/eclampsia model

Eclampsia is a serious complication of pregnancy and remains a leading cause of maternal mortality worldwide. Magnesium sulfate is commonly used in the prophylaxis and treatment of eclampsia. However, uncertainty remain regarding its anticonvulsant mechanism(s) of action. This study examined the effects of intravenous magnesium sulfate on the characteristics of eclamptic seizures in a rat preeclampsia/eclampsia model. All rats were implanted with stainless nickel-cadmium alloy bipolar electrodes one week before fertilization. Next, an experimental rat preeclampsia (PE) model was induced on gestational day 14 by anaesthetising rats and infusing over 1 hour into their tail veins lipopolysaccharide (LPS) (1.0μg/kg body weight) (with control rats receiving normal saline). The rats were then divided into three groups: a normal pregnancy (NP) group (n=6) which received a continuous infusion of saline; a control PE model group (n=7) (which had previously received the LPS treatment) which also received a continuous infusion of saline; and a treated PE model group (n=8) (which had previously received the LPS treatment) which received a continuous infusion of magnesium sulfate (60mg/kg/day). The continuous infusions in all three groups were delivered by implanted osmotic minipumps . Measurements were made of blood pressure, albuminuria, serum ALT, AST, and creatinine, BUN and serum magnesium concentrations. On gestational day 18, all experimental rats received a standardized electrical stimulus. Seizure activity was assessed using electroencephalogram (EEG) recordings. Terminations of pregnancy were performed on gestational day 21. Resorptions and pup birth weights were recorded. The pregnant LPS treated rats developed many features of human PE (e.g. hypertension, proteinuria, liver and kidney dysfunctions). The mean concentration of Mg(2+) in the magnesium sulfate therapy group (0.86±0.24mmol/L) was significantly higher (p<0.05) than in both the control PE model group (0.61±0.12mmol/L) and the NP group (0.62±0.09mmol/L). The magnesium sulfate therapy group had a significantly (p<0.05) increased latency period (21.7±8.9min) to evoke a full motor seizure compared to both the NP group (4.8±2.2min)and the control PE model group (3.3±1.4min), there being no significant difference (p>0.05) between the latency periods of the NP group and the control PE model group. Overall, the magnesium sulfate therapy regimen completely prevented seizure activity in 3/8 (37.5%) of the treated PE model rats compared to 6/6 (100%) of the NP rats and 7/7 (100%) of the control PE rats. The treated PE model group also had significantly (p<0.05) reduced seizure duration (26±4s) compared to both the NP (40±7s) and the control PE model (45±9s) groups. As well, there was a significantly (p<0.05) shorter EEG seizure amplitude change in the treated PE model group (58±6μv). In this rat preeclamsia/eclampsia model, the anticonvulsant characteristics of magnesium sulfate have been shown to include significantly increasing seizure latency period, reducing seizure duration and decreasing seizure EEG amplitude.

Retrospective analysis of parenteral magnesium sulfate administration in decreased incidence of clinical and neuroradiological cerebral vasospasm: a single center experience

Objective: Experimental work suggests a neuroprotective role for magnesium sulfate in aneurysmal subarachnoid hemorrhage. We retrospectively review the incidence of clinically relevant vasospasm in patients treated or not with continuous magnesium infusion after onset of subarachnoid hemorrhage.Methods: All patient records in Albany Medical Center with the diagnosis of SAH between January 1999 and June 2004 were reviewed. Patients who presented to the emergency department within 72 hours of onset were entered in the study. Patients were defined as in clinical vasospasm if there was an acute neurological change in association with abnormal trancranial Doppler (TCD), CT angiogram (CTA) or digital subtraction angiography (DSA).Results: A total of 85 patients were selected. Magnesium sulfate was infused in 43 patients. When compared with patients who did not receive MgSO4, there was a statistically significant lower incidence of clinical and radiological vasospasm in those who had the continuous infusion of magnesium sulfate (p<0.01). There was no statistically significant difference between patients who were coiled or clipped.Conclusion: Continuous magnesium sulfate infusion for the management of clinically significant cerebral vasospasm is safe and reduces the incidence of clinically significant cerebral vasospasm. Large, multicenter, controlled studies should be performed in order to determine the true effectiveness of the treatment in a controlled setting.

The effect of magnesium sulfate on the behavioral activities of fetal goats.

To investigate fetal heart rate accelerations, fetal breathing movements, and fetal electrocortical activities during administration of magnesium sulfate to fetal goats. The fetal heart rate accelerations, fetal breathing movements, and fetal electrocortical activities during 6 hours of continuous magnesium sulfate infusion into the fetal jugular vein were examined in 8 chronically instrumented fetal goats at 124-131 days of gestation. Fetal breathing movements were defined as repetitive negative fluctuations of the fetal tracheal pressure. Fetal electrocortical activities were assessed by visual analysis of periods of high-voltage and low-voltage electrocortical activities. Continuous infusion of magnesium sulfate for 6 hours significantly increased the fetal plasma magnesium concentration from 2.8 +/- 1.2 to 8.3 +/- 2.6 mg/dL without significant changes in fetal arterial blood gases. The incidence of fetal heart rate accelerations during magnesium infusion was significantly decreased from that found during the control periods. After 2 hours of infusion, the incidence of fetal breathing movements significantly decreased from 33.9% +/- 20.5% to 1.2% +/- 1.4% and remained at this level during the remaining 4 hours of magnesium infusion. The percentage of time that the fetuses were found to have low-voltage electrocortical activities decreased from 51.6% +/- 9.0% to 40.4% +/- 8.2% after 2 hours of infusion but recovered to 49.9% +/- 12.0% by 6 hours of magnesium infusion. We concluded that fetal magnesium sulfate administration affected fetal heart rate accelerations and fetal breathing movements continuously but electrocortical activities only temporarily during 6 hours of observations.

Antithrombotic effects of magnesium sulfate in in vivo experiments.

In this study, magnesium sulfate was effective in reducing the mortality of adenosine diphosphate-induced acute pulmonary thromboembolism in mice, when it was administered intravenously at doses of 100 and 200 microg/g body weight. In addition, intravenous injections of magnesium sulfate (100 and 200 microg/g) significantly prolonged bleeding time in the severed mesenteric arteries of rats by approximately 1.7- and 1.9-fold, respectively, compared with normal saline. Continuous infusion of magnesium sulfate (20 microg/g per minute) for 10 minutes also significantly increased the bleeding time by approximately 1.7-fold, and the bleeding time returned to baseline within 60 minutes of cessation of magnesium sulfate infusion. On the other hand, platelet thrombi formation was induced by irradiating mesenteric venules with filtered light in mice pretreated with intravenous fluorescein sodium. When magnesium sulfate was administered at 300 microg/g during induction of platelet plug formation with 10 microg/kg fluorescein sodium, occlusion time was not significantly prolonged, but a dose of 600 microg/g did significantly prolong the occlusion time. Furthermore, aspirin (250 microg/g) also showed a similar activity in this experiment in prolonging the occlusion time. In conclusion, these results suggest that magnesium sulfate has an effective antithrombotic activity in vivo, and treatment with magnesium sulfate may lower the risk of thromboembolic-related disorders.

Long-term magnesium sulfate treatment as protection against hypoxic-ischemic brain injury in seven-day-old rats

Objective: Our purpose was to study the effects of long-term treatment with magnesium sulfate on hypoxic-ischemic brain damage in newborn rats. Study Design: Seven-day-old rat pups (n = 120) were exposed to unilateral carotid artery ligation and 2 hours of hypoxia (8% oxygen in 92% nitrogen). Neuronal loss was evaluated in 4 groups. The loading dose group (n = 25) received a bolus injection of 270 mg/kg magnesium sulfate intraperitoneally. The maintenance group (n = 26) received 3 days of continuous infusion of magnesium sulfate with a micro-osmotic pump at a rate of 72 mg/kg per hour. The loading dose–plus–maintenance group (n = 23) received both. The control group (n = 46) did not receive magnesium. Seven days after the injury the pups were killed and the brains were removed for analysis. Severity of neuronal loss was evaluated in the cerebral cortex and hippocampus and compared among groups by χ2 test. Results: Cyst formation resulting from necrosis was significantly decreased in the maintenance group (15%) and loading dose–plus–maintenance group (9%) but not in the loading dose group (52%) relative to the control group (46%). Severity of neuronal loss in the cerebral cortex and the hippocampus was also significantly improved in the maintenance group and the loading dose–plus–maintenance group but not in the loading dose group. Mortality rates were not different among the groups. Magnesium ion concentrations at 24 hours were significantly decreased from the preinfusion value of 0.49 ± 0.01 mmol/L in the control group (0.34 ± 0.03 mmol/L) but remained within normal ranges in the maintenance group (0.46 ± 0.02 mmol/L with a pump infusing 72 mg/kg per hour and 0.56 ± 0.05 mmol/L with a pump infusing 24 mg/kg hour). There was an inverse relationship between the maintenance dose and neuronal loss but not between the maintenance dose and mortality rate. Conclusion: Long-term magnesium administration had neuroprotective effects against hypoxia-ischemia in newborn rats. (Am J Obstet Gynecol 2001;184:185-90.)

Continuous Infusion of Magnesium Sulfate (MgSO4) in the Management of Severe Asthma in Children. • 238

Continuous Infusion of Magnesium Sulfate (MgSO 4 ) in the Management of Severe Asthma in Children. • 238

Conservative management of pre-eclamptic and eclamptic patients: A re-evaluation

A philosophy of conservatism in regard to termination of gestations complicated by pregnancy-induced hypertension has been practiced at the University of Virginia Hospital for many years. The advent of improved methods to evaluate the intrauterine fetal status prompted retrospective review of 246 pre-eclamptic and 13 eclamptic patients managed during the antepartum period. Continuous magnesium sulfate infusion for periods up to 144 hours (265 grams) was the therapeutic measure used for prevention or control of convulsions. Average duration of predelivery hospitalization increased 8.7 days, and the incidence of neonates requiring intensive care increased 10.9 per cent with the use of tests to evaluate intrauterine fetal status. Frequency of spontaneous onset of labor and vaginal delivery decreased 18.6 per cent. The uncorrected perinatal mortality rate for all antepartum patients was 7.0 per cent. The mortality rate for infants of mothers with superimposed, severe or convulsive disease was significantly less in pregnancies in which tests of fetoplacental status were employed (8.2 per cent) compared to pregnancies in which they were not (15.2 per cent). The only maternal death was a 41-year-old patient with severe pre-eclampsia who suffered a corebral vascular accident on the fifth hospital day. These data reiterate the value of conservative management with meticulous individualized care.