Efficacy Of Magnesium Sulfate Research Articles

Efficacy of Magnesium Sulfate and Labetalol in the Treatment of Pregnancy-Induced Hypertension and Its Effect on Anxiety and Depression: A Retrospective Cohort Study.

In this study, the effect of magnesium sulfate and labetalol in treating pregnancy-induced hypertension (PIH) and its influence on anxiety and depression in patients are observed, and new ideas for treating anxiety and depression in PIH are introduced. A retrospective cohort study was conducted to select patients with PlH diagnosed from July 2020 to July 2023 from Affiliated Hospital of Electronic Science and Technology University and Chengdu Women' s and Children's Central Hospital in Chengdu of Sichuan Province. The changes in blood pressure, Edinburgh Postnatal Depression Scale (EPDS), and generalized anxiety disorder 7 (GAD-7) in patients with hypertensive pregnancy were collected and analyzed. In our investigation, 219 patients completed the study, and 36.1% (79/219) of them developed anxiety and depression. According to whether the patients were treated with magnesium sulfate and labetalol, 49 cases were assigned to the magnesium sulfate and labetalol treatment (MSLT) group, and 30 cases were assigned to the conventional treatment (CT) group. Edinburgh Postnatal Depression Scale scores and GAD-7 scores in the MSLT group were significantly lower than those in the CT group, indicating that magnesium sulfate and labetalol can improve anxiety and depression in hypertensive patients during pregnancy. The difference was statistically significant (P < .05). According to the changes in systolic blood pressure, the clinical efficacy of patients was evaluated, and no significant difference in efficacy existed between the MSLT and CT groups. Magnesium sulfate and labetalol can control the blood pressure of patients with PIH and indirectly improve anxiety and depression in patients with PIH, thereby introducing new ideas for the treatment of PIH accompanied by anxiety and depression.

Efficacy of Magnesium Sulphate and Dexmedetomidine in Controlled Hypotension for Functional Endoscopic Sinus Surgery: A Randomised Clinical Study

Introduction: The treatment of nasal sinus diseases with Functional Endoscopic Sinus Surgery (FESS) is a wellestablished and popular method. This procedure is performed under general anaesthesia or local anaesthesia. Intentional induction of hypotension has helped limit intraoperative blood loss. A bloodless surgical field improves visibility and lowers the possibility of damaging nearby structures, achieved by reducing the baseline Mean Arterial Pressure (MAP) by 30% or maintaining MAP at 60-70 mmHg. Aim: To compare the efficacy of dexmedetomidine and Magnesium Sulphate (MgSO4 ) in producing hypotensive anaesthesia during FESS. Materials and Methods: This randomised clinical study was conducted at BLDE Shri BM Patil Medical College and Research Centre, Vijayapura, Karnataka, India, from January 2021 to July 2022. In this study, 70 patients, aged 18 to 60 years of either sex, admitted for FESS surgeries under general anaesthesia with American Society of Anaesthesiologists (ASA) Grade 1 and 2 were randomly divided into two groups: 35 patients in the dexmedetomidine group and 35 patients in the MgSO4 group. Dexmedetomidine was given to group D as a loading dose of 1 µg/kg, followed by an infusion of 0.5 µg/kg/h, and MgSO4 was given to group M as a loading dosage of 40 mg/kg, followed by an infusion of 15 mg/kg/h. MAP was kept above 65 mmHg during induced hypotension. Parameters studied included Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), MAP. Data was analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Statistics Software Version 23.0. A p-value &lt;0.05 was considered statistically significant. Results: The demographic profiles regarding age, gender, ASA grade, and duration of surgery in both groups were comparable and showed no significant differences. At 30 minutes of surgery, MAP in group D was found to be statistically lower than that in group M with a p-value of 0.0001. Dexmedetomidine induced a significant reduction in HR, which was statistically validated with a p-value of 0.004 at 15 minutes. A statistically significant reduction in MAP was found in group D compared to group M at the time of intubation and later at 10 minutes (p-value=0.005) and 15 minutes (p-value=0.006). Conclusion: The target MAP of 60-70 mmHg or a 30% reduction from the baseline MAP was achieved significantly earlier in group D as compared with group M. Group D had lower infusion dosages, better surgical field visibility, and caused less bleeding. The dexmedetomidine group experienced extended sedation and postoperative recovery

Efficacy of Magnesium Sulfate as an Adjuvant to Bupivacaine in Transversus Abdominis Plane Block for Abdominal Hysterectomy Surgeries.

Background Major abdominal surgeries are often accompanied by excruciating pain, which, if not adequately managed, can reduce patient comfort and satisfaction, delay mobilization, compromise respiratory and cardiac functioning, and increase healthcare costs. The transversus abdominis plane (TAP) block is an efficient and safe complement to multimodal postoperative analgesia for abdominal surgery. This study evaluates the efficacy of combining magnesium sulfate (MgSO4) with bupivacaine for TAP block in patientsposted for total abdominal hysterectomy (TAH). Methodology Seventy female patients between the ages of 35 and 60 who were scheduled to have a TAH under spinal anesthesia were divided randomly into two groups of 35 each: group Bupivacaine (B) and group Bupivacaine-Magnesium sulfate (BM). Group B received 18 milliliters (mL) of bupivacaine 0.25 percentage (%) 45 milligrams (mg) with 2 mL normal saline (NS) whereas group BM received 18 mL of bupivacaine 0.25% (45 mg) with 1.5 mL of 10% weight/volume (w/v) MgSO4 (150 mg) and 0.5 mL NS in the ultrasonography-guided (USG) bilateral TAP block performed after the end of surgery. Groups were compared for the postoperative visual analog scale (VAS) scores, the time required for first rescue analgesia, the number of analgesic rescues at various time intervals, patient satisfaction score, and any side effects. Results Postoperative VAS scores at 4, 6, 12 and 24th hour (hr) (p < 0.05) in group BM were lower compared to group B.Time required for rescue analgesia was significantlyprolonged in group BM (882.94 ± 70.22 minutes) compared to group B (459 ± 100.53 minutes) with minimal usage of rescue analgesia (p < 0.05)up to 12 hr.In group BM, the patient satisfaction score was higher (p = 0.001). Conclusion In addition to a considerable reduction in post operative VAS scores and overall use of rescue analgesia, the addition of magnesium to bupivacaine significantly prolongs the TAP block and increases the initial postoperative period of bearable pain.

The effect of adding magnesium sulphate as an adjuvant to peribulbar block for glaucoma surgery in morbidly obese patients: A randomized controlled study

ABSTRACT Background This study aimed to evaluate safety and efficacy of magnesium sulphate as an adjuvant to peribulbar block at two different doses (75 and 100 mg) in reducing intraocular pressure (IOP) in obese patients undergoing glaucoma surgery. Methods Forty-six adult patients, American Society of Anesthesiologists status I–III, with body mass index of 30–55 kg/m2 undergoing glaucoma surgery under peribulbar block were enrolled during February, 2021. Patients were randomly assigned into two groups (1:1). Both groups received 4 ml of lidocaine 2%, 4 ml of bupivacaine 0.5%, and 1 ml of hyaluronidase (10IU of hyaluronidase/ml of lidocaine). Magnesium sulphate was added to this mixture either in a dose of 75 mg (group I) or 100 mg (group II). Primary outcomes included onset of globe and lid akinesia and IOP. Secondary outcomes included durations of analgesia and motor block, patients’ and surgeons’ satisfaction, and vital data. Results The mean onsets to globe and lid akinesia were significantly lower in group II compared to group I (2.7 vs. 4.2 min, p < 0.001 and 3.1 vs. 4.2 min, p = 0.001, respectively). After the block, the mean IOP was significantly lower in group II at 1 min (27.2 vs. 32.7 mmHg, p = 0.0034), 3 min (26.5 vs. 32.4 mmHg, p = 0.002) and 5 min (26.2 vs. 32.1 mmHg, p = 0.001). Group II had a significantly longer mean durations of analgesia (3.5 vs. 2 hours, p < 0.001) and recovery of motor block than group I (3.3 vs. 2.3 hours, p < 0.001). No complications were encountered during the surgery. Conclusion Magnesium sulphate at a dose of 100 mg demonstrated higher efficacy while maintaining safety compared to the dose of 75 mg.

Efficacy of Magnesium Sulfate and Nifedipine in Treating Gestational Hypertension

Efficacy of Magnesium Sulfate and Nifedipine in Treating Gestational Hypertension

Efficacy of magnesium sulfate in the chronic obstructive pulmonary disease population: a systematic review and meta-analysis.

Magnesium sulfate has been extensively used to treat asthma exacerbations, but its efficacy remains questionable in the chronic obstructive pulmonary disease (COPD) population. The aim of the study was to compare the efficacy of intravenous (IV) magnesium sulfate in COPD. A systemic review search was conducted on PubMed, Embase, and the Central Cochrane Registry. Randomized clinical trials were included with magnesium sulfate as an intervention arm in the COPD population. For continuous variables, standardized mean difference (SMD) and difference in means (MD) were calculated. For discrete variables, the Mantel-Haenszel (MH) odds ratio was used. For effect sizes, a confidence interval of 95% was used. A p-value of less than 0.05 was used for statistical significance. Analysis was done using both random and fixed effect models. Heterogeneity was evaluated using the I² statistic. Seven studies were included in the final analysis. In patients with acute exacerbations of COPD treated with IV magnesium, a significant increase in forced expiratory volume in one second (FEV₁) was observed (MD = 2.537 [0.717 to 4.357], p = 0.006), as well as in peak expiratory flow rate (PEFR) (SMD = 1.073 [0.748 to 1.397], p < 0.001) using the fixed model. Similarly, residual volume decreased significantly in the IV magnesium group (MD = -0.470 [-0.884 to -0.056], p = 0.026). The hospitalization rate was also lower in the magnesium group, (MH odds ratio 0.453 [0.233 to 0.882], p = 0.020). No statistically significant difference was noted in FEV₁ in the stable COPD population. IV magnesium was associated with a favorable deviation of FEV1 and PEFR, decreased residual volume, and decreased odds of admission in the COPD exacerbation population. Therefore, magnesium sulfate can be used as an adjunctive therapy in the treatment of acute exacerbations of COPD.

Efficacy of Magnesium Sulfate in Addition to Melatonin Therapy in Neonates With Hypoxic-Ischemic Encephalopathy.

Background: One of the most important causes of neonatal deaths in developing nations is birth asphyxia. Though the probability of a complete recovery is very low, hypoxic-ischemic encephalopathy (HIE) associated with asphyxia can be managed with multiple treatment options. The study evaluated the efficacy of the addition of magnesium sulfate (MgSO4) to melatonin therapy in neonates with HIE.Methodology: A prospective, observational study was conducted in the department of neonatal intensive care, Pakistan Institute of Medical Sciences Hospital, Islamabad, Pakistan from October 2020 to March 2021. All neonates with an Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score of less than five at five minutes, umbilical blood pH of less than 7.0, and moderate neonatal encephalopathy as detected on the modified Sarnat score which is a clinical tool used for the assessment of the severity of HIE were included in the study. Neonates with congenital abnormalities, intrauterine growth retardation, neonatal sepsis, and infants born to mothers with diabetes mellitus type 2 were excluded from the study. The infants were randomly assigned to either of the groups, i.e., i) group 1 included neonates who were administered at least three doses of magnesium sulfate (MgSO4) infusion in addition to melatonin, or ii) group 2 included neonates who were administered melatonin only. Blood samples of all neonates were evaluated and compared between the two groups.Results: A total of 90 neonates with HIE were included in the study. There was a predominance of female neonates. The mean ages of babies in group 1 and group 2 were 37.2 ± 0.43 and 37.3 ± 0.59 weeks, respectively. The mean weight on the term was 2.88 ± 0.11 and 2.89 ± 0.10, respectively. The Apgar score at 5 mins in group 1 was 1.73 ± 0.81 while in group 2, 1.82 ± 0.94. It was found that there was a more significant improvement in pH after 3 days and after one week of treatment in group 1 as compared to group 2. The mean pH in babies after three days of intervention was 7.23 ± 0.03 in group 1 which was significantly better than group 2 (p<0.0001). After seven days, the mean normalized to 7.39 ± 0.04 in group 1 (p < 0.0001). It was found that in patients in group 1, the mortality was lower than in group 2 (p < 0.0001).Conclusion: HIE patients who were administered melatonin in combination with magnesium sulfate yielded better patient outcomes. Thus, it was concluded that the use of magnesium sulfate as dual therapy with melatonin improved patient outcomes for HIE. However, it is recommended that similar studies are conducted with a wider range of parameters, such as duration of hospital stay and assessment of the neurological outcomes of the patients.

Fasciculations and Hyperkalaemia Associated with Suxamethonium: Efficacy of Magnesium Sulphate

General anesthesia with controlled ventilation through endotracheal tube is an anaesthetic technique used by the anesthesiologists all over the world. Laryngoscopy and endotracheal intubation is necessary to achieve this technique. Traditionally succinylcholine is drug of choice for induction due to its rapid onset of action. Aim: This study compared the efficiency of magnesium sulphate in reducing fasciculation and increase in serum potassium which are the common complications associated with suxamethonium administration. Methods: Fifty six patients being planned for lower abdominal surgery under general anaesthesia were randomized into two groups M and S. Serum potassium was taken in the theatre, three minutes before induction of anesthesia patients in M group were given 6 mg/kg of magnesium sulphate diluted in 10 ml normal saline intravenously while in S group 10 ml of normal saline was injected intravenously. The occurrence and degree of fasciculation were recorded after administration of suxamethonium in both groups while serum potassium was also taken at the end of fasciculations. The researcher was blinded to the content of the syringes until after the study. Results: More patients in the S group had fasciculations compared to the M group while the degree of fasciculations was more in the S group, the serum potassium increase was more in the saline group.

Efficacy of Magnesium Sulphate in Attenuation of Succinylcholine Induced FasciculationsA Randomised Clinical Study

Introduction: Magnesium Sulphate (MgSO4 ) pre-administration is effective in reducing Succinylcholine (Sch) induced fasciculations due to its effect at presynaptic end plate. Magnesium competes with calcium at the pre-synaptic end plate of neuromuscular junction and inhibits the release of acetylcholine (Ach) from the motor nerve terminal and to a lesser extent, decreases the sensitivity of the postjunctional membrane and reduces the excitability of the muscle fibre. Aim: To evaluate three doses of MgSO4 in reducing the incidence and severity of fasciculations and correlate with the serum magnesium levels. Materials and Methods: This prospective, randomised clinical trial was at Vijayanagar Institute of Medical Sciences (VIMS), Ballari, India. Ninety consenting adult patients aged 20-50 years scheduled for elective surgeries with endotracheal intubation under general anaesthesia were randomly allocated to three groups- Group 1, Group 2 and Group 3, to receive Injection (Inj.) MgSO4 20 mg/kg, 30 mg/kg and 40 mg/kg, respectively, before induction. Induction with Inj. propofol (2 mg/kg) was followed by administration of Inj. Sch (1.5 mg/kg). The main outcome parameters were the incidence of fasciculations and grading of the severity. Haemodynamic responses from the basal levels and after intubation, and adverse effects to the study drugs were noted. Chi-square test was used to find the significance of study parameters on categorical scale among the groups. Probability values at &lt;0.05 were considered as significant. Results: The incidence of fasciculations was 90%, 53.4% and 43.4% in groups 1, 2 &amp; 3, respectively. Greater number of patients had grade 3 fasciculations in group 1 (20%), compared to group 2 and group 3 (3.4% and nil) respectively. The fall in blood pressure after MgSO4 was comparable among the three groups. Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) increased by 23.5% and 18.5%, 7.9% and 4.1% and 2.8% and 2.7% in groups 1, 2 and 3, respectively at one minute. The SBP and DBP at 3rd and 5th minute stayed at statistically significant greater levels in group 1 as compared to groups 2 and 3, but were similar in groups 2 and 3 overall. The Heart Rate (HR) changes followed similar trend in all 3 groups. Incidence of feeling of warmth was highest in group three as compared to other groups. Conclusion: MgSO4 at 40 mg/kg can be the optimal dose to suppress Sch-induced fasciculations, with better attenuation of intubation associated haemodynamic changes.

Safety and efficacy of Magnesium Sulfate in the management of Tetanus: A systematic review.

Tetanus is a rare life-threatening condition often complicated by repetitive spasms, dysautonomia and neuromuscular respiratory failure contributing to high fatality rates in its severe form. Benzodiazepines used to treat muscle spasms pose a high risk of respiratory failure requiring mechanical ventilation, which is unaffordable and inaccessible for many. Magnesium sulfate, a cheap and widely available medication in all urban and rural health centres of LMICs for the treatment of eclampsia, can be used to control muscle spasms and dysautonomia. We thus conducted a systematic review of evidence to assess the safety and efficacy of magnesium sulfate in the treatment of tetanus. Any study published before April 15, 2021, discussing the efficacy and/or safety of MgSO4 infusion in the treatment of tetanus was systemically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our systematic review included data from 13studies, three were randomised, double-blind and controlled trials. The remaining ten studies were observational; six prospective and four retrospective studies. Our review showed no mortality benefit associated with the use of magnesium sulfate. However, magnesium sulfate was found to be effective in reducing spasms along with diazepam, leading to better control of dysautonomia, reduced need for mechanical ventilation and shorter hospital stay by 3-7days. The incidence of magnesium toxicity was very low in the studies included.

Efficacy of Magnesium Sulfate on Maternal Mortality in Eclampsia.

Eclampsia is a common complication of preeclampsia patients and can be life-threatening for both the mother and the fetus. Hence, timely intervention and appropriate management of this detrimental condition are extremely crucial. Eclampsia is described as the occurrence of generalized convulsions in patients with preeclampsia. Magnesium sulfate (MgSO4) is the drug of choice for treating and preventing eclampsia. This review aims to study and analyze the available literature on the pathogenesis of eclampsia, the pharmacology of MgSO4, and its effectiveness in the management of eclampsia. Other proposed treatments and their comparative study with MgSO4 are also discussed. Additionally, we examine the data regarding the impact of eclampsia, its public health burden, and the cost-effectiveness of MgSO4. One of the major drawbacks associated with the use of MgSO4 in low-income countries has been the cost of treatment and the lack of resources. We have analyzed the trials that have proposed alternate treatment regimens which could shape new guidelines to resolve these issues. For this review, we extensively studied abstract and full-text articles from multiple databases. This article discusses the pathophysiology of eclampsia, the pharmacology of MgSO4, the issues surrounding eclampsia management, and how MgSO4 benefits these patients.

Efficacy of magnesium sulfate as an adjuvant to rocuronium in general anaesthesia: a meta-analysis.

ObjectiveMagnesium sulfate is considered to be an effective adjuvant to rocuronium in general anaesthesia. We conducted a meta-analysis to clarify its efficacy.MethodsWe searched the PubMed, Embase, Web of Science, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) of magnesium sulfate as an adjuvant to rocuronium from the start of the database establishment until May 2020.ResultsEleven RCTs were analysed. The pooled meta-analysis showed that using magnesium sulfate as an adjuvant significantly shortened the onset time and prolonged the clinical duration of neuromuscular blockade by rocuronium compared with the control group without magnesium sulfate. However, there was no significant difference in recovery index of neuromuscular block between the magnesium and control groups. Furthermore, magnesium sulfate significantly increased the rates of excellent and clinically acceptable intubation conditions.ConclusionAdding magnesium sulfate to rocuronium during general anaesthesia can alter the neuromuscular parameters, including shortening the anaesthesia-onset time and prolonging the clinical duration, without significantly increasing the recovery time. Pretreatment with magnesium sulfate may also improve intubation conditions during general anaesthesia.

Efficacy of Magnesium Sulphate as an Adjunct to Ropivacaine in Local Subcutaneous Infiltration for Postoperative Analgesia Following Lower Segmental Ceasfrean Section in Parturents under Spinal Anesthesia

Introduction: Magnesium is an antagonist of NMDA receptors and associated ion channels. It is found in very small concentrations in the plasma and is chiefly an intracellular ion. It is suggested that magnesium has many important roles to play in nociception. An inverse relationship has been documented between the severity of pain with different painful medical and surgical conditions and the serum magnesium levels. Methodology: Patients were monitored for postoperative pain and any analgesic requirement for a period of 24 hours. Any patient complaining of pain or reporting VAS ≥ at any time was administered In tramadol 100 mg IV slowly over 2-3 minutes. If pain was not relieved after 30 minutes and patients still complained of pain, additional doses of Inj tramadol 50mg IV was given and this dose could be repeated every 30 minutes upto a total dose of 250 mg in 6 hourly and maximum of 400mg of Inj tramadol over 24 hours. Results: The number of patients who were administered 2nd, 3rd and 4th doses of rescue analgesics was significantly greater in group A as compared to group B. None of the patients in group B needed more than 4 doses of rescue analgesia while in group A, 5 patients were administered a rescue analgesic for 5th time. The study suggests that local infiltration of local anaesthetic agent alone or in conjunction with magnesium is safe. Conclusion: The addition of magnesium to local anaesthetics potentiates the effect of local anaesthetics and reduces the postoperative opioid requirement.

Safety and Efficacy of Magnesium Sulphate as an Adjuvant to Levobupivacaine in Ultra-sound Guided Transversus Abdominis Plan Block in Pediatric Abdominal Cancer Surgery

Safety and Efficacy of Magnesium Sulphate as an Adjuvant to Levobupivacaine in Ultra-sound Guided Transversus Abdominis Plan Block in Pediatric Abdominal Cancer Surgery

The Efficacy of Magnesium Sulfate in Reduction of Post Cardiac Surgery Arrhythmia, Agitation and Pain: A randomized controlled study

The Efficacy of Magnesium Sulfate in Reduction of Post Cardiac Surgery Arrhythmia, Agitation and Pain: A randomized controlled study

Intravenous Regional Anesthesia: Comparing Efficacy of Magnesium Sulfate and Clonidine as an Adjuvant to Lignocaine for Intraoperative and Postoperative Analgesia

Intravenous Regional Anesthesia: Comparing Efficacy of Magnesium Sulfate and Clonidine as an Adjuvant to Lignocaine for Intraoperative and Postoperative Analgesia

Efficacy of Magnesium Sulfate as Adjuvant to Ropivacaine 0.4% for Supraclavicular Brachial Plexus Block in Patients undergoing Upper Limb Surgery: A Randomized Controlled Trial

Objectives: To prolong the duration of brachial plexus block, different adjuvants have been used. We evaluated the effect of adding magnesium sulfate to local anesthetic ropivacaine 0.4% for institution of supraclavicular brachia plexus block. Onset of sensory and motor block, duration of motor block, and rescue analgesia were observed. Materials and methods: Total 120 patients (20–50 years) scheduled for elective surgeries of upper limb under supraclavicular brachial plexus block were randomized into two groups. Group I received 24 mL 0.5% ropivacaine (120 mg) + 6.0 mL normal saline (NS) to make total volume of 30 mL. Group II received 24 mL 0.5% ropivacaine (120 mg) + 150 mg magnesium sulfate + 5.5 mL NS to make total volume of 30 mL. Results: Onset of sensory block in group I was 16.63 ± 2.79 min and in group II was 17.33 ± 2.25 min (statistically not significant, p < 0.05). Onset of motor block in group I was 18.63 ± 2.79 min and in group II was 19.76 ± 2.18 min (statistically significant, p < 0.05). The duration of motor block was significantly longer in group II; 322.00 ± 81.35 min than group I; 260.25 ± 66.79 min (p < 0.05). Similarly, time of rescue analgesia was significantly prolonged in group II; 491 ± 100.22 min than group I; 377.67 ± 73.31 min (p < 0.05). Conclusion: From our study, we concluded that the addition of 150 mg magnesium sulfate as adjuvant to 30 mL of 0.4% ropivacaine in comparison to 30 mL of 0.4% ropivacaine provides longer duration of analgesia. Although the onset of sensory block is not affected, onset of motor block is delayed. Motor block lasts for longer duration.

Efficacy of magnesium sulphate and/or fentanyl as adjuvants to intrathecal low-dose bupivacaine in parturients undergoing elective caesarean section

Background and Aim: Recent developments in the field of intrathecal adjuvants have led to accelerated functional recovery with adequate postoperative analgesia following caesarean section. Encouraging results have been obtained with the use of intrathecal magnesium with or without fentanyl in parturients. This study was conceived to evaluate the effects of adding magnesium sulphate and/or fentanyl to low-dose intrathecal bupivacaine in parturients undergoing caesarean section under subarachnoid block (SAB). Materials and Methods: Ninety, American Society of Anesthesiologists I or II, parturients for the elective caesarean section were enrolled in this prospective randomized, double-blind study. The parturients were randomly assigned to three groups. In Group M, parturients received 8.5 mg (1.7 mL) hyperbaric bupivacaine 0.5% with 50 mg (0.1 mL) magnesium sulphate and 0.4 mL normal saline. Group F received 8.5 mg hyperbaric bupivacaine 0.5% with 20 μg (0.4 mL) fentanyl and 0.1 mL of normal saline and Group MF parturients received 8.5 mg hyperbaric bupivacaine 0.5% with 20 μg fentanyl added to 50 mg magnesium sulphate. Results: Parturients in the group MF were pain free for longest period (273.70 ± 49.30 min) as compared to group M (252.67 ± 40.76 min) and group F (239.80 ± 38.45 mins) [gp MF vs F and, gp M vs F (P = 0.00)]. The total doses of rescue analgesics were least in group MF (2.43 ± 0.56) and maximum in group F (3.30 ± 0.63), with comparable neonatal outcomes in three groups. Conclusion: Our data supports synergistic action of intrathecal magnesium sulphate to fentanyl, and it is concluded that on addition of intrathecal magnesium sulphate and fentanyl to low-dose bupivacaine as adjuvant in subarachnoid block, results in prolonged duration of postoperative analgesia with lesser pain scores and lesser dose of rescue analgesia with better haemodynamic stability.

A Prospective Randomized and Double-blind Study to evaluate the Efficacy of Magnesium Sulfate on Postoperative Analgesic Requirement in Patients undergoing Laparoscopic Cholecystectomy

Background and aims: Magnesium sulfate has recently gained popularity as an adjuvant to general anesthesia. It acts as a blocker of N-methyl D-aspartate (NMDA) antagonist and hence may have a potential role in the prevention of postoperative pain. The aim of the present prospective, randomized, double-blind, and placebocontrolled study was to evaluate the efficacy of injection magnesium sulfate 50 mg/kg as premedication upon postoperative pain and analgesic requirement in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Materials and methods: After obtaining institutional ethical committee approval, 100 patients of American Society of Anesthesiologists (ASA) grade 1 and 2 undergoing laparoscopic cholecystectomy under general anesthesia were randomly allocated into two groups to receive either 50 mg/kg magnesium sulfate in normal saline to a total volume of 5 mL (group M, n = 50) or 5 mL of normal saline (group S, n = 50) as premedication prior to general anesthesia. The patients were continuously monitored for postoperative pain using visual analog scale (VAS) in the immediate postoperative period and subsequently at 2-hour intervals for the next 24 hours. Injection tramadol 1 mg/kg was given as the rescue analgesic (VAS ≥ 4). Results: Both the groups were comparable with respect to demographic variables. There was no statistically significant difference in the postoperative VAS scores (p = 0.489) and tramadol requirement among the groups (p = 0.38). Conclusion: Magnesium sulfate 50 mg/kg premedication is ineffective in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials.

The efficacy of magnesium sulphate in chronic obstructive pulmonary disease (COPD) was assessed by conducting a systematic review of published randomized clinical trials through extensive searches in MEDLINE and SCOPUS with no date limits, as well as manual review of journals. Outcome measures varied depending on route(s) of administration of magnesium sulphate and medications co-administered. Risk of bias was evaluated and quality of evidence was graded. Four (4) randomized trials were included. All trials had a moderate risk of bias and were of average methodological quality. Magnesium sulphate given intravenously did not seem to have an immediate bronchodilatory effect; however it appears to potentiate the bronchodilatory effect of inhaled beta-2 agonists. Increase in peak expiratory flow rate (PEFR) at 30 and 45 min was greater in those who received magnesium sulphate compared to placebo (P = 0.03), although the mean percentage change in PEFR was just 24%, without significant differences in dyspnoea scores, hospital admission rates, or emergency department readmission rates compared to placebo. Nebulized magnesium sulphate with salbutamol versus nebulized salbutamol with saline placebo showed no significant differences is forced expiratory volume in 1 s (FEV1) measured at 90 min after adjustment for baseline FEV1 (P = 0.34) or differences in the need for hospital admission. Combined inhalational and intravenous magnesium sulphate versus intravenous saline placebo and nebulized ipratropium bromide were comparable in terms of hospital admission, intubation and death, but the ipratropium bromide group showed better bronchodilator effect and improvement in arterial blood gas parameters. Overall, trial evidence for trial evidence for magnesium sulphate in acute exacerbation of COPD is poor, and further well-designed trials are needed.