Magnesium Sulfate Infusion Research Articles

The Effect of Intravenous Magnesium Sulphate as an Adjuvant in the Treatment of Acute Exacerbations of COPD in the Emergency Department: A Double-Blind Randomized Clinical Trial.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are serious complications that often require immediate intervention in an emergency department (ED). The aim of this study was to investigate the effect of intravenous magnesium sulphate as an adjuvant in the treatment of AECOPD in the ED. In a double-blind, randomized clinical trial, a total of 60 patients with AECOPD presenting to the ED of Imam Khomeini Hospital in Sari, Iran, were included. The study was conducted between September 2016 and February 2018. Eligible patients were randomly allocated into two groups of intervention and control. Patients in the intervention and control groups received intravenous infusion of magnesium sulfate (2 gr) or normal saline over 30 minutes, respectively. For all patients, Borgdyspnea score, forced expiratory volume in one second (FEV1) result and clinical variables of interest were evaluated before the beginning of the intervention, and also 45 minutes and 6 hours after the commencement of intervention. Regardless of time of evaluation, pulse rate (PR), respiratory rate (RR) and Borg score in intervention group was lower than control group. Also, FEV1 and SPO2 were greater in intervention group compared to control group. However, these differences were not statistically significant (between-subject differences or group effect) (p<0.001). The trends of FEV1, SPO2, PR, RR and Borg score were similar between two groups of study (no interaction effect; P>0.05). According to the results of this study, it seems that using intravenous magnesium sulfate has no significant effect on SPO2, FEV1, RR, and PR of patients with AECOPD who presented to ED.

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.

Role of magnesium in abdominal wall dyskinesia.

Objective: Jerky involuntary intermittent abdominal wall movements are mentioned with numerous names including abdominal wall dyskinasia and belly dancer’s dyskinesia. Literature incorporates a sizeable amount of case reports. Patterson analyzed the largest series published in 2011. Although associated with central and peripheral nervous system disorders and published precipitating factors like anxiety, operations particularly abdominal, diarrhea, nutritional imbalances, pregnancy under the umbrella of idiopathic/psychogenic /functional belly’s dancer’s dyskinesia. Various investigations including blood count, ESR, CT, MRI, ECG plain radiography do not reflect any abnormality. Similarly a large number of modalities are utilized to manage the disorder from diazepam to phrenic nerve block; however no definite treatment has been mentioned. Magnesium calms down the excitability of central and peripheral nervous systems by inhibition of NMDA receptors and calcium influx mediated acetylcholine release. Magnesium deficiency results in excitability of the excitable tissues resulting in neuromuscular hyperactivity. We are reporting a patient who presented with abdominal wall dyskinasia, managed successfully with an infusion of magnesium sulphate which has never been described.

Analgesic and hemodynamic effects of intravenous infusion of magnesium sulphate versus dexmedetomidine in patients undergoing bilateral inguinal hernial surgeries under spinal anesthesia: a randomized controlled study

BackgroundSpinal anesthesia is commonly employed during inguinal hernial surgeries. Its short duration may, however, be considered a limitation, especially for bilateral hernial repair. The aim of this research is to investigate the analgesic and hemodynamic effects of intravenous infusion of both MgSO4 and dexmedetomidine on patients undergoing bilateral inguinal hernia surgeries under spinal anesthesia. MethodsThis study was a prospective, randomized, double-blinded controlled trail. It included 60 male patients who had been scheduled for bilateral elective inguinal hernia surgery under spinal anesthesia at Kasr Al-Aini hospital. Patients were randomly allocated to one of three groups (n = 20 each) to receive 50 mL of 0.9% saline intravenous infusion of either dexmedetomidine 0.5 μg.kg-1. h-1 (Group D) or magnesium sulphate 15 mg.kg-1. h-1 (Group M) or normal saline (Group S). The primary outcome of this study was set as the total duration of analgesia. Secondary outcomes were set as the onset and duration of sensory and motor blockade, perioperative hemodynamics, and the total 24-hour postoperative morphine consumption. ResultsDurations of sensory and motor blockades as well as durations of analgesia were all significantly longer among patients in Group D (mean 2.2, 3.5, 5.8 hours respectively) and Group M (mean 2.2, 3.3, 5.2 hours respectively), in comparison to Group S (mean 1.5, 2.7, 3.9 hours respectively). No significant differences were found in systolic or diastolic arterial blood pressure, heart rate oxygen saturation, cardiac output, or stroke volume among the study groups. Seven patients in Group D and four patients in Groups M and S developed hypotension. ConclusionIntravenous infusion of either dexmedetomidine or MgSO4 with spinal anesthesia effectively improves the quality of spinal anesthesia and prolongs the duration of postoperative analgesia and decreases the 24-hour postoperative morphine consumption. Results also demonstrated that the use of dexmedetomidine resulted in a slightly longer duration of analgesia, whilst the use of MgSO4 resulted in slightly better hemodynamic stability.

934 Factors associated with acute response to treatment of severe hypertension in pregnancy

Pulse pressure (systolic – diastolic blood pressure; PP) has been proposed to guide medication choice for treatment of severe hypertension (HTN), as it may indicate whether the HTN is mediated by cardiac output (high PP) or systemic vascular resistance (low PP). We aimed to identify factors associated with response to treatment during pregnancy that may aid in tailoring therapy. This is a retrospective cohort study of women with severe HTN who were initially treated with intravenous labetalol, hydralazine or oral nifedipine at a tertiary care center (2015-2018). Severe HTN was defined as systolic blood pressure (BP) ≥ 160 mmHg and/or diastolic BP ≥ 110 mmHg sustained for 15 minutes or more. Association between medication choice and demographic characteristics at the time of treatment was evaluated using Pearson’s chi-square and ANOVA, where appropriate. Those with P < .2 were considered for incorporation into a multivariable model to predict resolution of severe HTN within 60 minutes of treatment. We identified 435 women who received treatment for severe HTN and grouped by initial medication received: 194 received labetalol, 137 nifedipine, and 104 hydralazine. Baseline BPs were similar among groups, but women receiving nifedipine had lower post-treatment BP and required less doses (Table 1). In the multivariable model, independent factors negatively correlated with resolution of severe HTN within 60 minutes included mean arterial pressure ≥ 125 mmHg, ≥ 2 doses administered, labetalol as first agent, PP > 75, gestational age < 37 weeks, postpartum treatment, and magnesium sulfate infusion > 10 minutes prior to resolution of severe HTN (Figure 1). The model had an optimism-corrected bootstrapped (1000 replicates) area under the curve of 0.84 (95% CI 0.76-0.86). Labetalol was associated with a longer time to resolution of severe HTN irrespective of PP. Nifedipine was associated with lower post-treatment BP and fewer required doses. Pulse pressure was not predictive of response to antihypertensives in our cohort.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Lidocaine versus magnesium sulfate infusion during isoflurane anesthesia for brain tumor resection, effect on minimum alveolar concentration reduction guided by bispectral index: a prospective randomized controlled trial

Objective: Goals of neuro-anesthesia include smooth induction, stable perioperative hemodynamics, early and quiet recovery with adequate analgesia. Intraoperative use of co-sedatives allows reduction of anesthetic agents consumption while maintaining a desirable depth of anesthesia. Many drugs like opioids and dexmedetomidine had been studied in different surgeries. Using such drugs enhances rapid recovery for early postoperative assessment and detection of complications. Methods: This study enrolled 50 adult patients undergoing supratentorial brain tumor surgery. Patients of the lidocaine group (group L) received 1.5 mg.kg−1 of lidocaine as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 1.5 mg.kg−1.h−1. Patients of the magnesium group (group M) received 30 mg.kg−1 of magnesium sulfate as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 10 mg.kg−1.h−1. Depth of anesthesia was guided by bispectral index in a range of 50 ± 2, with the primary outcome objective, minimum alveolar concentration reduction of inhaled isoflurane. Results: No significant difference was found regarding patient demographics, basal hemodynamic data, and anesthesia duration. The used isoflurane concentration at the matching time points (every 15 min intraoperatively) and the total dose of muscle relaxant (160 ± 15 mg, 175 ± 18 mg respectively, p 0.003) were statistically lower in group M than in group L. The time required for recovery was statistically shorter in group M than in group L (5.1 ± 0.99 min vs 9.8 ± 1.9 min, respectively, p 0.00). Conclusion: Compared to lidocaine infusion, magnesium sulfate (MgSO4) infusion during anesthesia for brain surgery resulted in lower anesthetic consumption, muscle relaxant requirement, a shorter recovery time, and a better postoperative pain profile. MgSO4 can be used effectively as a co-sedative adjuvant with superior clinical properties than lidocaine infusion.

Efficacy of iv infusion of magnesium sulphate and dromperidol on the management of neuropathic and somatosensory chronic pain - a two pain center study

Introduction: Droperidol as a medicine has unique properties and it has been successfully used as analgesic, antipsychotic, antiemetic and as a sedative [1]. It is an antagonist for d2-dopamine, serotonin, histamine, and nicotinic and muscarinic cholinergic receptors. It is also a dose-dependent agonist/antagonist of GABA receptors and an agonist of a2 adrenergic receptors. Moreover, is a sodium channel blocker such as lidocaine and potentiate μ opioid receptors. Its multi-receptor action justifies its use as analgesic, antiemetic and antiphycotic medication [2]. Magnesium seems to function as an antagonist for NMDA receptors and it has been used for relief of acute and chronic pain [3, 4]. The aim of the current study is the evaluation of the efficacy of droperidol and magnesium co-administration on the patients with chronic pain. Method: All patients that attended the pain clinic for chronic pain and aged over 18 years old were included in the study. Patients with atrioventricular block any grade and patients with chronic renal failure were excluded from the study. All included patients received droperidol to the dose 2.5 mg maximum and 1 gr magnesium sulphate iv. DN4 questionnaire was used to assess the presence of neuropathic pain. VAS scale and NPS scale were used to assess the intensity of pain before and after the administration. Change in the pain scales calculated as a percentage. Results: 48 patients included in the study. 23 of them had neuropathic pain. There was a 40–50% reduction of the intensity of pain after iv administration of droperidol and magnesium. There weren’t any complications. Conclusions: The co-administration of magnesium and droperidol can relieve neuropathic and somatosensory pain. Long-term evaluation is needed.

To study the efficacy of intravenous infusion of magnesium sulfate in the Indian population during epidural anesthesia using 0.5% bupivacaine for postoperative pain in infra-umbilical surgery

To study the efficacy of intravenous infusion of magnesium sulfate in the Indian population during epidural anesthesia using 0.5% bupivacaine for postoperative pain in infra-umbilical surgery

Effect of magnesium sulphate on the intracranial pressure of preeclampsia patients using ultrasound-guided optic nerve sheath diameter: A pilot study.

Background:Increased intracranial pressure (ICP) is a known complication of pre-eclampsia with severe features. The use of magnesium sulphate (MgSO4) is the standard treatment and is associated with marked reduction of cerebral perfusion pressure (CPP) and prevention of cerebral damage. Optic nerve sheath diameter (ONSD) ultrasonography is a bedside tool used to reflect changes in the ICP. The aim of this study is to detect the effect of MgSO4 administration on ICP in severe preeclampsia through measuring changes in the ONDS.Methods:Thirty pregnant female patients suffering from severe pre-eclampsia were enrolled in this prospective pilot study. Ultrasound measurement of ONSD was measured before the commencement of MgSO4 and after 1, 6, and 24 h after the administration.Results:There was a significant difference in ONSD measurements between that at baseline and post magnesium administration at 1, 6, and 24 h (P-value 0.001). Additionally, a significant difference in measurements between 1 and 6 and 6 and 24 h after magnesium initiation (P-value 0.001).Conclusions:Ultrasound ONSD measurement in patients with severe preeclampsia is a non-invasive easy tool to detect increased intracranial pressure and monitor the response to magnesium sulphate infusion.

Minocycline and Magnesium As Neuroprotective Agents for Ischemic Stroke: A Systematic Review.

Stroke is a leading cause of death, disability, and dementia worldwide. Strokes can be divided into ischemic strokes and hemorrhagic strokes. At the moment, tissue plasminogen activator (tPA) is the only FDA-approved drug for ischemic stroke. Minocycline (MC) and Magnesium (Mg) are promising therapies for ischemic stroke, especially in the pre-hospital setting. These drugs are readily available, inexpensive, and generally safe. We decided to investigate these drugs' neuroprotective effects in treating ischemic stroke in the acute and chronic setting. We conducted a systematic review of the published literature on MC and Mg's functional outcome in ischemic stroke. This paper's methodology included only clinical trials published in the last 15 years, using PubMed as a database. The systematic review demonstrated that MC infusion in the pre-hospital and hospital setting improved functional outcomes and disability scores.Furthermore, MC also decreased matrix metalloproteinase 9 (MMP-9) levels. MC might have a more significant effect on men than women because different molecular pathways of cerebral ischemia seem to be involved between both genders. The systematic review showed that patients with ischemic stroke did not benefit from magnesium sulfate infusion in the pre-hospital and hospital setting. Nevertheless, patients with lacunar strokes and patients who supplemented their meals with potassium-magnesium salt in the diet had better functional outcomes. Future studies would need a more significant sample of participants and a better selection to increase the study's power and avoid selection bias, respectively. Further publications could benefit from subcategorizing strokes and investigating the gender role in stroke treatment. These directives could give a more robust conclusion regarding the neuroprotective effects of these drugs.

Intravenous Hydrogen Therapy With Intracisternal Magnesium Sulfate Infusion in Severe Aneurysmal Subarachnoid Hemorrhage.

Poor-grade subarachnoid hemorrhage still has a poor prognosis. This randomized controlled clinical trial evaluated intracisternal magnesium sulfate infusion combined with intravenous hydrogen therapy in patients with poor-grade subarachnoid hemorrhage. Thirty-seven patients with poor-grade subarachnoid hemorrhage were randomized to Mg+H2, Mg, and control groups. Mg and Mg+H2 groups received intracisternal magnesium sulfate infusion (2.5 mmol/L) at 20 mL/h for 14 days. Mg+H2 group also received intravenous hydrogen-rich solution infusion for 14 days. Primary outcome measures were occurrence of delayed cerebral ischemia and cerebral vasospasm. Secondary outcome measures were modified Rankin Scale and Karnofsky performance status at 3 and 12 months, Barthel index at 12 months, and serum and cerebrospinal fluid malondialdehyde and neuron-specific enolase. Serum neuron-specific enolase levels were significantly lower in the Mg+H2 group from days 3 to 14 than in the control group. Cerebrospinal fluid neuron-specific enolase levels were also significantly lower in the Mg+H2 group from days 3 to 7 than in the control group. Incidences of cerebral vasospasm and delayed cerebral ischemia were significantly higher in the control group than in other groups. Modified Rankin Scale and Karnofsky performance status did not significantly differ between the three groups at 3 months. Modified Rankin Scale scores 0 to 2 were more common in the Mg and Mg+H2 groups at 1 year. Barthel index was higher in the Mg+H2 group than in the control group. Intracisternal magnesium sulfate infusion started immediately after surgery reduces the incidence of cerebral vasospasm and delayed cerebral ischemia and improves clinical outcomes without complications in patients with poor-grade subarachnoid hemorrhage. Intracisternal magnesium sulfate infusion combined with intravenous hydrogen therapy decreases serum malondialdehyde and neuron-specific enolase and improves Barthel index, indicating hydrogen has additional effects. Registration: URL: https://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000014696.

The Effect of Intraoperative Magnesium Sulphate Infusion on Emergence Agitation after Ambulatory Ophthalmic Surgery in Children

This study investigated whether intraoperative infusion of magnesium sulphate reduces the incidence of emergence agitation (EA) in paediatric patients who undergo ambulatory ophthalmic surgery using the Paediatric Anaesthesia Emergence Delirium (PAED) scale. Ninety-two paediatric patients who were scheduled for elective ophthalmic surgery were randomly allocated to two groups: control or magnesium. In the magnesium group, patients received an initial intravenous loading dose of 30 mg/kg of 10% solution of magnesium sulphate over 10 min and then a continuous infusion of 10 mg/kg×h during the surgery. In the control group, an equal volume of 0.9% isotonic saline was administered in the same way as in the magnesium group. The PAED scale was assessed at 15-min intervals until the PAED score reached below 10 at the postanaesthetic care unit. EA was defined as a PAED score of 10 or higher. Of the 86 patients recruited, 44 and 42 were allocated to the control and magnesium groups, respectively. The incidence of EA was 77.3% in the control group and 57.1% in the magnesium group (odds ratio, 0.392; 95% confidence interval, 0.154 to 0.997; p = 0.046). The intraoperative infusion of magnesium sulphate significantly reduced the incidence of EA.

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.

Use of Sequential Compression Devices for Prevention of Maternal Hypotension After Epidural Analgesia in Birth

Reduce the use of vasopressors to treat hypotension when less invasive methods can be used and reduce adverse fetal outcomes. Sequential compression devices (SCDs) will be placed on all women until the second stage of labor or birth, immediately before placement of epidural analgesia in labor. Poster training of all nurses on the process occurred for 2 weeks before implementation of the practice, with nurses signing off on understanding the process. A chart reminder sheet was created and attached to the physical charts for all women in labor. The presence of SCDs was confirmed in each patient room and unit per level of SCD leg wraps increased. On July 15, SCD use began. From July 15 until October 15, 2019, data were collected on use of SCDs on all intrapartum patients meeting study parameters who received epidural analgesia. The principal outcome will be the reduced occurrence of maternal hypotension within 1 hour of epidural placement, defined as a systolic blood pressure (SBP) lower than 90 mm Hg or 80% lower than the value before epidural analgesia. In addition, the need for vasopressors (ephedrine, phenylephrine) and changes in fetal heart rate categories within 1 hour of epidural analgesia will be secondary outcomes. Cases from a historical cohort before introduction of SCD and cases in which SCDs were not placed during the study period will constitute the control group. Results will be controlled for maternal demographic, obstetric characteristics, and medical characteristics. Outcome information (mode of birth, indications for operative birth, neonatal outcome) will be recorded. Statistical analysis will use chi-square or Fisher’s exact test for categorical variables, and Student’s t test or one-way analysis of variance for continuous variables, with a two-tailed p value less than .05 will be considered significant. Change in use of SCDs (before this study, SCDs were primarily used at this facility on morbidly obese patients, patients receiving magnesium sulfate infusion, and postoperative patients). Application and documentation of application before placement of epidural analgesia. Use of SCDs during second-stage labor and the potential changes to the physical environment. Reduction in use of vasopressors.

Controlled Hypotension During Endoscopic Sinus Surgery: A Comparison of Propofol and Magnesium Sulfate

Objective: Controlled hypotension is considered as an effective technique for reducing blood loss and optimizing the surgical field. This study was designed to compare intravenous infusion of propofol and magnesium sulfate for achieving controlled hypotension during elective endoscopic sinus surgery.

Antitussive effect of a magnesium infusion during anesthetic emergence in patients with double-lumen endotracheal tube: a randomized controlled trial.

BackgroundA double-lumen endotracheal tube (DLT) inserted into the bronchus can stimulate the respiratory tracts, causing coughing. Opioids have been introduced to prevent emergence cough. However, the administration of a significant opioid dose at the end of surgery may result in undesirable events. Magnesium, common intracellular ion, suppress bronchial smooth muscle contraction and have antitussive effect. We investigated the antitussive effects of a magnesium infusion during anesthetic emergence in patients who underwent thoracic surgery requiring one-lung ventilation (OLV) anesthesia with a DLT.MethodsOne-hundred forty patients undergoing OLV anesthesia with a DLT were enrolled in this prospective, randomized double-blinded trial. In combination with a low dose of remifentanil, patients were randomly allocated to receive either magnesium sulphate (infusion of 15 mg/kg/hour after a single bolus of 30 mg/kg) or normal saline during the operation and emergence. Primary outcomes were the severity and incidence of cough during emergence.ResultsThe severity of cough was assessed by the cough severity grading score: 0, no cough; 1, single cough; 2, cough persistence <5 seconds; 3, cough persistence ≥5 seconds. There was a significant difference in the severity score of cough between the groups [median (IQR): 2 (0 to 3) in control group vs. 0 (0 to 1) in magnesium group, P=0.003]. However, there was no significant difference in the overall incidence of cough between both groups [42 (64.6%) in control group vs. 31 (47.7%) in magnesium group, P=0.077].ConclusionsMagnesium attenuated the severity of cough during emergence after OLV anesthesia using a DLT without adverse events.

Bakri balonun 12 saatten daha uzun süre uygulanması postpartum uterus atonisi tedavisinde olumlu klinik sonuçlar sağlar mı?

Aim: If the initial treatment techniques fail, intrauterine balloon tamponade (IUBT) devices such as Bakri balloon tamponade (BBT) is an effective treatment for reducing the bleeding in uterine atony patients. However, the duration of the Bakri balloon varies widely in clinical practice, and there is no consensus in this issue. This study aimed to compare the clinical outcomes of the Bakri balloon removed in less or more than 12 hours in patients with severe postpartum haemorrhage (PPH).&#x0D; Materials and methods: This retrospective study included 108 patients who underwent Bakri balloon for severe PPH after vaginal delivery. Patients were divided into two groups as the duration of Bakri balloon 8-12 hours (Group I) and &gt;12 hours (Group II). BBT was considered to be successful if the bleeding was stopped, and the patient did not require additional invasive procedures. Age, parity, gestational week, cause of bleeding, presence of co-morbidity that may increase bleeding (multiple gestation, magnesium sulphate infusion), estimated blood loss (EBL) before and after Bakri balloon, postpartum infection, erythrocyte and fresh frozen plasma requirement and invasive procedure requirement of the groups were compared.&#x0D; Results: In group I, 26 patients (52%) underwent erythrocyte transfusion, and 18 patients (36%) underwent both erythrocyte and fresh frozen plasma (FFP) transfusion. In group II, 28 patients (41.2%) underwent erythrocyte transfusion, and 21 patients (30.9%) underwent both erythrocyte and FFP transfusion. These differences were not statistically significant (p=0.42 and p=0.21, respectively). Bacri balloon was failed to reduce bleeding in one patient (2%) in group I and one patient (1.5%) in group II, and these patients had to undergo invasive surgical procedures (hysterectomy). There was no statistically significant difference between the groups in terms of failed to reduce bleeding rates (p=0.52).&#x0D; Conclusion: Keeping the Bakri balloon in place for longer than 12 hours does not provide favourable clinical outcomes compared to keeping in place for less than 12 hours.

Intraoperative Infusion of Magnesium Sulphate does not Reduce Laryngospasm and Agitation during Emergence from Anaesthesia in Children

Background Laryngospasm and agitation during emergence from general anaesthesia are frequent in children. Magnesium sulphate may have the potential of reducing both of these adverse events. In addition, magnesium has analgesic and anaesthetic properties. Objective To find out the effectiveness of magnesium sulphate in reducing the occurrence of emergence laryngospasm and agitation and other adverse events if any in children. Method Randomized, placebo controlled study was conducted at a tertiary care hospital in 132 children, aged 3-12 years undergoing general anaesthesia for hernia and hydrocele surgery. Children with American Society of Anaesthesiologist Physical Status > II were excluded. After insertion of laryngeal mask airway, 20 ml of either magnesium sulphate 15 mg/kg (Group M) or normal saline (Group N) was infused at the rate of 1 ml/min. The severity of laryngospasm and agitation was assessed. We also noted other adverse events, if occurred. Result Laryngospasm occurred in 7(10.6%) patients of group M and in 10(15.1%) patients of group N(p=0.40). While 14(10.6%) patients developed laryngospasm immediately after removal of LMA, only 3(2.2%) patients developed it in the post anaesthetic care unit. Two (3.0%) patients of group M and four patients (6.0%) of group N were agitated (p=0.40). Three (4.5%) patients of group M and 14(21.2%) patients of group N coughed during emergence (p=0.004). Conclusion Intraoperative infusion of 15 mg/kg magnesium sulphate, does not reduce the occurrence of emergence laryngospasm and agitation in children. However, it significantly reduce emergence cough.

Effects of perioperative magnesium sulfate infusion on intraoperative blood loss and postoperative analgesia in patients undergoing posterior lumbar spinal fusion surgery: A randomized controlled trial

ObjectiveMany studies have suggested the anti-nociceptive role for magnesium either as an adjunct for postoperative pain. Although several studies have been carried out to evaluate the anti-nociceptive effect of magnesium, there is still considerable uncertainty. Patients and MethodsEighty patients who underwent posterior spinal fusion were randomly divided into two groups (magnesium and saline). Changes in cell count, magnesium concentration and coagulation status were assessed one hour after operation at both group and compared to baseline. At recovery room, their pain score was assessed according to 10 points visual analogue scale (VAS). Morphine consumption was evaluated at regular times after the surgery by patient controlled analgesia (PCA) device. ResultsVAS scores were significantly lower in the magnesium group. Cumulative PCA morphine consumption after the surgery was significantly lower in the magnesium group. Pre and postoperative values for haemoglobin, platelet count, Prothrombin Time (PT), fibrinogen were not significantly different. There was a significant increase in activated Partial Thromboplastin Time (aPTT), International Normalized Ratio (INR), and bleeding time (BT), one hour after the operation in the magnesium group but intraoperative blood loss was similar in both groups. ConclusionsPerioperative magnesium sulfate infusion improves the postoperative analgesia, decreases the amount of morphine consumption after the operation and does not change the intraoperative bleeding in patients undergoing posterior spinal fusion surgery.

Could intraoperative magnesium sulphate protect against postoperative cognitive dysfunction?

Although there is much concern about the pathogenesis of postoperative cognitive dysfunction (POCD); no effective prevention strategies are currently described. The aim of this work was to study whether intraoperative magnesium sulphate could have a protective effect against developing POCD and to study its impact on serum level of S100B, a marker of neuronal degeneration. This is a prospective randomized controlled trial carried out on 80 participants undergoing elective laparoscopic cholecystectomy, 40 participants received conventional general anesthesia (conventional anesthesia group) and 40 participants received conventional general anesthesia with extra administration of intraoperative magnesium sulphate (Mg sulphate group). Cognitive assessment for both groups was done preoperatively and 1 week postoperatively using Paired Associate Learning test (PALT) and Benton Visual Retention Test (BVRT). Quantitative determination of serum S100B was done for both groups preoperatively and one week postoperatively by using an enzyme- linked immunoabsorbent assay technique. Postoperative PALT and BVRT were significantly lower than preoperative PALT and BVRT in the conventional anesthesia group (P value =0.043, P value =0.015 respectively), but not in the Mg sulphate group (P value =0.134, P value =0.151 respectively). Postoperative S100B was significantly higher than preoperative S100B in the conventional anesthesia group (P value =0.006), but not in the Mg sulphate group (P value =0.293). Administration of intravenous infusion of magnesium sulphate during conventional general anesthesia can protect against POCD and attenuate the post operative elevation of serum S100B.