Intravenous Magnesium Sulfate Infusion Research Articles

Influence of Intravenous Magnesium Sulfate Infusion on the Subjective Postoperative Quality of Recovery: A Meta-Analysis of Randomized Controlled Trials.

This meta-analysis investigated the effects of intravenous magnesium sulfate on the postoperative recovery quality, as assessed using the Quality of Recovery (QoR) questionnaire, in adult surgical patients. Seven randomized controlled trials involving 622 patients were included. Compared with the placebo, magnesium sulfate significantly improved the global QoR score on postoperative day 1 (standardized mean difference [SMD]: 1.24; 95% confidence interval: 0.70-1.78; p < 0.00001). It also enhanced specific QoR dimensions, with substantial effects on pain (SMD: 1, p < 0.00001) and physical comfort (SMD: 0.85, p < 0.0001), a moderate effect on emotional state (SMD: 0.65, p = 0.002), and small improvements in physical independence (SMD: 0.43, p < 0.00001) and psychological support (SMD: 0.37, p < 0.0001). In addition, magnesium sulfate reduced the intraoperative opioid consumption (SMD: -0.66, p < 0.0001), postoperative pain severity, and the incidence of postoperative nausea and vomiting (risk ratio: 0.48, p = 0.008). The extubation times were unaffected, whereas the post-anesthesia care unit stay was slightly prolonged. These findings highlight the potential of magnesium sulfate as a valuable adjunct for multimodal analgesia and enhanced recovery. Future studies should aim to elucidate the optimal dosing strategies, timing of administration, and specific surgical populations that may derive maximum benefits.

Effects of intravenous single-bolus lidocaine infusion versus intravenous single-bolus magnesium sulfate infusion on postoperative pain, emotional status, and quality of life in patients undergoing spine fusion surgery: a randomized study.

We assessed the efficiency of intravenous adjuvants in decreasing opioid intake and pain scores after spine fusion surgery. This study included 120 patients aged 18-60 listed for spine fusion surgery under general anesthesia. Patients were randomly assigned to four groups: Group (Lidocaine): received IV lidocaine 4 mg/kg in 50 mL volume over 30 min. Group (Magnesium): received IV magnesium sulfate 30mg/kg in 50 mL volume over 30 min. Group (combined Lidocaine and Magnesium): received IV lidocaine 4 mg/kg in 50 mL volume over 30 min.+IV magnesium sulfate 30mg/kg in 50 mL volume over 30 min. Group (Control): received IV saline 50 mL. The time to the first request analgesia, the postoperative pain score, total analgesic use, patient satisfaction, anxiety, depression, mental state, quality of life, and side effects were measured. The combined group had more extended time for the first analgesic request and fewer rescue analgesia doses than the other groups. NRS scores at rest or movement were statistically significantly lower in the lidocaine group and the combined group compared to the control group (P1, P3<0.05) at almost all times. This combination reduces anxiety and depression and improves overall health up to three months after a single infusion. The combined group had higher patient satisfaction. A synergistic effect of a combination of lidocaine and magnesium sulfate on perioperative pain was found. It reduces analgesic consumption, depression, and anxiety and improves overall health up to three months after a single infusion dose.

Analgesic and hemodynamic effects of intravenous magnesium sulfate infusion versus lidocaine infusion in patients undergoing thyroid surgery for toxic goiter resection: a randomized controlled study

Background Anesthesia for toxic goiter resection is challenging as manipulation of the thyroid gland and inadequate postoperative pain control could lead to hemodynamic instability due to stress and a neurohormonal response. Both magnesium sulfate and lidocaine are known for their analgesic effects and decreasing stress response. Herein, we compared the previous two medications regarding intraoperative hemodynamics and postoperative analgesia. Patients and methods 57 patients who underwent toxic goiter resection were enrolled in this prospective randomized trial (group M received magnesium sulfate, group L received lidocaine, and group C received normal saline). Intraoperative hemodynamics and postoperative analgesic profiles were assessed. Results Both injection groups expressed significantly lower pain scores compared with control group at Post anaesthesia care unit (PACU) and one-hour postoperative. Postoperative fentanyl consumption was significantly lower, and the time to first analgesic request was significantly prolonged in Magnesium and Lidocaine groups than in the control group. The previous beneficial effects were more prominent in the Magnesium Group compared with the Lidocaine Group. There was no significant difference in mean arterial pressure (MAP) and heart rate (HR) among the three study groups at the baseline, after the end of infusion, and after induction. Nonetheless, there was a significant rise in mean arterial pressure and heart rate values in the control group compared with the Magnesium and Lidocaine Groups with intubation and during the first hour of surgery. Conclusion Both magnesium sulfate and lidocaine have beneficial hemodynamic stabilizing and analgesic effects in patients undergoing thyroid surgery for toxic goiter, with a slight superiority for magnesium.

A prospective comparative study of efficacy of intravenous magnesium sulfate infusion versus placebo, as an adjuvant to nebulized salbutamol in the management of acute exacerbations of chronic obstructive pulmonary disease

Background: Acute exacerbations of chronic obstructive pulmonary diseases (AECOPD) are a frequent cause of hospitalization, morbidity, and mortality and require serious medical attention. Much research has demonstrated the beneficial effects of intravenous and nebulized magnesium sulfate (MgSO4) as a bronchodilator, in the management of acute severe asthma. Nevertheless, the extent of the benefits of intravenous MgSO4 as an adjuvant to bronchodilators in AECOPD remains uncertain. Therefore, the current study aims to address this gap in knowledge. Aims and Objectives: The study aimed to compare the effectiveness of intravenous magnesium sulfate (MgSO4) versus placebo when used as an adjuvant to nebulized salbutamol in managing AECOPD. Materials and Methods: In this comparative prospective interventional, parallel-group, placebo-controlled study, a total of 60 subjects were assigned to two groups consisting of 30 individuals each. The allocation was non-randomized and open-label, with one group receiving intravenous MgSO4 as an adjuvant to nebulized salbutamol, while the other group received a placebo in the same manner. The evaluation of MgSO4 efficacy involved measuring the peak expiratory flow rate (PEFR), which served as the primary outcome parameter. PEFR measurements were taken at 0, 15, 30, and 45 min to assess the effectiveness of MgSO4. Safety and tolerability of MgSO4 were assessed based on changes in heart rate, blood pressure, deep tendon reflexes, and respiratory rate. Results: At 45 min, the mean change in PEFR was significantly higher (P = 0.061) in the MgSO4 group (178.33 ± 49.18) compared to the placebo group (155.43 ± 41.86). Moreover, the mean difference in PEFR between the two groups was consistently higher in the MgSO4 group at every observation. MgSO4 showed considerable safety and tolerability in subjects based on the postmedication monitoring of hypermagnesemia symptoms. Conclusion: Administering intravenous magnesium sulfate (MgSO4) as an adjuvant to bronchodilators in AECOPD led to the improvement of both clinical condition and PEFR. In AECOPD, MgSO4 exhibits enhanced early bronchodilator response when combined with other drugs, demonstrating significant efficacy, good safety, and tolerability at the prescribed dosage.

A prospective comparative study of efficacy of intravenous magnesium sulfate infusion versus placebo, as an adjuvant to nebulized salbutamol in the management of acute exacerbations of chronic obstructive pulmonary disease

Background: Acute exacerbations of chronic obstructive pulmonary diseases (AECOPD) are a frequent cause of hospitalization, morbidity, and mortality and require serious medical attention. Much research has demonstrated the beneficial effects of intravenous and nebulized magnesium sulfate (MgSO4) as a bronchodilator, in the management of acute severe asthma. Nevertheless, the extent of the benefits of intravenous MgSO4 as an adjuvant to bronchodilators in AECOPD remains uncertain. Therefore, the current study aims to address this gap in knowledge. Aims and Objectives: The study aimed to compare the effectiveness of intravenous magnesium sulfate (MgSO4) versus placebo when used as an adjuvant to nebulized salbutamol in managing AECOPD. Materials and Methods: In this comparative prospective interventional, parallel-group, placebo-controlled study, a total of 60 subjects were assigned to two groups consisting of 30 individuals each. The allocation was non-randomized and open-label, with one group receiving intravenous MgSO4 as an adjuvant to nebulized salbutamol, while the other group received a placebo in the same manner. The evaluation of MgSO4 efficacy involved measuring the peak expiratory flow rate (PEFR), which served as the primary outcome parameter. PEFR measurements were taken at 0, 15, 30, and 45 min to assess the effectiveness of MgSO4. Safety and tolerability of MgSO4 were assessed based on changes in heart rate, blood pressure, deep tendon reflexes, and respiratory rate. Results: At 45 min, the mean change in PEFR was significantly higher (P = 0.061) in the MgSO4 group (178.33 ± 49.18) compared to the placebo group (155.43 ± 41.86). Moreover, the mean difference in PEFR between the two groups was consistently higher in the MgSO4 group at every observation. MgSO4 showed considerable safety and tolerability in subjects based on the postmedication monitoring of hypermagnesemia symptoms. Conclusion: Administering intravenous magnesium sulfate (MgSO4) as an adjuvant to bronchodilators in AECOPD led to the improvement of both clinical condition and PEFR. In AECOPD, MgSO4 exhibits enhanced early bronchodilator response when combined with other drugs, demonstrating significant efficacy, good safety, and tolerability at the prescribed dosage.

Efficacy of intravenous magnesium sulfate infusion on postoperative pain and quality of recovery for septorhinoplasty: a randomized controlled study

Background The pain that occurs after septorhinoplasty is an important factor affecting the comfort of the patient. Objectives To investigate the effect of perioperative intravenous magnesium sulfate infusion on postoperative pain and quality of recovery in patients underwent septorhinoplasty surgery. Material and methods One hundred twenty patients who underwent septorhinoplasty were randomly divided into two groups. Magnesium group received intravenous magnesium after induction of anesthesia (30 mg/kg), then infused until the end of the surgical procedure (9 mg/kg). The placebo group received the same volume of saline infusion. The VAS score was used for postoperative pain assessment, and the Quality of Recovery-40 (QoR-40) score was used for the assessment of recovery status. Results The postoperative 30 min, 1st, 2nd, 4th (p < .001) and 24th hour (p < .05) VAS scores of the patients in the magnesium infusion group were significantly lower compared to the placebo group. Also; in terms of physical comfort (p < .001), emotional state (p < .05), psychological support, pain and total score values (p < .001), patients in magnesium group had significantly higher QoR-40 scores than those in placebo group. Conclusion Intraoperative magnesium infusion, which is widely used in many surgeries to provide controlled hypotension, also contributes significantly to patient comfort with its positive effect on postoperative pain and recovery scores.

A Clinical Study of Low Molecular Weight Heparin Sodium Injection Combined with Magnesium Sulfate Injection and Labetalol Tablets in the Treatment of Severe Pregnancy-Induced Hypertension

Objective: To investigate the clinical effect of low molecular weight heparin sodium injection combined with magnesium sulfate injection and labetalol in the treatment of severe pregnancy-induced hypertension. Methods: A total of 48 patients with severe pregnancy-induced hypertension admitted from February 2021 to February 2023 were selected, and the patients were divided into two groups by simple sampling, with 24 cases in each group. Patients in the control group received labetalol orally and intravenous infusion of magnesium sulfate, whereas those in the observation group received subcutaneous injection of low molecular weight heparin sodium on the basis of the control group. The two groups of patients underwent 5 days of treatment, and the blood pressure control, vascular endothelial function, renal function, and blood coagulation were compared between the two groups. Results: Before treatment, there were no significant differences in blood pressure readings, endothelin-1 (ET-1) and nitric oxide (NO) levels, serum creatinine (SCr) and blood urea nitrogen (BUN) levels, and the four coagulation indices between the two groups (all P &gt; 0.05). After treatment, the blood pressure readings in the observation group were lower than those in the control group (P &lt; 0.05); ET-1 in the observation group was lower than that in the control group, and the NO level in the observation group was higher than that in the control group (P &lt; 0.05); compared with the control group, the observation group had lower SCr and BUN (P &lt; 0.05), longer prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT), and lower fibrinogen (Fib) level (P &lt; 0.05). Conclusion: Low molecular weight heparin sodium injection combined with magnesium sulfate injection and labetalol in the treatment of severe pregnancy-induced hypertension can help control blood pressure levels, promote the recovery of vascular endothelial function and renal function, and effectively correct coagulation function.

Evaluation of intravenous infusion of labetalol versus magnesium sulfate on cerebral hemodynamics of preeclampsia patients with severe features using transcranial doppler

PurposeIt is essential to understand the underlying pathophysiological mechanisms of preeclampsia cerebral complications. This study aimed to compare the cerebral hemodynamic effects of magnesium sulfate (MgSO4) and labetalol in pre-eclampsia patients with severe features.MethodsSingleton pregnant women who suffered from late onset preeclampsia with severe features were enrolled and subjected to baseline Transcranial doppler (TCD) evaluation and then randomly assigned to either the magnesium sulfate group or labetalol group. TCD to measure middle cerebral artery (MCA) blood flow indices including mean flow velocity (cm/s), mean end-diastolic velocity (DIAS), and pulsatility index (PI) and to estimate CPP and MCA velocity were performed as basal measurements before study drug administration and at post-treatment one and six hours after administration. The occurrence of seizures and any adverse effects were recorded for each group.ResultsSixty preeclampsia patients with severe features were included and randomly allocated into two equal groups. In group M the PI was 0.77 ± 0.04 at baseline versus 0.66 ± 0.05 at 1hour and 0.66 ± 0.05 at 6 hours after MgSO4 administration (p value < 0.001) also the calculated CPP was significantly decreased from 103.3 ± 12.7mmHg to 87.8 ± 10.6mmHg and 89.8 ± 10.9mmHg (p value < 0.001) at 1 and 6 hours respectively. Similarly, in group L the PI was significantly decreased from 0.77 ± 0.05 at baseline to 0.67 ± 0.05 and 0.67 ± 0.06 at 1 and 6 hours (p value < 0.001) after labetalol administration. Moreover, the calculated CPP was significantly decreased from 103.6 ± 12.6 mmHg to 86.2 ± 13.02mmHg at 1 hour and to 83.7 ± 14.6mmHg at 6 hours (p value < 0.001). In terms of changes in blood pressure and the heart rate, they were significantly lower in the labetalol group.ConclusionBoth magnesium sulfate and labetalol reduce CPP while maintaining cerebral blood flow (CBF) in preeclampsia patients with severe features.Trial registrationThe institutional review board of the Faculty of Medicine, Zagazig University approved this study with the reference number (ZU-IRB#: 6353-23-3-2020) and it was registered at clinicaltrials.gov (NCT04539379).

Effect of single dose preemptive intravenous paracetamol, dexamethasone, and magnesium sulfate on perioperative hemodynamic variables and post-operative nausea, vomiting, and pain in open cholecystectomy done under general anesthesia: A prospective, randomized, and single-blind study

Background: Pain due to open cholecystectomy can result in delayed recovery and poor operative outcomes. Multimodal approaches to pain control cause functional improvement. We compared the efficacy of paracetamol 1 g, dexamethasone 8 mg, and magnesium sulfate 2 g with normal saline in control over perioperative hemodynamics and post-operative pain in patients undergoing open cholecystectomy under general anesthesia. Aims and Objectives: This study conducted to assess the effect of preemptive intravenous paracetamol, dexamethasone, and magnesium sulfate on perioperative hemodynamic variables (primary outcome) and post-operative nausea, vomiting, and pain (secondary outcome) in open cholecystectomy. Materials and Methods: Sixty patients of ASA Grade I/II were randomized into two groups to receive either normal saline 100 ml iv (Group C, n=30) or infusion containing inj. paracetamol 1 g, inj. dexamethasone 8 mg and inj. magnesium sulfate 2 g iv (group PDM, n=30), 20 min before induction. Intraoperative and post-operative hemodynamic data, post-operative pain scores, and incidence of nausea vomiting were recorded. Results: Intraoperative pulse rate was significantly higher at intubation and 15 min after intubation in the control group and intraoperative systolic, diastolic, and mean arterial blood pressure were significantly higher in control group at intubation and until 60 min. Post-operative pulse rate was significantly higher in the control groups at 180 min and incidence of PONV reduced in PDM group until 90 min. Conclusion: Preemptive intravenous infusion of paracetamol, dexamethasone, and magnesium sulfate provided better stability over perioperative hemodynamics, reduced the incidence of post-operative nausea vomiting, and provided better post-operative pain control.

Effect of pre-emptive intravenous paracetamol, magnesium sulfate, and lignocaine on hemodynamic variables during perioperative period in pre-eclampsia patients scheduled for lower segment cesarean section under general anesthesia: A prospective randomized study

Background: Hemodynamic alterations during general anesthesia with endotracheal intubation are due to stimulation of the sympathetic nervous system and catecholamine release. Therefore, it is important to attenuate these responses in pre-eclampsia patients who are already under stress. Aims and Objectives: The present study aimed to evaluate the combined efficacy of paracetamol, magnesium sulfate, and lignocaine in attenuating hemodynamic responses during intubation and perioperative period. Materials and Methods: Eighty ASA II pre-eclampsia patients were randomly divided into two groups. Group PLM received intravenous infusion of paracetamol (1 g) and magnesium sulfate (30 mg/kg) in 100 ml normal saline and IV bolus Inj. lignocaine (1.5 mg/kg) 15 min before induction. Group C received only IV infusion of 100 ml normal saline. Pulse rate (PR), blood pressure (BP), and oxygen saturation were measured at various time intervals up to 40 min of delivery of baby and in up to 240 min in post-operative period. Post-operative visual analog score (VAS) and the time for first rescue analgesia (TRA I) were recorded. Results: Demographic and baseline hemodynamic parameters were comparable in both groups (P&gt;0.05). Changes in PR and BP during laryngoscopy, intubation, and perioperative period were significantly lesser in Group PLM as compared to Group C (P&lt;0.05). The post-operative VAS score was significantly lower whereas TRA I was significantly longer in Group PLM than in Group C at all measuring times (P&lt;0.05). Conclusion: Combination of paracetamol, magnesium sulfate, and lignocaine attenuates hemodynamic responses during laryngoscopy, intubation, and perioperative period along with prolonged post-operative analgesia in cesarean section under general anesthesia in pre-eclampsia patients.

Study the Effect of Intravenous Infusion of Dexamethasone versus Magnesium Sulphate on Incidence and severity of Post Dural Puncture Headache in Parturient Undergoing Caesarean Section

Study the Effect of Intravenous Infusion of Dexamethasone versus Magnesium Sulphate on Incidence and severity of Post Dural Puncture Headache in Parturient Undergoing Caesarean Section

Pain and Multimodal Analgesia in Laparoscopic Cholecystectomy.

Background: The administration of high doses of opioids during surgery can lead to higher postoperative pain scores at rest and when coughing. Multimodal analgesia may lower the need for opioids during surgery and the suffering of postoperative pain. Multimodal analgesia can be achieved by providing non-opioid drugs (lidocaine, ketamine, and magnesium sulfate), three different types of drugs. Each of these drugs as different analgesic effects and they belong to three different pharmacological groups. The aim of this study is to develop a better understanding of the effects of each drug (lidocaine, ketamine, and magnesium sulfate) on postoperative analgesia, the needs for rescue analgesics, and analyze the total amount of fentanyl during the intraoperative period in patients undergoing laparoscopic cholecystectomy. Methods: 120 patients were enrolled in this randomized controlled study. They were classified as ASA 1 and 2 and were scheduled for laparoscopic cholecystectomy. They were further divided into 3 groups. Group 1, or the lidocaine group, had received lidocaine at 1 mg/kg and a continuous intravenous infusion with lidocaine at 2 mg/kg/h. Group 2, or the ketamine group, received ketamine at 0.5 mg/kg. Group 3, or the magnesium sulfate group, received a continuous intravenous infusion of magnesium sulfate at 1.5 gr/kg. The intensity of postoperative pain was assessed using a VAS score at rest and when coughing, with evaluation at 1, 4, 8, 12, and 24 hours, postoperatively. Also, the needs for rescue analgesics and the total amount of fentanyl during the intraoperative period in all groups was also followed. Results: The patients from the lidocaine group had the highest scores of pain in the postoperative period at rest and when coughing, and the ketamine group had the lowest pain scores. Rescue analgesia was given the most to lidocaine group, and less so in the magnesium group. The magnesium group received the highest dose of fentanyl during surgery and the lowest dose was received by patients from the lidocaine group. Conclusion: Multimodal analgesia can lower the need for opioids in the intra- and postoperative period after laparoscopic cholecystectomy.

Efficacy and Safety of Prolonged Magnesium Sulfate Infusions in Children With Refractory Status Asthmaticus.

ObjectivesThere is a paucity of data on the use of intravenous magnesium sulfate infusion in children with refractory status asthmaticus. The purpose of this study was to evaluate the efficacy and safety of prolonged magnesium sulfate infusion as an advanced therapy.MethodsThis is a single center retrospective study of children admitted to our pediatric intensive care unit (PICU) with status asthmaticus requiring continuous albuterol. Treatment group included patients receiving magnesium for ≥4 h and control group included those on other therapies only. Patients were matched 1:4 based on age, sex, obesity, pediatric index of mortality III and pediatric risk of mortality III scores. Primary outcomes included PICU length of stay (LOS) and mechanical ventilation (MV) requirement. Secondary outcomes included mortality, extracorporeal membrane oxygenation (ECMO) requirement, analyses of factors associated with PICU LOS and MV requirement and safety of magnesium infusion. Logistic and linear regressions were employed to determine factors associated with MV requirement and PICU LOS, respectively.ResultsTreatment and control groups included 27 and 108 patients, respectively. Median initial infusion rate was 15 mg/kg/hour, with median duration of 28 h. There was no difference in the MV requirement between the treatment and control groups [7 (25.9%) vs. 20 patients (18.5%), p = 0.39]. Median PICU LOS and ECMO use were significantly higher in treatment vs. control group [(3.63 vs. 1.09 days, p < 0.01) and (11.1 vs. 0%, p < 0.01), respectively]. No mortality difference was noted. On regression analysis, patients receiving ketamine and higher prednisone equivalent dosing had higher odds of MV requirement [OR 19.29 (95% CI 5.40–68.88), p < 0.01 and 1.099 (95% CI 1.03–1.17), p < 0.01, respectively]. Each mg/kg increase in prednisone equivalent dosing corresponded to an increase in PICU LOS by 0.13 days (95% CI 0.096–0.160, p < 0.01). Magnesium infusions were not associated with lower MV requirement or lower PICU LOS after controlling for covariates. Fourteen (51.9%) patients in the treatment group had an adverse event, hypotension being the most common.ConclusionMagnesium sulfate infusions were not associated with MV requirement, PICU LOS or mortality.

A comparative study of clonidine and magnesium sulfate premedication on perioperative hormonal stress responses, hemodynamic stability and postoperative analgesia in patients with gallbladder diseases undergoing laparoscopic cholecystectomy. A randomized, double-blind, controlled study

ABSTRACT Background Hemodynamic derangement due to pneumoperitoneum and postoperative pain after laparoscopic cholecystectomy can be detrimental; this study investigated whether preoperative intravenous (I.V.) infusion of clonidine or Magnesium Sulfate (MgSO4) could attenuate hemodynamic responses, reduce serum cortisol level and improve post-operative analgesia. Materials and Methods In total, 105 patients scheduled for laparoscopic cholecystectomy were randomized to either group C (I.V. infusion of clonidine 1.5 µg/kg), group M (I.V.infusion of MgSO2 30 mg/kg) or group S (I.V. infusion of isotonic saline) 15 min before induction of general anesthesia. Outcome variables were heart rate (H.R.), mean arterial pressure (MAP), serum cortisol leveln, total analgesic requirements and recovery time. Results HR was significantly lower in group C than that in groups M and S. MAP and serum cortisol were significantly lower in groups C and M than that in control group. Pain score was better in groups C and M than group S at the first 2 hours post-operative with (P values 0.024 and 0.19), respectively. Reduced post-operative analgesic requirement with delayed onset to first analgesic request were observed in groups C and M compared with the control group . Recovery time was significantly rapid in group C than that of groups M and S. Conclusion Pre-operative I.V. infusion of clonidine and MgSO4 significantly attenuated the hemodynamic response to pneumoperitoneum, reduced serum cortisol level, reduced postoperative pain and analgesic requirement as compared to controls in patients undergoing laparoscopic cholecystectomy. Clonidine was superior compared to MgSO4 regarding H.R. control and rapid recovery.

Effect of IV Infusion of Magnesium Sulfate on Postoperative Pain after Spinal Anesthesia: A Prospective Randomized Trial

Background: The current study attempts to evaluate the effect of intravenous (IV) infusion of magnesium sulfate during spinal anesthesia on postoperative pain and postoperative analgesic requirements in lower limb surgeries.&#x0D; Methods: In this double blind, randomized controlled study, 60 patients undergoing elective lower limb surgeries, were selected and randomly divided into two groups. Group I received isotonic saline and group II was administered magnesium sulfate 50 mg Kg-1 IV for 15 min and then 15 mg Kg-1 h-1 by continuous IV infusion till the end of surgery or 2 hours, whichever was earlier. Ramsay sedation scores, VAS scores for pain, time of first administration of rescue analgesic and total analgesic requirement were noted in both the groups.&#x0D; Results: Statistically significant difference was observed in the VAS score between the two groups at 1st, 2nd, 3rd, 6th, 9th and 12th hour intervals; with VAS scores being lower in the magnesium group (p&lt;0.05). The mean time of first rescue analgesic requirement in control group was 144.00 mins, while in magnesium group was 246.00 mins (p&lt;0.05). The total rescue analgesic requirement was found to be 251.67 mg and 181.67 mg at the end of 24 hours, in control and magnesium groups, respectively (p&lt;0.05).&#x0D; Conclusion: This study demonstrates statistically significant lowering of postoperative VAS scores, delayed need of postoperative analgesia and reduced total postoperative analgesic requirement in patients receiving intraoperative IV magnesium sulfate compared to the control group. Magnesium sulfate did not cause sedation or any other significant adverse effect in the doses used in the study.

A CASE OF CATASTROPHIC MAGNESIUM OVERDOSE

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Magnesium toxicity can occur due to decreased excretion or overconsumption and is rare in the general population. Early-onset symptoms of toxicity are nausea, flushing, weakness, and urinary retention. However, severe toxicity and its management is not well-described. We present a case of magnesium overdose with intractable hypotension. CASE PRESENTATION: A 34-year-old male presented to the emergency department after he was found unresponsive in a restaurant in the presence of empty bottles of magnesium supplements and ibuprofen. He was hypotensive, hypothermic, and emergently intubated for airway protection. His serum magnesium level was 11.7mg/dl. He was treated with gastric decontamination, intravenous calcium and admitted to the intensive care unit. Continuous Renal Replacement Therapy (CRRT) was initiated and led to a reduction in the measured serum magnesium concentration. Despite aggressive volume administration and multiple vasopressors, he had refractory shock and severe acidosis. An echocardiogram revealed adequate cardiac function; hence, he was not a candidate for Extracorporeal Membranous Oxygenation (ECMO). A trial of hydrocortisone and methylene blue also yielded no benefit to his distributive shock. His hospital course was further complicated by abdominal compartment syndrome requiring a bedside exploratory laparotomy, aspiration pneumonia, acute respiratory distress syndrome, and disseminated intravascular coagulation. Ultimately, his family elected to transition to comfort care, and the patient passed away on hospital day 4. DISCUSSION: Magnesium competitively blocks the entry of calcium into presynaptic terminals of smooth muscle cells, inhibiting the release of acetylcholinesterase, causing smooth muscle relaxation. In the setting of an overdose, this translates to refractory vasoplegia. Magnesium also alters the polarization of the cytoplasmic membrane in cardiac myocytes, causing lengthening of the action potential, thus predisposing to arrhythmias. While iatrogenic magnesium toxicity has been reported at levels of 3-5mg/dL, a level of >10mg/dL is uncommon. There may be a dose-dependent refractoriness that has not been identified in the literature so far. Treatment of severe magnesium toxicity requires urgent dialysis in conjunction with IV calcium which acts as an antagonist. If there is catecholamine resistance, methylene blue may be used to restore systemic vascular resistance. CONCLUSIONS: Severe magnesium toxicity can present with shock & acidosis. Despite dialysis and aggressive resuscitation, the vasoplegia can be refractory and lead to fatal complications, including respiratory collapse and cardiac arrest. Even with early recognition and treatment, the mortality can be high, and further studies are needed to improve outcomes. REFERENCE #1: Ajib FA, Childress JM. Magnesium Toxicity. [Updated 2021 Jan 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. REFERENCE #2: Cavell GF, Bryant C, Jheeta S. Iatrogenic magnesium toxicity following intravenous infusion of magnesium sulfate: risks and strategies for prevention. BMJ Case Rep. 2015;2015:bcr2015209499. Published 2015 Jul 31. doi:10.1136/bcr-2015-209499 REFERENCE #3: Pietro Delva, Magnesium and cardiac arrhythmias, Molecular Aspects of Medicine, Volume 24, Issues 1–3, 2003, Pages 53-62, ISSN 0098-2997, https://doi.org/10.1016/S0098-2997(02)00091-2. DISCLOSURES: No relevant relationships by Ayesha Azmeen, source=Web Response No relevant relationships by Daniel Condit, source=Web Response No relevant relationships by Angad Deengar, source=Web Response No relevant relationships by Prashant Grover, source=Web Response No relevant relationships by Samantha McPeck, source=Web Response No relevant relationships by Evan Nadler, source=Web Response No relevant relationships by Erin Rosenberg, source=Web Response No relevant relationships by Sharad Sathyan, source=Web Response

The effect of intravenous infusion of magnesium sulphate during spinal anesthesia on post-operative analgesia in patients undergoing total hip replacement

Abstract Introduction Fundamental of regional anesthesia is pharmacologically interrupting transmission of sensation in the specific nerve fiber. The sensory signals generated by tissue damage triggers a state of increased excitability, leading to prolonged post-operative pain or sensitization to such pain. The optimal pain treatment pre-empts the establishment of pain hypersensitivity during and after surgery by minimizing the patient discomfort while leaving physiologic nociceptive mechanisms intact so as to function as an early warning symptom. Aim To measure the effect of intravenous magnesium infusion during spinal anesthesia on post operative analgesia in patients undergoing total hip replacement. Patients and Methods Patients were randomly assigned to two groups using closed envelopes chosen by patients before the study. Patients in the magnesium group (Group M, n = 15) received magnesium sulphate 50 mg per Kg over 15 min after spinal anesthesia and then 15 mg per Kg per hr by continuous i.v. infusion until the end of surgery. Patients in the saline group (Group S, n = 15) received the same volume of isotonic saline over the same period. Infusions were prepared in pharmacy and they were administered using the infusion machines. Study data were recorded by an observer unaware of group assignments. Results the study showed that intravenous magnesium infusion during spinal anesthesia decreased VAS results in magnesium group specifically in the first 24 hours and hence decreasing need for post operative rescue analgesic consumption .Also post operative nausea,vomiting and shivering were lower in magnesium group. Conclusion We concluded that intravenous magnesium infusion during spinal anesthesia improves post operative analgesia and reduces incidence of nausea, vomiting and shivering in patients undergoing total hip replacement.

The Effect of Dexmedetomidine Infusion Versus Magnesium Sulphate Infusion on Emergence Delirium in Pediatric Patients Undergoing Lower Abdominal Surgery

Abstract Background Emergence delirium (ED) is a clinical state during emergence from general anesthesia in which patients are awake but have an altered mental state. Its underlying cause remains unknown. Age, preoperative anxiety, anesthetic technique or agents, surgical procedure and pain are all suggested to play a role in its development. Several drugs were used to lower it's incidence in children. Objective Evaluating the incidence and intensity of emergence delirium in pediatric patients undergoing lower abdominal surgery after using either intravenous dexmedetomidine infusion or magnesium sulphate infusion intraoperatively. Patients and Methods 100 patients were randomized to receive intraoperatively either dexmedetomidine loading dose (0.5 µg/kg) over 10 min. followed by infusion rate of (0.2 µg / kg / hr.) or magnesium sulphate loading dose (30 mg/kg) followed by infusion rate of (10 mg/kg/hr) after induction with sevoflurane, LMA application and administration of caudal block. PEAD score was used for assessing emergence delirium. Results Incidence of emergence delirium according to PAED scale ≥10 was significantly lower in dexmedetomidine group than magnesium sulphate group with Pvalue &amp;lt;0.001, &amp;lt;0.001, 0.031, 0.012, 0.012 at 0,5,10,15,20 min. respectively during PACU stay. This statistically significant vanishes after 20 min. stay in PACU. There were no significant differences as regard fentanyl top up doses, postoperative FLACC pain score, postoperative fentanyl requirements. Conclusion This study shows that intraoperative administration of dexmedetomidine infusion is more effective than magnesium sulphate infusion in lowering the incidence of emergence delirium during the first 20 minutes postoperatively. In preschool aged children undergoing lower abdominal surgeries.

Intravenous magnesium sulfate for prevention of vancomycin plus piperacillin-tazobactam induced acute kidney injury in critically ill patients: An open-label, placebo-controlled, randomized clinical trial.

Recent studies have shown an increased risk of acute kidney injury (AKI) induced by vancomycin + piperacillin-tazobactam (VPT) combination. In this study, the efficacy of intravenous magnesium sulfate in prevention of VPT induced AKI in critically ill patients admitted to the ICU has been evaluated. In an open-label, placebo-controlled, randomized clinical trial, 72 adults (≥ 18years old) who had indications to receive VPT as empiric therapy were assigned to the magnesium or control group in 1:1 ratio. Concomitant with VPT, intravenous infusion of magnesium sulfate was started for patients in the magnesium group. The target serum level of magnesium was defined 3mg/dl. Patients in the control group received normal saline as placebo. The target serum level of magnesium was defined 1.9mg/dl in this group. The study's primary outcome was incidence of AKI during and up to 48h after the treatment course. Escalation and de-escalation of VPT regimen, duration of hospitalization, length of ICU stay and 28-day mortality were secondary outcomes. Thirty patients in each group completed the examination. Five patients in the magnesium group and 11 patients in the control group experienced AKI (p = 0.072). De-escalation of VPT regimen was done approximately in 60% of patients. Duration of hospitalization and length of ICU stay were not statistically different between the groups. Finally, 28-day mortality was 23.33% in each group. Although the incidence of AKI was not statistically different between the groups in unadjusted logistic regression model, it became significant after adjusting for confounding factors [unadjusted model (OR = 0.34; 95% CI: 0.10-1.16, p = 0.084), adjusted model: (OR = 0.26; 95% CI: 0.07-0.96, p = 0.04)]. Administration of magnesium sulfate with the target serum levels around 3mg/dL reduced the incidence of AKI in critically ill patients who were receiving VPT as empric therapy.

A Clinical Trial of Patient Reported Alterations in Pain and Opioid Intake Following Paracetamol and Magnesium Sulfate after Orthognathic Surgery

Background and Objectives: Paracetamol and magnesium sulphate may aid in pain management, which is crucial to examine in view of the potential detrimental effects of taking opioids increased doses postoperatively for pain management.This study investigated the impact of paracetamol and magnesium sulphate on the amount of pain experienced after orthognathic surgery, as well as the amount of opioids needed. Place of Study: Avicenna Medical College Lahore Study Duration: January 2021 to December 2021 Materials and Methods: Patients who were due to undergo bimaxillary orthognathic surgery were separated into two groups, each containing 20 individuals, for the purpose of this randomized, double-masked clinical experiment. Patients in group 1 received an intravenous infusion of 1 gram of acetaminophen (paracetamol) within 20 minutes, while patients in group 2 received an intravenous infusion of magnesium sulphate at a rate of 50 milligrams per kilogram one hour before the surgery was completed. Before the patients were permitted to leave the recovery area, they were given a visual analogue scale and asked to rate their level of discomfort on it. This proceeded at the same four-hour intervals for the next twelve hours (VAS). A dose of 30 milligrams of pethidine was delivered to anyone with a pain score of five or higher at any time. Results: In addition to the Chi-square test, the t-test, and the Mann-Whitney U test, the data were analyzed using the generalized estimating equation (GEE).(P &gt; 0.05) There was no statistically significant difference in the amount of pain reported by either group during recovery or after 4 and 8 hours. This was true at all three time intervals. At the 12-hour point, the pain score of the magnesium sulphate group was considerably lower than that of the other groups (P = 0.008). It was concluded that there was no discernible change in the required amount of pethidine (P&gt;0.05). Conclusion: It was shown that magnesium sulphate was marginally more effective than paracetamol at reducing postoperative pain and the need for opioids. Both magnesium sulphate and paracetamol were effective in alleviating postoperative pain and minimizing the need for opioids. Keywords: Acetaminophen; Magnesium Sulfate; Analgesics, Opioid; Orthognathic Surgery; Pain