Intravenous Magnesium Sulfate Research Articles

Loperamide-Induced Torsades de Pointes: A Case Series

BackgroundLoperamide is an over-the-counter, inexpensive, antidiarrheal opioid that can produce life-threatening toxicity at high concentrations. Case Report 1A 28-year-old man with a history of depression and substance abuse disorder (SUD) presented to the emergency department (ED) with shortness of breath and lightheadedness. He ingested large amounts of loperamide daily. The patient's initial electrocardiogram (ECG) demonstrated sinus rhythm, right axis deviation, undetectable PR interval, QRS 168 ms, and QTc 693 ms. He was administered intravenous sodium bicarbonate and magnesium sulfate and admitted to the intensive care unit, eventually developing Torsades de Pointes (TdP). He was given lidocaine and isoproterenol infusions, and an external pacemaker was placed. He was discharged in stable condition on hospital day (HD) 16. Case Report 2A 39-year-old woman with a history of hepatitis C, depression, and SUD was transported to the ED after reported seizure-like activity. The patient experienced TdP in the ED and admitted to ingesting large amount of loperamide daily. An ECG demonstrated sinus rhythm, right axis deviation, PR interval 208 ms, QRS interval 142 ms, and QTc 687 ms. She was administered intravenous magnesium, sodium bicarbonate, and isoproterenol. After intensive care unit admission, the patient experienced no further TdP and was discharged on HD 6. Why Should an Emergency Physician Be Aware of This?Emergency physicians should proceed with caution when treating patients with loperamide toxicity. Even in asymptomatic patients and drug discontinuance, obtain consultation with a medical toxicologist, promptly treat ECG abnormalities aggressively, and admit all patients for further monitoring.

Evaluation of zinc as anti-asthma agent: a preclinical study on guinea pigs

Background: The role of intravenous magnesium sulfate in acute asthma is restricted to severe and resistant cases while that of zinc as prophylactic agent. What is quite interesting is to know the benefits of zinc in acute attack of asthma and that of magnesium as prophylactic agent. The objective of the study was to analyze the bronchodilatory effects of zinc sulfate and prophylactic role of magnesium sulfate using a preclinical model of histamine and acetylcholine induced acute bronchial asthma in conscious guinea pigs.Methods: Animals were exposed to histamine diphosphate (1%) and acetylcholine chloride (10%) aerosols before and after administration of the respective test drugs after acute and sub-acute treatment regimens. Time for onset of preconvulsive dyspnea (PCD) was noted and compared within and between the treatment groups interms of percentage of protection.Results: Magnesium significantly prolonged time for convulsion compared to control group. But this difference was insignificant when compared with antihistaminic and anticholinergic drugs. Zinc was superior to control and magnesium treatment group in sub-acute treatment study.Conclusions: Magensium sulfate has bronchodilatory effects but no prophylactic effects while it is vice versa with zinc sulfate.

Effectiveness and Safety of Magnesium Replacement in Critically Ill Patients Admitted to the Medical Intensive Care Unit in an Academic Medical Center: A Retrospective, Cohort Study.

"Rules of thumb" for the replacement of electrolytes, including magnesium, in critical care settings are used, despite minimal empirical validation of their ability to achieve a target serum concentration. This study's purpose was to evaluate the effectiveness and safety surrounding magnesium replacement in medically, critically ill patients with mild-to-moderate hypomagnesemia. This was a single-center, retrospective, observational evaluation of episodes of intravenous magnesium replacement ordered for patients with mild-to-moderate hypomagnesemia (1.0-1.9 mEq/L) admitted to a medical intensive care unit from May 2014 to April 2016. The primary effectiveness outcome, achievement of target serum magnesium concentration (≥2 mEq/L) compared to expected achievement using a "rule of thumb" estimation that 1 g intravenous magnesium sulfate raises the magnesium concentration 0.15 mEq/L, was tested using 1-sample z test. Logistic regression analysis was conducted to assess the effect of infusion rate on target achievement. Of 152 days on which magnesium replacements were provided for 72 patients, a follow-up serum magnesium concentration was checked within 24 hours in 89 (58.6%) episodes. Of these 89 episodes, serum magnesium concentration reached target in only 49 (59.8%) episodes compared to an expected 89 (100%; P < .0001). There was no significant association between infusion rate and achievement of the target serum magnesium concentration (odds ratio: 0.962, 95% confidence interval: 0.411-2.256). Medically, critically ill patients who received nonprotocolized magnesium replacement achieved the target serum magnesium concentration less frequently than the "rule of thumb" estimation predicted.

Intravenous caffeine citrate vs. magnesium sulfate for reducing pain in patients with acute migraine headache; a prospective quasi-experimental study.

BackgroundCurrent evidence suggests that intravenous magnesium sulfate might be effective for reducing migraine pain. In a recent pilot study, we showed that intravenous caffeine citrate could reduce the severity of migraine headache. The objective of this study is to investigate the efficacy of intravenous caffeine citrate vs. magnesium sulfate for management of acute migraine headache.MethodsWe conducted a prospective quasi-experimental study from January until May 2016 in two educational medical centers of Shahid Beheshti University of Medical Sciences (Shoahadaye Tajrish Hospital and Imam Hossein Hospital), Tehran, Iran. The study included patients who were referred to the emergency department and met the migraine diagnosis criteria of the International Headache Society. Patients were allocated into 2 groups receiving either 60 mg intravenous caffeine or 2 g intravenous magnesium sulfate. The pain scores, based on the visual analog scale, were recorded on admission, as well as one and two hours after receiving the drug. A Chi-Square test and student t-test were used for analysis of baseline characteristics. A Mann-Whitney U test and Wilcoxon singed rank test were used to analyze differences in the visual analogue scale (VAS) score between and within the groups respectively.ResultsIn total, 70 patients (35 patients in each group) with the mean age of 33.1 ± 11.3 years were included (64.3% female). For the Caffeine citrate group, the median pain score decreased from 9.0 (2.0) to 5.0 (4.0) after one hour and to 3.0 (4.0) after two hours. For the magnesium sulfate group, the pain score decreased from 8.0 (2.0) to 2.0 (2.0) after one hour and to 0.0 (1.0) after two hours. Both intravenous caffeine citrate and intravenous magnesium sulfate reduced pain scores significantly but the magnesium sulfate group showed more improvement than the Caffeine citrate group after one hour (P < 0.001) and after two hours (P < 0.001).ConclusionsIt is likely that both intravenous caffeine and intravenous magnesium sulfate can reduce the severity of migraine headache. Moreover, intravenous magnesium sulfate at a dose of 2 g might be superior to intravenous caffeine citrate 60 mg for the short term management of migraine headache in emergency departments.

Landiolol suppression of electrical storm of torsades de pointes in patients with congenital long-QT syndrome type 2 and myocardial ischemia

A 76-year-old man who had been diagnosed with long-QT syndrome type 2 had frequent syncopal attacks. The electrocardiogram was monitored, and frequent torsades de pointes (TdP) was detected despite administration of conventional medications: oral propranolol, verapamil, intravenous magnesium sulfate, verapamil, and lidocaine. In contrast, 2μg/kg/min landiolol could completely suppress TdP. Subsequently, an implantable cardioverter defibrillator was placed, and he was diagnosed with silent myocardial ischemia using myocardial perfusion scintigraphy and coronary angiography. This is the first case report wherein landiolol effectively suppressed TdP due to long-QT syndrome with silent myocardial ischemia.

Role of magnesium sulphate in management and prevention of short term complications of birth asphyxia

Objective: To assess the efficacy of intravenous (IV) magnesium sulphate in treating birth asphyxia and improving short term neurological outcome. Method: A prospective study was conducted in Onake Obavva Women and Children Hospital from February 2015 to March 2016. A sample size of 100 term neonates (50 study group and 50 control group) with perinatal asphyxia were included in the study. Congenitally malformed babies and babies born to mothers who received general anaesthesia, magnesium sulphate and drugs likely to depress the baby were excluded from study. Routine protocol for asphyxiated babies in the neonatal intensive care unit (NICU) was followed in all 100 neonates. In addition, babies in the study group were given IV magnesium sulphate 250 mg/kg/dose within 6 hours of birth, after 24 hours of birth and at 48 hours of birth. During their stay in the NICU all 100 neonates were neurologically assessed. Results: Each group comprised 50 neonates. Seizure control with a single anticonvulsant was significantly greater in the study group compared with the control group (p Conclusions: Postnatal IV magnesium sulphate infusion is effective in improving short term outcomes for infants with perinatal asphyxia when it is given early (within 6 hours). (Keywords: Perinatal asphyxia, neonates, magnesium sulphate, anticonvulsant, hypoxic ischaemic encephalopathy) Sri Lanka Journal of Child Health , 2017; 46 (2): 148-151

The Relationship Between Maternal Fatigue and Observed Unsafe Infant Sleep Practices

To determine if a relationship exists between maternal fatigue and unsafe maternal–infant sleep practices or infant drops. Descriptive study design. Three randomly designated postpartum rooms in a 33-bed mother–baby unit that provides couplet nursing care. A convenience sample of 92 women in the postpartum period, 18 years and older, English speaking, and not receiving intravenous magnesium sulfate for hypertension. The time frame studied was time to admission to the mother–baby unit to discharge from the hospital. Women were assessed hourly for fatigue using the Stanford Sleepiness Scale. In addition, the hospital room environment was assessed hourly for evidence of unsafe sleep practices using an investigator developed environmental safety survey. Unsafe sleep practices that were identified were immediately rectified. During the project period, five infant drops occurred although no infant drops occurred among the 92 participants. Unsafe infant sleep practices were identified in 22% (n = 20) of the participants and immediately rectified. Common unsafe sleep practices included a hospital bed not in its lowest position, co-sleeping, and having less than two side rails in upright position. These mothers averaged 6.8 hours of observed sleep (0–13 hours) during the postpartum hospital stay (31–59 hours) with an average sleep interval of 2.94 hours (0–6 hours) Hourly observation of environment and subjective assessment of maternal fatigue may prevent infant drops.

Nifedipine Versus Magnesium Sulfate for Treatment of Preterm Labor: Comparison of Efficacy and Adverse Effects in a Randomized Controlled Trial

Objectives: The study aimed to compare the efficacy and side effects of intravenous magnesium sulfate (MgSO4) and oral nifedipine for inhibition of preterm labor. Methods: This randomized controlled trial was performed on 220 women with preterm labor between 32 and 34 weeks of gestation who were randomly assigned to receive either MgSO4 or nifedipine. The primary outcome was inhibition of preterm labor, defined as prevention of delivery for 48 hours with inhibition of uterine contraction, and the secondary outcome was maternal side effects. Results: From 220 patients, 110 received nifedipine and 110 received MgSO4. There were no differences in suppression of labor pain in 24 hours and 48 hours between the two groups. Also, there were not statistically significant differences in one-minute and five-minute Apgar scores, neonatal respiratory distress syndrome, and NICU admission between the two groups. Maternal hypotension was higher in the nifedipine group, but the difference was not significant (P = 0.08). Dyspnea (P = 0.01) and minor maternal side effects (P ≤ 0.001) were significantly higher in the MgSO4 group than the nifedipine group. Serious maternal adverse effects and severe hypotension were not seen in any of the groups. Conclusions: Nifedipine is as effective as MgSO4 in arresting labor and delaying delivery for 48 hours. However, nifedipine is associated with significantly fewer maternal adverse effects.

Intravenous magnesium sulfate as a rescue therapeutic for bronchoconstriction in equine pasture asthma

Intravenous magnesium sulfate as a rescue therapeutic for bronchoconstriction in equine pasture asthma

A double-blind, placebo-controlled, crossover study of magnesium supplementation in patients with XMEN syndrome: preliminary results.

Abstract Introduction X-linked immunodeficiency magnesium defect, Epstein-Barr virus (EBV) infection and neoplasia (XMEN) syndrome is a primary immunodeficiency caused by the loss of expression of the magnesium transporter 1 (MAGT1). This syndrome is associated with CD4 lymphopenia, chronic EBV infection in most patients, and EBV related lympho proliferative disorders. The loss of MAGT1 leads to impaired T cell activation and decreased expression of the activator receptor, NKG2D on natural killer (NK) cells and CD8 T cells, leading to decreased EBV-specific cytolytic function of these cells. Results of previous studies suggest that magnesium supplementation may be a viable therapeutic option for patients with XMEN. Methods Patients ≥6 years of age with XMEN syndrome and persistent EBV viral load of ≥5,000 copies/mL by whole blood PCR are randomized to receive escalating doses of either placebo or oral magnesium L-threonate for 12 weeks. This is followed by crossover treatment for an additional 12 weeks. For patients who experience a 0.5-log decrease in the number of EBV-infected B cells by FISH with oral magnesium as compared to placebo, the study is complete. Patients who do not meet this outcome then undergo a 2-week washout period and proceed to Part II, an open-label, non-randomized evaluation of intravenous magnesium sulfate (MgSO4) followed by oral magnesium L-threonate. Results here we report the preliminary results for the first patient enrolled in the clinical trial, including changes in the number of EBV infected B cells and NKG2D expression with magnesium treatment.

Magnesium for treating sickle cell disease.

Sickle cell disease is an autosomal recessive inherited haemoglobinopathy which causes painful vaso-occlusive crises due to sickle red blood cell dehydration. Vaso-occlusive crises are common painful events responsible for a variety of clinical complications; overall mortality is increased and life expectancy decreased compared to the general population. Experimental studies suggest that intravenous magnesium has proven to be well-tolerated in individuals hospitalised for the immediate relief of acute (sudden onset) painful crisis and has the potential to decrease the length of hospital stay. Some in vitro studies and open studies of long-term oral magnesium showed promising effect on pain relief but failed to show its efficacy. The studies show that oral magnesium therapy may prevent sickle red blood cell dehydration and prevent recurrent painful episodes. There is a need to access evidence for the impact of oral and intravenous magnesium effect on frequency of pain, length of hospital stay and quality of life. To evaluate the effects of short-term intravenous magnesium on the length of hospital stay and quality of life in children and adults with sickle cell disease. To determine the effects of long-term oral magnesium therapy on the frequency of painful crises and the quality of life in children and adults with sickle cell disease. We searched the Cochrane Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.Date of last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 01 December 2016.Date of last search of other resources (clinical trials registries): 29 March 2017. We searched for published and unpublished randomized controlled studies of oral or intravenous magnesium compared to placebo or no magnesium. Authors independently assessed the study quality and extracted the data using standard Cochrane methodologies. We included five randomized placebo-controlled studies with a total of 386 participants (aged three to 53 years). Two shorter parallel studies (n = 306) compared intravenous magnesium sulphate to placebo (normal saline) for admission to hospital due to a vaso-occlusive crisis, for which we were able to analyse data. The quality of evidence was moderate for studies presenting this comparison mainly due to limitations due to risk of bias and imprecision. Two of the three longer-term studies comparing oral magnesium pidolate to placebo had a cross-over design. The third was a parallel factorial study which compared hydroxyurea and oral magnesium to each other and to placebo over a longer period of time; we only present the comparison of oral magnesium to placebo from this study. The quality of evidence was very low with uncertainty of the estimation.The eight-hourly dose levels in the two studies of intravenous magnesium were different; one used 100 mg/kg while the second used 40 mg/kg. Only one of these studies (n = 104) reported the mean daily pain score while hospitalised (a non-significant difference between groups, moderate quality evidence). The second study (n = 202) reported a number of child- and parent-reported quality of life scores. None of the scores showed any difference between treatment groups (low quality evidence). Data from one study (n = 106) showed no difference in length of stay in hospital between groups (low quality evidence). Both studies reported on adverse events, but not defined by severity as we had planned. One study showed significantly more participants receiving intravenous magnesium experienced warmth at infusion site compared to placebo; there were no differences between groups for other adverse events (low quality evidence).Three studies (n = 80) compared oral magnesium pidolate to placebo. None of them reported data which we were able to analyse. One study (n = 24) reported on the number of painful days and stated there was no difference between two groups (low quality evidence). None of the studies reported on quality of life or length of hospital stay. Two studies (n = 68) reported there were no differences in levels of magnesium in either plasma or red blood cells (moderate quality evidence). Two studies (n = 56) reported adverse events. One reported episodes of mild diarrhoea and headache, all of which resolved without stopping treatment. The second study reported adverse events as gastrointestinal disorders, headache or migraine, upper respiratory infections and rash; which were all evenly distributed across treatment groups (moderate quality evidence). Moderate to low quality evidence showed neither intravenous magnesium and oral magnesium therapy has an effect on reducing painful crisis, length of hospital stay and changing quality of life in treating sickle cell disease. Therefore, no definitive conclusions can be made regarding its clinical benefit. Further randomized controlled studies, perhaps multicentre, are necessary to establish whether intravenous and oral magnesium therapies have any effect on improving the health of people with sickle cell disease.

Effects of Maternal Magnesium Sulfate Treatment on Neonatal Feeding Tolerance.

To determine whether antenatal exposure to magnesium sulfate has an effect on neonatal enteral feeding tolerance. In this single-center, retrospective, observational study, charts of pregnant women who received intravenous magnesium sulfate infusions prior to delivery between July 1, 2012, and July 31, 2013, were reviewed. Neonates born at 24 weeks' gestational age or greater admitted to the neonatal intensive care unit (NICU) whose mothers received magnesium sulfate infusions prior to delivery were included. Neonates with independent factors that could lead to feeding intolerance were excluded. The primary outcome was incidence of neonatal enteral feeding intolerance measured by deviations from the NICU feeding protocol. Secondary outcomes included days on parenteral nutrition, incidence of necrotizing enterocolitis, time to first stool, and urine output in the first 72 hours of life. Cumulative maternal magnesium sulfate dose was significantly higher in the enteral feeding intolerance group than those infants who tolerated enteral feeds (70.4 ± 52.3 vs 47.4 ± 40.1 g; p = 0.04). Infants exposed to more than 80 g of maternal magnesium sulfate therapy were more likely to develop enteral feeding intolerance (44% vs 22%; p = 0.04). Multivariate logistic regression indicated that prematurity and cumulative maternal magnesium sulfate dose were the strongest predictors of neonatal enteral feeding intolerance. Infants of mothers who received more than 80 g of intravenous magnesium sulfate prior to delivery were more likely to develop feeding intolerance. Prematurity also was a significant predictor of intolerance.

The Effect of Intravenous Magnesium Sulfate Versus Intravenous Sufentanil on the Duration of Analgesia and Postoperative Pain in Patients with Tibia Fracture.

BackgroundIn the recent decades controlling postoperative pain has become a popular topic as it leads to the patients’ wellbeing and improved life quality, while it reduces the costs for both patients and medical facilities.ObjectivesThis study aimed at comparing intravenous magnesium sulfate versus intravenous sufentanil on the duration of analgesia and postoperative pain in patients undergoing tibia fracture surgery.MethodsThis double blind clinical trial study was performed on 70 candidates of tibia fractures between the ages of 18 and 55 years with American society of anesthesiologists (ASA) class I and II. The patients were randomly divided to 2 groups, 1 receiving magnesium sulfate (M) and another receiving sufentanil (S). Both of the groups underwent spinal anesthesia with 10 mg bupivacaine 0.5%. One hour after ensuring the sensorimotor blockade, in the S group 0.1 µg/kg/hour and in the M group 8 mg/kg/hour was diluted in 1 liter of Ringer’s solution and infused. In this study, full weakness of the lower limb was considered as the sign of sensorimotor blockade initiation. The postoperative pain intensity was measured using the Visual Analog Scale (VAS), 0, 1, 4, 8, 16, and 24 hours after the end of anesthesia duration. In case of VAS ≥ 3, the patients received 0.3 mg/kg pethidine, intravenously. At last, the time of requesting the first narcotic drug and the total usage of pethidine were recorded.Results and ConclusionsSufentanil was found to be more effective than magnesium sulfate in reducing postoperative pain and the time of first narcotics request was later in patients receiving sufentanil (P < 0.05).

What to use for bronchial asthma; nebulized or intravenous magnesium sulfate?

BackgroundAsthma is characterized by airways narrowing and airflow limitation. The conventional therapy for asthma exacerbation is usually efficient but sometimes patients not respond to it, consequently; other additive drugs may be used as magnesium sulfate(MgSO4) either intravenously or by nebulization. ObjectiveTo compare the bronchodilator effect of MgSO4 via intravenous injection and nebulization in controlling asthma exacerbation. Methods40 patients with asthma exacerbation were equally and randomly enrolled in two groups. One group received nebulized MgSO4 (A), and the other group received intravenous MgSO4 (B). ResultsImprovement was higher in group B than in group A but without significant change in PEFR also there was no high significant difference in the two group parameters after MgSO4 treatment. Complications were few and manageable in both groups. ConclusionIntravenous MgSO4 is effective affordable and cheap drug for asthma exacerbation management with good response while nebulized MgSO4 didn’t give the aimed response in these patients.

Abstract TP234: The Effect of Early Treatment with Magnesium on Blood Pressure Variability in Hyperacute Stroke

Background: Increased blood pressure (BP) variability has been associated with worse outcomes in acute stroke. Magnesium has been shown to have both vasoactive and cardio-active properties that could potentially attenuate blood pressure variability emergently. Objective: To investigate whether intravenous magnesium sulfate can minimize blood pressure variability in hyperacute stroke. Methods: All patients with a diagnosis of stroke (cerebral ischemia, intracerebral hemorrhage) enrolled in the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 trial were included. FAST-MAG was a multicenter, randomized, double-blind, placebo-controlled study looking at whether initiation of magnesium sulfate (20 grams/24 hours) in the prehospital setting of acute stroke would reduce disability. Study agent was initiated prior to hospital arrival &lt; 2 hours from symptom onset. Blood pressure variability was defined as the standard deviation (SD) of systolic blood pressure of all readings obtained by 4 hours after initiation of study agent. BP variability was compared using t-test of the bootstrapped SD between groups. Results: In total, 1,700 patients were included in the study with a median of 6 (IQR 5-6) BP readings, of which 1,245 had cerebral ischemia (CI), 387 had intracerebral hemorrhage (ICH), and 68 had stroke mimics. Of those with CI, 632 received magnesium and 613 placebo; the standard deviation of systolic blood pressure was not significantly different between those who received magnesium and those who did not (14.9mmHg vs. 15.3mmHg, p=0.315). In the ICH population (195 magnesium, 192 placebo), magnesium treatment also did not affect BP variability (22.5mmHg vs. 21.1mmHg, p=0.197). For the overall study group, hyperacute magnesium treatment had no effect on blood pressure variability (16.7mmHg vs. 16.6mmHg, p=.907). Conclusion: Treatment with magnesium did not reduce BP variability in hyperacute stroke.

Early standardized treatment of critical blood pressure elevations is associated with a reduction in eclampsia and severe maternal morbidity

Hypertensive disorders of pregnancy result in significant maternal morbidity and mortality. State and national guidelines have been proposed to increase treatment of patients with hypertensive emergencies or critically elevated blood pressures. There are limited data available to assess the impact of these recommendations on maternal morbidity. The purpose of this prospective quality improvement project was to determine if maternal morbidity would be improved using a standardized approach for treatment of critically elevated blood pressures. In all, 23 hospitals participated in this project. Treatment recommendations included the use of an intravenous blood pressure medication and magnesium sulfate when there was a sustained blood pressure of ≥160 mm Hg systolic and/or ≥110 mm Hg diastolic. Compliance with the metric recommendations was monitored based on the number of patients treated with an intravenous blood pressure medication, use of magnesium sulfate, and if they received a timely postpartum follow-up appointment. The metric was scored as all or none; missing any of the 3 metric components was considered noncompliant. From January through June 2015 baseline data were collected and hospitals were made aware that ongoing monitoring of compliance would begin in July 2015 through June 2016. The primary outcomes were composite metric compliance, the incidence of eclampsia per 1000 births, and severe maternal morbidity. During the 18 months of this study there were 69,449 births. Within this population, 2034 met criteria for a critically elevated blood pressure, preeclampsia, or superimposed preeclampsia with severe features. Of this group, 1520 had a sustained critical blood elevation. Initial compliance with treatment recommendations was low (50.5%) and increased to >90% after April 2016 (P < .001). Compliance with utilization of intravenous blood pressure medication increased by 33.2%, from a baseline of 57.1-90.3% (P < .01) during the last 6 months of monitoring. Compliance with utilization of magnesium sulfate increased by 10.8%, from a baseline of 85.4-96.2% (P < .01). The incidence of eclampsia declined by 42.6% (1.15 ± 0.15/1000 to 0.62 ± 0.09/1000 births). Severe maternal morbidity decreased by 16.7% from 2.4 ± 0.10% to 2.0 ± 0.15% (P < .01). We noted 3 important findings: (1) compliance with state and national treatment guidelines is low without monitoring; (2) high levels of compliance can be achieved in a relatively short period of time; and (3) early intervention with intravenous blood pressure medication and magnesium sulfate for verified sustained critical maternal blood pressures resulted in a significant reduction in the rate of eclampsia and severe maternal morbidity. The reduction in the rate of eclampsia could only partially be attributed to the increase in the use of magnesium sulfate, suggesting an additive or synergistic effect of the combined treatment of an antihypertensive medication and magnesium sulfate on the rate of eclampsia and severe maternal morbidity.

The Effect of Magnesium Sulfate on Renal Colic Pain Relief; a Randomized Clinical Trial.

Renal colic can be managed by preventing the contraction movements of ureter muscles. By reducing acetylcholine in the nerve terminals, magnesium sulfate could be effective in this regard. The aim of this study is to investigate the effect of magnesium sulfate on acute renal colic pain relief. The present study was a double-blind clinical trial in which the patients suffering from acute renal colic were randomly divided into 2 groups of who either received standard protocol (intravenous infusion of 0.1 mg/Kg morphine sulfate, 30 mg of Ketorolac, and 100 ml normal saline as placebo/15 minutes) or standard protocol plus 15 mg/Kg of intravenous magnesium sulfate 50%/100 ml normal saline/15 minutes. Severity of patients' pain was measured by visual analogue scale (VAS) at baseline, and 30 and 60 minutes after infusion. The collected data were analyzed using STATA statistical software. 100 cases were randomly allocated to intervention or control group. The two groups were similar in baseline pain score and demographic characteristics. At 30 and 60 minutes, mean pain score was less in the intervention group compared to the control group. Moreover, the difference between the two groups was statistically significant regarding the additional amount of morphine, suggesting that the intervention group needed less additional morphine than the control group. The results of this study showed that Magnesium sulfate can be used as an adjunct drug in treatment of patients suffering from renal colic. It not only alleviates the pain in the patients, but also diminishes the need for pain medications.

Evaluation of effect of intravenous Magnesium Sulfate infusion on tourniquet induced hypertension and pain in arthroscopic knee surgery patients under epidural anesthesia

ObjectiveThis prospective randomized, double blind controlled study was designed to evaluate the effect of Intravenous (i.v) magnesium sulfate infusion on attenuation of tourniquet induced hypertension (TIH) and tourniquet pain and also its effect on postoperative analgesia in patients undergoing arthroscopic knee surgery under epidural anesthesia.Patients and methodsSeventy ASA I and II patients were scheduled for arthroscopic knee surgery with tourniquet under epidural anesthesia. Patients were allocated randomly into two equal groups (n = 35): Magnesium (Mg group) received a bolus dose of IV magnesium sulfate 30 mg/kg in 50 ml saline over 10 min, followed by infusion 10 mg/kg/h and control group received iv saline. Systolic and Diastolic blood pressure (SBP, DBP) and Heart rate (HR) were measured at baseline (before anesthesia), after epidural anesthesia, then every 10 min after the tourniquet inflation, and 1, 5, 10, and 30 min after deflation with recording incidence of (TIH), tourniquet pain, and total iv fentanyl consumption (was given iv 1 ug/kg with tourniquet pain); postoperative Visual Analogue Scale (VAS) score was assessed at 1, 2, 4, 8, 12, 18, and 24 h, postoperative pethidine consumption (given iv 0.5 mg/kg if VAS > 3) was recorded, and serum magnesium was measured preoperatively and at 6 and 24 h postoperatively.ResultsSBP, DBP and HR were significantly higher in the control group than in the Mg group (p < 0.001) after 50 min of inflation. The number of patients who developed TIH and tourniquet pain was significantly lower in Mg group compared to control group 3(8.57%) vs 12(34.28%) (p < 0.05), with significantly shorter time to feel pain in control group 48 ± 8 min versus 71 ± 7 min (p < 0.001). Intraoperative fentanyl requirements were significantly higher in control group compared to Mg group (p < 0.001). Mg group had significantly lower postoperative VAS scores and pethidine consumption (p < 0.001) and significantly longer time to first request of postoperative analgesia compared to control group (p < 0.001). Postoperative serum magnesium was significantly higher in Mg group at 6 h postoperative (p < 0.001).ConclusionIn patients undergoing arthroscopic knee surgery under epidural anesthesia, IV magnesium sulfate in a dose of 30 mg/kg, followed by 10 mg/kg/h infused before tourniquet inflation could reduce TIH, and tourniquet pain with reduction in intraoperative IV fentanyl and postoperative pethidine requirements.

Contrast induced nephropathy after transcatheter aortic valve implantation

Background : Aortic stenosis ranks the third in the structure of all cardiovascular diseases, conceding only to arterial hypertension and coronary heart disease. Transcatheter aortic valve implantation (TAVI) is a promising area of interventional endovascular surgery that enables to provide surgical care to a significant group of the patients with severe aortal stenosis. Aim : To assess the efficacy of prevention of the contrast induced nephropathy (CIN) in patients who underwent TAVI under general anesthesia. Materials and methods : We evaluated incidence of CIN in 19 patients who underwent surgery for aortic valve stenosis under general anesthesia with hemodilution and intravenous magnesium sulfate 1 g before administration of the contrast. Results : Laboratory signs of nephropathy within the first 72 hours after the intervention were found in 8/19 (42.1%) of patients. In 4 (50%) of patients with CIN, its risk had been very high, in 3 (38%), high, and in 1 (12%), moderate. The results obtained are compatible with the contrast-induced acute kidney injury risk estimated from the Mehran-Barrett-Parfrey scale. Conclusion: The used technique of hemodilution and magnesium-based prevention can be considered a safe method of CIN prophylaxis in TAVI patients.

Comparison of Intravenous Clonidine and Magnesium Sulfate on Hemodynamic Response during Laparoscopic Surgeries

Comparison of Intravenous Clonidine and Magnesium Sulfate on Hemodynamic Response during Laparoscopic Surgeries