Intravenous Magnesium Sulfate Research Articles

Recurarization with magnesium sulfate administered after two minutes sugammadex reversal: A randomized, double-blind, controlled trial

Study objectiveThe current study tested the hypothesis that magnesium sulfate after reversal with sugammadex causes recurarization. DesignA single-center, prospective, randomized, double-blind, controlled trial. SettingTerciary care hospital in Rio de Janeiro, Brazil. PatientsIncluded 60 patients undergoing for elective otolaryngological surgery. InterventionsAll patients received total intravenous anesthesia and a single dose of rocuronium (0.6 mg/kg). In 30 patients, the neuromuscular blockade was reversed with sugammadex (4 mg/kg) at the reappearance of one or two posttetanic counts (deep-blockade series). In 30 other patients, sugammadex (2 mg/kg) was administered at the reappearance of the second twitch of the train-of-four (moderate-blockade series). After the normalized train-of-four ratio recovered to ≥0.9, the patients in each series were randomized to receive intravenous magnesium sulfate (60 mg/kg) or placebo for 10 min. Neuromuscular function was measured by acceleromyography. MeasurementsThe primary outcome was the number of patients who exhibited recurarization (normalized train-of-four ratio < 0.9). The secondary outcome was rescue with an additional dose of sugammadex after 60 min. Main resultsIn the deep-blockade series, a normalized train-of-four ratio < 0.9 occurred in 9/14 (64%) patients receiving magnesium sulfate and 1/14 (7%) receiving placebo, RR 9.0 (95% CI: 62–1.30), and (p = 0.002), with four rescues with sugammadex. In the moderate-blockade series, neuromuscular blockade recurred in 11/15 (73%) patients receiving magnesium sulfate and in 0/14 (0%) receiving placebo (p < 0.001), with two rescues. The absolute differences in recurarization were 57% and 73% in the deep-blockade and moderate-blockade, respectively. ConclusionsSingle-dose magnesium sulfate led to a normalized train-of-four ratio < 0.9, 2 min after recovery from rocuronium-induced deep and moderate neuromuscular blockade using sugammadex. Additional sugammadex reversed prolonged recurarization.

Pediatric extracorporeal life support for refractory status asthmaticus: ELSO Registry trends from the past decade.

Extracorporeal life support (ECLS) for status asthmaticus (SA) is rare. Increased safety and experience may increase utilization of ECLS for SA. We reviewed pediatric (<18 years old) patients requiring ECLS for SA between 1998 and 2019 within the Extracorporeal Life Support Organization (ELSO) Registry and Nemours Children's Health (NCH) system. We compared patient characteristics, pre-ECLS medications, clinical data, complications, and survival to discharge between Early (1988-2008) and Late (2009-2019) eras. From the ELSO Registry, we identified 173 children, 53 in Early and 120 in Late eras, with primary diagnosis of SA. Pre-ECLS hypercarbic respiratory failure was similar between eras (median pH 7.0 and pCO2 111 mm Hg). Venovenous mode (79% vs. 82%), median ECLS time (116 vs. 99 h), time to extubation (53 vs. 62 h), and hospital survival (89% vs. 88%) also remained similar. Intubation to cannulation time significantly decreased (20 vs. 10 h, p = 0.01). ECLS without complication occurred more in the Late era (19% vs. 39%, p < 0.01), with decreased hemorrhagic (24% vs. 12%, p = 0.05) and noncannula-related mechanical (19% vs. 6%, p = 0.008) complications. Within NCH, we identified six Late era patients. Pre-ECLS medication favored intravenous beta agonists, bronchodilators, magnesium sulfate, and steroids. One patient died from neurological complications following pre-ECLS cardiac arrest. Collective experience supports ECLS as a rescue therapy for pediatric SA. Survival to discharge remains good, and complication rates have improved. Pre-ECLS cardiac arrest may potentiate neurologic injury and impact survival. Further study is needed to evaluate causal relationships between complications and outcomes.

Intravenous Clonidine and Magnesium Sulphate in Attenuating Hemodynamic Response to Pneumoperitoneum During Laparoscopic Cholecystectomy: A Randomized Blinded Comparative Study

ABSTRACT Background: Conflicting data are demonstrating the superiority between Clonidine and Magnesium Sulphate in attenuating hemodynamic response to pneumoperitoneum. Methods and Methodology: This was a prospective randomized blinded trial comparing the efficacy of injection Clonidine 1.5 μg/kg (group A) and Magnesium Sulphate (MgSO4) 50 mg/kg (group B) done over six. Results: Sixty-eighty patients were included and assigned randomly to two groups of 34 (50.0%) patients. The mean (SD) age in groups A and B was 34.32 (11.35) and 37.20 (10.17) years respectively. Comparison of systolic blood pressure and mean arterial pressure were similar in both groups. The heart rate (HR) of patients in group A with group B, was almost the same at pre-induction and the end of infusion while HR was noted to be higher in group B, compared to group A at 5 minutes. Comparisons of EtCO2 (mm Hg) and SpO2 (%) between group A and group B were comparable in both the groups at pre-induction, at 5 min, 10 min, 15 min, 20 min, 25 min, 30 min, 35 min and 40 min. However, at the end of the infusion SpO2 levels were higher in Group A (p = 0.004). According to Modified Ramsay Sedation Score, half of the patients (50.0%) from group A were cooperative, oriented, and tranquil. In Group B, about one-third (38.2%) were cooperative, oriented, and tranquil. Immediate postoperative complications included nausea (8.8%) and vomiting (2.9%) which were comparable between both groups. Conclusion: Overall observations suggested that Clonidine (1.5 μg/kg) was equally effective as MgSO4 (50 mg/kg) in attenuating hemodynamic responses during pneumoperitoneum in laparoscopic cholecystectomy.

A Comparative Study of Intravenous Magnesium Sulphate Versus Intrathecal Magnesium Sulphate in 0.5% Hyperbaric Bupivacaine Spinal Anaesthesia for Elective Infraumbilical Surgery

BACKGROUND&#x0D; In this study, we wanted to compare the characteristics of subarachnoid block when intrathecal versus intravenous magnesium sulphate was used with 0.5 % hyperbaric bupivacaine spinal anaesthesia in elective infraumbilical surgery.&#x0D; METHODS&#x0D; This was a hospital based prospective randomized clinical parallel arm study double-blinded (patient and observer blinded) single hospital study conducted among 100 patients who presented with elective infraumbilical surgery under spinal anaesthesia to the Department of Anesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati, from 1st June 2021 to 31st May 2022 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.&#x0D; RESULTS&#x0D; The onset of sensory block, and comparison of duration of analgesia with respect to time to first analgesic request was found to be statistically significant. While comparing, duration of analgesia was significantly prolonged in the intravenous group. Magnesium administered intravenously or intrathecally was not linked to any harmful side effects.&#x0D; CONCLUSIONS&#x0D; Infraumbilical procedures that use intravenous magnesium sulphate as an adjuvant to 0.5% hyperbaric bupivacaine spinal anaesthetic extend the time that post-operative analgesia lasts. Intrathecal co-administration of Magnesium sulphate with 0.5% hyperbaric bupicavaine delays the onset of sensory block compared to intravenous MgSO4.

Comparison of the efficacy of atracurium pretreatment versus magnesium sulphate for prevention of suxamethonium-induced fasciculation and post-operative myalgia

Background: Suxamethonium remains the best option for rapid sequence induction, it is the only depolarizing muscle relaxant in clinical use. However, fasciculation and myalgia are frequent adverse effects of the drug. Myalgia can last for several days with associated discomfort. Non-depolarizing muscle relaxant and magnesium sulphate have been tried as pretreatments to attenuate the fasciculation and myalgia with varying results.Methods: A double blind, randomized study of 100 adult surgical patients of ASA I or II Class were recruited to receive either intravenous atracurium (0.05mg/kg) (Group A) or intravenous magnesium sulphate (30mg/kg)(Group B). The occurrence, severity and duration of fasciculation as well as the occurrence and severity of post-operative myalgia were also recorded.Results: Muscle fasciculation occurred in 39 (78%) patients in Group A and 27(54%) patients in Group B (p= 0.001). The severity of fasciculation was mild to moderate in Group B while Group A in addition also recorded some cases of severe episodes of fasciculation. Mean duration of fasciculation in Group A waslonger (28.48 ± 1.07sec) than in group B (19.44± 1.93seconds) (p= 0.001). Post-operative myalgia was not experienced at 6hrs and 48hrs, while 2 patients (1 in each Group) had it at 12hrs. At 24hrs, postoperative myalgia was present in 13(26%) patients in group A and 5(10%) patients in group B, (p=0.043). The severity of post-operative myalgia recorded both at 12hrs and 24hrs was mild.Conclusion: Magnesium sulphate demonstrated better efficacy at reducing fasciculation and postoperative myalgia than atracurium

Evaluation of the Efficacy of Magnesium Sulfate in Reducing Blood Loss in Functional Endoscopic Sinus Surgery: A Randomized Double-Blinded Controlled Trial.

Objectives The primary concern in functional endoscopic sinus surgery (FESS) is maintaining a clear and unobstructed surgical field. Achieving this objective necessitates controlled hypotension, which can aid in the surgical dissection process and reduce the overall duration of the operation. This study aims to evaluate the efficacy of a sole bolus injection of intravenous magnesium sulfate in FESS. The outcomes measured include blood loss, surgical field grading, the additional intraoperative requirement of fentanyl, stress attenuation during laryngoscopy and endotracheal intubation, and extubation time. Methods In this prospective, double-blinded, randomized control trial (CTRI/2021/04/033052), 50 patients scheduled for FESS were randomly divided into two groups: Group M received 50 mg/kg MgSO4 in 100 ml normal saline, and Group N received 100 ml plain normal saline 15 min before induction. The study assessed total blood loss, measured by blood collected from the surgical field and weighing gauze. The surgical field grading was assessed by a six-point Fromme and Boezaart scale. We also observed stress attenuation during laryngoscopy and endotracheal intubation, additional intraoperative fentanyl requirements, and time taken for extubation. The sample size was estimated using the G power calculator 3.1.9.2 (http://www.gpower.hhu.de/). Data were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using Statistical Package for Social Sciences version 20.0 (IBM Corp., Armonk, NY). Results The demographic data and duration of the surgery were comparable in both groups. The total blood loss in Group M was 100.40 ml ±60.71 ml, which is lower than Group N (133.80 ml ±59.7 ml) with a p-value of 0.016. In addition, the surgical field grading was also better in Group M. The total vecuronium consumption was significantly lower in Group M, which was (7.23±0.84 mg); in Group N, it was (10.64±1.74 mg) with a p-value of 0.0001, respectively. The dosage of additional fentanyl in Group N was 38.46 mcg ± 8.99 mcg, more than in Group M (33.64 mcg ± 11.20 mcg). The time required for extubation was similar in both groups. The duration of the surgery was significantly more significant in Group M (150.0 ±31.36) than in Group N (205.0 ±32.79), with a p-value of 0.0001, respectively. Furthermore, the mean arterial pressure after induction, at 2 min and 4 min after laryngoscopy, was less in Group M, with p=0.001, p=0.003, and p<0.0001, respectively, when compared with Group N. The heart rate after induction, at 2 min and 4 min after laryngoscopy, was also less in Group M, with p=0.016, p=0.003, and p=0.003, respectively, when compared with Group N. The Ramsay Sedation Score was higher in Group M than in Group N's fourth, eighth, and sixteenth hour, with p=0.001, p=0.021, and p=0.001, respectively, in the postoperative period. The sedation score was statistically insignificant after that. No complications were encountered during the study. Conclusion We conclude that a single bolus dose of MgSO4 reduced surgical blood loss more effectively than in the control group. The surgical field grading was also better in Group M, as was the stress attenuation during laryngoscopy and endotracheal intubation. The intraoperative fentanyl requirement was not statistically significant. The time for extubation was similar between the groups. No other adverse effects were encountered during the study.

Elevated Neutrophil-to-Lymphocyte Ratio Is Associated with Severe Asthma Exacerbation in Children.

Asthma is the most common chronic respiratory disease in children. The neutrophil-to-lymphocyte ratio (NLR) is a marker of a chronic inflammatory state; however, data on the association of NLR with acute asthma exacerbations in children is lacking. In this cross-sectional study, between 2016 and 2021, children aged 2-18 years who were referred to the emergency department (ED) due to asthma exacerbation, were included. NLR, calculated from complete blood count upon arrival, was assessed as a continuous variable and was classified into four groups according to quartiles. The association between severity parameters and NLR quartiles was examined. A total of 831 ED visits for asthma exacerbation were included in the study. The median NLR was 1.6, 3.8, 6.7, and 12.9 in quartiles 1-4, respectively (p < 0.001). Demographic parameters, background diseases, and chronic medications were similar between the quartiles. Higher heart rate, body temperature, systolic blood pressure, and respiratory rate were observed in the higher NLR quartiles, as well as lower oxygen saturation. Higher urgency scale and higher rates of intravenous magnesium sulfate were observed in the higher NLR quartiles, with higher admission rates and prolonged hospitalizations. In summary, NLR upon admission is associated with the severity of asthma exacerbation and higher chances of hospitalization among children in the ED.

A COMPARATIVE STUDY BETWEEN MAGNESIUM SULPHATE AND DEXMEDETOMIDINE FOR ATTENUATION OF HAEMODYNAMIC PRESSOR RESPONSE DURING LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION

Backround:Direct laryngoscopy followed by endotracheal intubation is prone to haemodynamic fluctuations which may be detrimental in subjects with coronary artery disease, hypertension, and cerebral vascular disease. The aim is we wanted to compare Dexmedetomidine with Magnesium sulphate to determine the better drug with regard to attenuation of the haemodynamic responses during laryngoscopy and endotracheal intubation Objectives: 1. To study the effects of magnesium sulphate and dexmedetomidine in attenuation of haemodynamic response to laryngoscopy and intubation . 2. To study the side effects of the above drugs Methodology: This study was conducted among 60 subjects aged between 20 and 60 years belonging to ASA grade IandII, posted for elective surgeries under general anaesthesia. The study subjects were included randomly in 2 groups of 30 each. Group A received intravenous Dexmedetomidine 0.75µg/kg body weight and Group B received intravenous Magnesium sulphate 50%, 25 mg/kg body weight, both diluted in 20 ml of normal saline. Both were administered intravenously over 10 minutes. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Heart Rate (HR) were noted at baseline, after study drug infusion, before induction, before intubation,1,2,3,4,6,8,10 and 15th min after intubation. If any sideeffects present, were also noted and treated. Result: Data was compared using paired t-test,chi-square test,Fisher exact probability test and the reduction in the heart rate was found to be statistically significant (p&lt;0.05) at all intervals. There was also significant decrease in systolic,diastolic and MAP during the immediate post intubation period. Conclusion:Dexmedetomidine 0.75 μg/kg IV infusion is more effective than Magnesium sulphate 25mg/kg IV infusion for attenuating the haemodynamic response to laryngoscopy and intubation in elective general surgical patients.

An observational study to compare the effect of intravenous dexmedetomidine versus intravenous magnesium sulphate pretreatment on characteristics of spinal anaesthesia

The study was conducted to assess &amp; compare the effect of pretreatment with intravenous Dexmedetomidine and Magnesium sulphate on characteristics of SAB with hyperbaric bupivacaine. 80 ASA grade I and II patients (age: 18-60 years) scheduled for infraumblical surgery under spinal anesthesia were included &amp; randomly divided into group-D (dexmedetomidine 1μ gm/kg) and group-M (magnesium sulfate 50 mg/kg). patients were given prefixed doses of either intravenous dexmedetomidine or Magnesium sulfate 15 mins before SAB. Incidence of hypotension, highest level &amp; duration of sensory &amp; motor blockage, duration of analgesia, vasopressor requirement and incidence of sedation, nausea &amp; vomiting were compared. highest upper level of sensory block after SAB was higher in group-D (p value &amp;#60; 0.001) than group-M. onset of sensory &amp; motor block was earlier &amp; duration of sensory and motor block, time of rescue analgesia was longer in group-D (p value &amp;#60; 0.001). Depth of sedation was higher in group-D though oxygen saturation and respiratory rate was comparable in both groups. Postoperative VAS score (p value &amp;#60; 0.001) was lower in dexmedetomidine group.Study suggests that Intravenous dexmedetomidine at a dose of 1μg/kg is a better adjuvant to 0.5% hyperbaric bupivacaine than MgSo at a dose of 50 mg/kg in infra-umbilical surgeries, with complications of hypotension and bradycardia occurring at acceptable incidences.

Intravenous magnesium sulfate in asthmatic exacerbation: is it a useful and safe therapy?

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EFFICACY OF INTRAVENOUS DEXMEDETOMIDINE VERSUS MAGNESIUM SULPHATE FOR CONTROLLED HYPOTENSION IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY: A RANDOMIZED DOUBLEBLIND STUDY.

Background &amp; Aim: Controlled hypotension is an anaesthestic technique in which there is deliberate reduction of systemic blood pressure during general anaesthesia. The aim of our study was to compare the efcacy of intravenous dexmedetomidine and magnesium sulphate for controlled hypotension in functional endoscopic sinus surgery. A randomized, Method: prospective, and double-blind study was carried out, which included 92 patients of either sex of ASA grade I &amp; II who underwent elective FESS. Patients were randomly assigned to two groups: Group D, patients received dexmedetomidine 1 µg/kg infused over 10 minutes before induction of anesthesia, followed by continuous infusion of 0.4-0.8μg/kg/hr. Group M, Patients received intravenous MgSO4 40 mg/kg infused over 10 minutes before induction of anesthesia, followed by continuous infusion of 10 to 15 mg/Kg/hr. Results: There was no signicant difference in MAP and HR between both the groups. Average category scale was lower (p&lt;0.001) and surgeon's satisfaction score was higher (p&lt;0.001) in group D when its compared group M. Blood loss was less in group D than group M. Incidence of Bradycardia &amp; Hypotension in group D was 15.22% &amp; 36.96% while in group M was 2.17% &amp; 13.04%. The difference in incidence of Bradycardia &amp; Hypotension in both the groups was statistically signicant. Both dexmedetomidine and MgSO4 provide satisfac Conclusion: tory controlled hypotension in FESS. However, dexmedetomidine is found to be more effective in terms of good surgical eld, less blood loss, better surgeon satisfaction score.

Challenging Case in Clinical Practice: Multimodal Management of Concurrent Structural and Virally Exacerbated Trigeminal Neuralgia

Introduction: Trigeminal neuralgia (TN) is among the most painful disorders of the orofacial region. Although TN has many possible etiologies, such as nerve compression, recently published evidence suggests that TN, or its exacerbations, may be the result of viral infections in the head and neck. This case presents clinical findings from a TN patient experiencing virally-induced exacerbations treated with intravenous (IV) magnesium sulfate and oral anti-inflammatories who was previously non-responsive to first-line pharmaceuticals. Methods: AM is a 51-year-old cis-female with a four-year history of TN caused by vascular encroachment of the trigeminal nerve and exacerbated by episodes of viral sinusitis and COVID-19. AM presented to the National University of Natural Medicine clinic in May 2019 and again in April 2022. After screening for contraindications, she was started on an IV Myer's push with an elevated dose of magnesium sulfate and oral anti-inflammatories: curcumin and omega-3. Results: Since her second presentation to our clinic in April 2022, the patient has undergone 11 treatments and reports significant benefit in pain and quality of life. Despite the initial MRI revealing vascular encroachment on her trigeminal nerve she experienced benefit from her treatment regimen and denied a neurosurgical consultation and repeat MRI. Conclusion: This study contributes to a growing body of literature suggesting that cranial neuralgias may be exacerbated by orofacial or upper-respiratory viral infections and that TN specifically may be well managed with IV nutrient therapy and oral anti-inflammatories. Given the paucity of successful treatment strategies, exploring cost-effective treatments with low side effect profiles is a worthwhile approach to improving clinical outcomes in patients with TN.

Comparative study of I.V. magnesium sulphate and lignocaine for attenuating the haemodynamic stress during laryngoscopy and intubation

Background: Following induction of general anesthesia, laryngoscopy and endotracheal intubation produce pressor response that are somatic visceral reflexes brought on by stimulation of epipharynx and laryngopharynx. To avoid hemodynamic responses to intubation, several strategies have been tested. Agents like opioids, local anesthetics have been used to attenuate such response. Our study was employed with intravenous magnesium sulphate and lignocaine. Methods: A total of 60 patients of both sexes in the age group between 15-50years, belonging to ASA grade I and II undergoing elective surgery under general anaesthesia. Out of the 60 patients 30 were randomly included in the L group (lignocaine group) and the other 30 were included in the M group (magnesium sulphate group). Results: There was fall in heart rate (p &lt; 0.05) noted following induction, laryngoscopy, and intubation, in Magnesium group and Lignocaine group, but the fall in heart rate was more significant in the Magnesium group when compared with the Lignocaine group Like heart rate there was a significant fall in mean arterial pressure in both the groups, but there was statistically significant fall (p &lt; 0.05) in the Magnesium group when compared with the Lignocaine group.

A study of the effects of intravenous magnesium sulphate on post-operative atrial fibrillation in patients undergoing off pump coronary artery bypass grafting (CABG)

Atrial fibrillation (AF) occurs in almost 30% of patients undergoing coronary artery bypass grafting (CABG). Around 80% of these patients have decreased levels of total and ionized serum magnesium postoperatively. The association between magnesium deficiency and post CABG AF is still undetermined. Therefore, a large variety of prophylactic strategies have been assessed including perioperative magnesium administration. However, the efficacy is still questionable. The aim of this study was to find out any correlation of serum magnesium levels with the incidence of post-operative atrial fibrillation in patients undergoing off pump CABG and whether magnesium supplementation modifies the incidence. One hundred fifty patients undergoing CABG were selected and divided into treatment and control groups. Perioperative serum magnesium assays were done, and patients were monitored in the postoperative period for occurrence of Atrial Fibrillation. The risk of post CABG atrial fibrillation was more among females, obese patients, patients with EF &amp;#60; 50% and RWMA. Post-operative AF occurred in 5 patients in the treatment group (n = 75) and 11 patients in the control group (n = 75). : The proportion of patients with post-operative atrial fibrillation among cases (6.7%) was lower than that of controls (14.7%) which may indicate an important role of magnesium in prevention of AF following cardiac surgeries. The results however didn’t reach a statistical significance which could be due to sample size, the duration and design of the study and the period of post-operative AF monitoring.

Shiv-mix for perioperative hemodynamic stability and analgesia: A new paradigm for limited resource centres

Dear editor, A very interesting article has been published in your esteemed journal titled “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” by Kothari et al., (December 2022|Vol 13|Issue 12). Research is not complete unless it reaches to its potential audience. We, firstly, would like to congratulate the authors and the journal for publishing their research on such a very important topic. Authors have described their findings in a clear and scientific manner. Randomized and double-blinded studies provide inferences which are considered more authentic. Authors in this study used envelop method for allocating patient in the two groups; the intervention and the control. Findings of this study will definitely help readers and practitioners in providing safe and stable anesthesia to their patients. In this prospective randomized study, authors concluded that combination of paracetamol, magnesium sulfate, and lignocaine is effective in attenuating hemodynamic responses to laryngoscopy and intubation. They also found better hemodynamic stability during intraoperative and post-operative period in pre-eclampsia patients scheduled for lower segment cesarean section under general anesthesia. Finally, they opined that when paracetamol, magnesium sulfate, and lignocaine are given together effective and prolonged post-operative analgesia can be obtained. Authors discussed efficacy and safety of various medications (Lignocaine, fentanyl, esmolol, and magnesium sulfate) comparing with placebo and different combinations used to attenuate laryngoscopy and intubation response. However, in last paragraph of introduction and in discussion, authors wrote that they could not find any single study using all three drugs (intravenous paracetamol, magnesium sulfate, and lignocaine) simultaneously for attenuation of hemodynamic changes during laryngoscopy and intubation. We would like to draw your kind attention published work that have utilized the same combination with similar effects and this study support the conclusions of those studies. We do agree that these were nor RCTs but case series. Two related articles are discussed here. Khan and Singh in their narrative review described efficacy, safety, and patient satisfaction of various combinations of paracetamol, tramadol, magnesium sulfate, and lignocaine (Shiv-mix 1, 2, and 3). Authors found the described opioid free anesthesia (OFA) regimen (Shiv-mix) very effective in attenuating laryngoscopic and intubation response. In their case series, they also found stable intraoperative hemodynamics and absence of some commonly seen post-operative complications such as PONV and shivering. In another case series by Ansari et al., using similar OFA describing ten cases of laparoscopic cholecystectomy, the authors found that OFA using Shiv-Mix (A combination of paracetamol, tramadol, magnesium sulfate, and lignocaine) infusion preoperatively was a safe, opioid‑sparing, and feasible option that provide good perioperative analgesia, stable hemodynamics, and an uneventful recovery profile. We again support the findings of the study by Kothari et al. We hope that this discussion will help researchers and practitioners to provide effective and safe perioperative course of their patients and opening new horizons for multimodal analgesia.

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.

Effectiveness of Intravenous Magnesium Sulfate in Children Presenting to the Emergency Department with Acute Exacerbation of Asthma

Asthma is a serious medical condition in the pediatric age group and can have a high mortality, therefore it should be managed effectively. Patients not responding adequately to first line therapy need additional treatment. A few research studies have evaluated the use of intravenous magnesium sulfate in improving respiratory scores in severe acute pediatric asthma but the results have been conflicting. Objectives: To determine the benefit of intravenous magnesium sulfate in treating children presenting with worsening of asthma symptoms. Methods: A cross-sectional prospective study carried out at the Pediatrics Unit of Zia Uddin University Hospital, Karachi from 1st March 2021 to 1st March 2022. On the whole, 280 children in the age group 2-12 years with acute worsening of asthma of were selected by non-probability purposive sampling technique, however, children in need of invasive ventilation and those having asthma related complications on radiological investigations were omitted. Chi-square was applied for categorical variables and a p-value &lt;0.05 was considered statistically significant. Results: Out of 280 patients who came to the Pediatric Emergency Department with acute severe asthma, 236 (84.3%) patients responded to a single dose of intravenous magnesium sulfate manifested by an improvement in clinical asthma score, while 44 patients (15.7%) did not show improvement. The admission rate to the pediatric intensive care unit was only 12.8%. Conclusion: Magnesium sulfate infusion helps improve respiratory symptoms in acute worsening of pediatric asthma.

Effect of intravenous magnesium on post-operative pain following Latarjet shoulder reconstruction.

Single injection ropivacaine interscalene anesthesia (ISA) is frequently used in Latarjet reconstruction to enhance post-operative analgesia. A potential limitation is the occurrence of severe rebound pain on block resolution. We investigated the effect of intravenous magnesium on post-operative pain, particularly at the transition of block resolution to multimodal analgesia. Elective patients (n = 40) having Latarjet open shoulder reconstruction were randomised to receive either intravenous magnesium sulphate 50 mg/kg (M) or normal saline (S) before induction. Post-operatively, a standardised analgesic regimen was used, and post-operative pain was recorded using a verbal numerical rating assessment (VNRA) score. Requirement for injected opioid analgesia was recorded. ISA provided longstanding analgesia in all patients with block duration slightly prolonged in the magnesium group (16.7(1.0) (S), 17.8(1.3) h (M), p = 0.049). Magnesium resulted in less rebound pain following ISA resolution (VNRA 4.0 (0.6) M, 6.2 (0.8) S, p = 0.03) and lower pain intensity at 24 h. Four patients had nausea and two required rescue opioid injection. Magnesium before Latarjet surgery results in less rebound pain following ropivacaine block and improves post-operative analgesia. Magnesium may be indicated in major upper limb surgery, where significant pain intensity is anticipated. Treatment study; Randomised blinded; Level 2.

Resolution of sustained ventricular tachycardia in a horse presenting with colic with magnesium sulfate

SummaryCase reports demonstrating a return to sinus rhythm from sustained ventricular tachycardia (VT) are limited. VT is uncommon in horses but can be life threatening and has been reported in horses with primary gastrointestinal disease. Treatment is recommended if there is poor perfusion, if heart rate exceeds 100 beats/min, if multiform/polymorphic complexes or torsades des pointes is present. Lidocaine or magnesium sulfate is the first‐line medication. In this case, a 19‐year‐old Warmblood gelding with a history of exploratory laparotomy presented with an irregularly irregular cardiac rhythm and heart rate of 80 beats/min. ECG demonstrated VT with a heart rate of 75 beats/min. As the horse was already receiving a lidocaine bolus, the VT was treated with multiple boluses of intravenous magnesium sulfate over a period of several hours. This converted the VT to normal sinus rhythm (NSR) with heart rate of 44 beats/min and the horse remained in NSR until discharge 8 days later.

Early Intravenous Magnesium Sulfate Administration in the Emergency Department for Severe Asthma Exacerbations.

Severe asthma exacerbations in pediatric patients occur frequently and can require pediatric intensive care unit (PICU) admission. To determine if early administration of intravenous magnesium sulfate (IVMg) to pediatric patients experiencing severe asthma exacerbations, defined as a respiratory clinical score (RCS) of 9 to 12, resulted in fewer PICU admissions. Retrospective chart review of pediatric patients aged from 2 to 17 years presenting with a severe asthma exacerbation to a single tertiary care pediatric emergency department. Univariable and multivariable logistic regression analyses were used to determine if admission to the PICU was associated with early IVMg treatment, within 60 minutes of registration. A total of 1911 patients were included in the study, of which 1541 received IVMg. The average time to IVMg was 79 minutes, with 35% of the patients receiving it within 60 minutes of arrival. Two hundred forty-eight (13%) were admitted to the PICU, 641 (34%) were admitted to the general inpatient floor, and 1022 (53%) were discharged home. Factors associated with increased odds ratio (OR) of PICU admission were: early IVMg (OR, 1.63; 95% CI: 1.16-2.28), arrival mode to the emergency department via ambulance (OR, 2.23; 95% CI: 1.45-3.43), history of PICU admission for asthma (OR, 1.73; 95% CI: 1.22-2.44), and diagnosis of status asthmaticus (OR, 8.88; 95% CI: 3.49-30.07). Calculated OR of PICU admission subcategorized by RCS for early IVMg patients, after controlling for PICU risk factors, are as follows: RCS 9 (reference), RCS 10 (OR, 2.52; 95% CI: 0.89-2.23), RCS 11 (OR, 2.19; 95% CI: 1.3-3.70), and RCS 12 (OR, 4.12; 95% CI: 2.13-7.95). Early administration of IVMg to pediatric patients experiencing severe asthma exacerbations does not result in fewer PICU admissions.