Intravenous Magnesium Sulfate Research Articles

Intravenous Magnesium in Asthma Pharmacotherapy: Variability in Use in the PECARN Registry

To examine the use, efficacy, and safety of intravenous magnesium sulfate (IVMg) in children with asthma whose emergency department (ED) management is recorded in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. This multicenter retrospective cohort study analyzed clinical data from 7 EDs from 2012 to 2017. We described use of IVMg in children aged 2-17years treated for acute asthma and its effect on blood pressure. We also used multivariable analysis to examine factors associated with use of IVMg and its association with return visits within 72hours. Across 61 854 asthma visits for children, clinicians administered IVMg in 6497 (10.5%). Median time from triage to IVMg administration was 154minutes (IQR 84, 244). During 22 495 ED visits resulting in hospitalization after ED treatment, IVMg was administered in 5774 (25.7%) (range by site 15.9%, 50.6%). Patients were discharged home from the ED after 11.1% of IVMg administrations, and hypotension occurred after 6.8%. Variation in IVMg use was not explained by patient characteristics. Revisits did not differ between patients discharged after IVMg and those not receiving IVMg. In PECARN Registry EDs, administration of IVMg occurs late in ED treatment, for a minority of the children likely to benefit, with variation between sites, which suggests the current clinical role for IVMg in preventing hospitalization is limited. Discharge after IVMg administration is likely safe. Further research should prospectively assess the efficacy and safety of early IVMg administration.

Use of intravenous magnesium sulfate among patients with acute myocardial infarction in China from 2001 to 2015: China PEACE—Retrospective AMI Study

ObjectiveIn 2001, Chinese guidelines for the care of acute myocardial infarction (AMI) included a new recommendation against the routine use of magnesium. We studied temporal trends and institutional variation in...

Magnesium Sulphate for Neuroprotection when Preterm Birth is Anticipated

Preterm births are rising, and neonatal care provisions are advancing with research and technology. Intravenous Magnesium Sulphate (MgSO4), given to the mother when preterm birth is expected or planned, will help protect the baby’s brain and reduce the incidence of cerebral palsy. Cerebral palsy is a lifelong condition with varying degrees of severity and disability. The PReCePT project is now a national project and should be delivered in all NHS hospitals across the country.

Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review – A Comment

Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review – A Comment

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Perioperative Use of Intravenous Magnesium Sulfate to Decrease Postoperative Pain

Comparing Intravenous Magnesium Sulfate With Dexamethasone as Adjuvants to Ultrasound Guided TAPblock

Comparing Intravenous Magnesium Sulfate With Dexamethasone as Adjuvants to Ultrasound Guided TAPblock

Intravenous magnesium sulfate in the management of severe pre-eclampsia: A randomized study of 12-hour versus 24-hour maintenance dose.

To assess the effectiveness of a 12-hour versus 24-hour intravenous maintenance dose of magnesium sulfate (MgSO4 ) in women with pre-eclampsia, and the maternal and fetal outcomes. This was a randomized controlled trial conducted at the labor ward complex of University College Hospital, Ibadan, Nigeria between May and August 2014. Pregnant women with severe pre-eclampsia were randomized to receive a 12-hour versus 24-hour maintenance dose of MgSO4 . Study outcomes were occurrence of seizures, adverse maternal effects, neonatal survival, and admission to the intensive care unit. Data analysis involved descriptive statistics and bivariate analysis using Statistical Package for Social Science (SPSS) version 20. There were 80 patients randomized to the 12-hour (n=40) and 24-hour (n=40) groups. The participants in the two groups had comparable demographic features. There was no significant difference (P>0.999) between the satisfactory maternal outcome following the 12-hour maintenance dose and the standard 24-hour regimen (95.0% vs 97.5%). Similarly, there was no significant difference (P=0.276) in perinatal mortality in the 12-hour versus 24-hour arm (17.5% vs 12.5%, respectively). No case of eclampsia and maternal death was recorded. A 12-hour maintenance dose of intravenous MgSO4 in the management of severe pre-eclampsia is effective and safe when compared with the 24-hour maintenance dose.

Effect of Prophylaxis of Amiodarone and Magnesium to Prevent Atrial Fibrillation in Patients with Rheumatic Valve Disease Undergoing Mitral Valve Replacement Surgery.

Context:Maintenance of sinus rhythm is superior to the incidence of atrial fibrillation (AF) in patients with rheumatic valve disease undergoing mitral valve replacement (MVR) surgery.Aim:To evaluate the effect of prophylactic combination of intravenous (i.v.) amiodarone and magnesium sulfate (MgSO4) in patients undergoing MVR surgery.Materials and Methods:One hundred and twenty patients with valvular heart disease with or without AF were randomly divided into two groups. Group I (n = 60) received amiodarone (3 mg.kg −1 in 20 mL saline) + MgSO4 (30 mg.kg − 1 in 20 mL saline), and Group II (n = 60) received 40 mL of normal saline. The standardized protocol for cardiopulmonary bypass was maintained for all the patients.Statistical Analysis:Continuous variables were expressed as mean ± standard deviation and categorical variables were summarized as frequencies and percentages. Student's independent t-test was employed for comparing continuous variables. Chi-square test was applied for comparing categorical variables.Results:Before surgery, AF was observed in 58.3% of patients in Group I and in 53.3% of patients in Group II (P = 0.581). Postoperatively, in the intensive care unit, 26.7% of the patients in Group I and 71.7% in Group II had AF (P < 0.001). At the time of discharge, 30% of patients in Group I and 73.3% of patients in Group II had AF (P < 0.001).Conclusion:A single combined prophylactic intraoperative dose of i.v. amiodarone and MgSO4 decreased postbypass arrhythmia in comparison to the placebo group in patients of MVR surgery.

A randomized double blind comparative study of intravenous magnesium sulphate and intravenous lignocaine for attenuation of haemodynamic response to laryngoscopy and tracheal intubation

A randomized double blind comparative study of intravenous magnesium sulphate and intravenous lignocaine for attenuation of haemodynamic response to laryngoscopy and tracheal intubation

SARS- CoV-2 infection presented as acute exacerbation of bronchial Asthma.

Dear Editor, The varied presentation of acute respiratory illness from SARS-CoV-2 poses a diagnostic challenge to the physician. The classic presentation of fever, cough and shortness of breath is often not reported in a number of patients. We report a case of acute respiratory illness in a middle-aged asthmatic man who presented with acute severe bronchospasm. A 59-year-old male patient presented in emergency department with a history of shortness of breath for 5 days and he was immediately shifted to the screening intensive care unit (ICU) as dyspnea was rapidly increasing. He was a known case of bronchial asthma for 4 months and type 2 diabetes for 2 years, on regular medical management. He denied any history of fever and cough or any relevant contact history. On arrival in the ICU, he was conscious and oriented, but dyspneic, using accessory muscles of respiration with respiratory rate of 28 per minute and maintaining SpO2 of 86% on room air. The rest of the hemodynamic parameters were stable. Lung ultrasonography showed B profile in zone 1 of right lung with shredding. The other lung zones were normal. Oxygen supplementation by face mask, and nebulization with salbutamol were started and intravenous hydrocortisone 100 mg was administered. Nasal and throat swabs were sent for real time polymerase chain reaction (RT-PCR) for SARS-CoV-2 identification. However, despite of medical management, respiratory rate increased to 40 and SpO2 decreased to 65-70% and altered sensorium was also noted. Immediately, endotracheal intubation was performed by videolaryngoscope after administering intravenous propofol 2 mg/kg and rocuronium 1.2 mg/kg. Mechanical ventilation was initiated by volume-controlled ventilation with a tidal volume of 350 ml, respiratory rate of 18/m and an initial PEEP of 5 cm H2O. A peak airway pressure of 45 cm H2O and a plateau airway pressure of 25 cm H2O was noted which further supported the diagnosis of acute bronchospasm. Intravenous magnesium sulphate of 2 gm administered followed by intravenous ketamine infusion which decreased peak airway pressure to 35 cm H2O and SpO2 increased to 95%. RT- PCR revealed that the patient was infected with SARS-CoV-2. Viral respiratory infections are often implicated as an inciting event for acute exacerbation of bronchial asthma[1] and asthma is associated with adverse outcome in patients with viral respiratory infection.[2] SARS-CoV-2 exhibited a diverse range of clinical symptoms including the classic triad of fever, cough and shortness of breath.[3] However, majority of the large series did not actually mention the proportion of asthmatic patients who were infected with SARS-COV-2.[4] Richardson et al. mentioned 9% of the cases had bronchial asthma as a comorbidity but the presentation as acute exacerbation of asthma was not described.[5] The presentation in our patient was unique, as he presented with only rapidly progressive dyspnea without any other clinical feature. In the era of current pandemic, SARS-CoV-2 must be kept as a differential diagnosis in any patient who is presenting with acute exacerbation of asthma. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Intravenous Magnesium Sulfate for Pain Management in Patients with Acute Renal Colic; a Randomized Clinical Trial.

It seems that magnesium (Mg) sulfate can be helpful in controlling the acute pain caused by the stone passing from the ureter by reducing ureter smooth muscle contractions. The present study has been designed with the aim of assessing the role of Mg sulfate in controlling the renal colic pain in emergency department (ED). This double blind randomized clinical trial was performed on 18 to 60 year-old patients with acute renal colic presenting to the ED of a teaching hospital during 1 year. Patients were allocated to one of the 2 groups receiving either IV morphine or IV Mg sulfate using block randomization method and were then compared regarding pain control characteristics and probable side effects. 90 patients with the mean age of 37.34 ± 12.10 (18 - 60) years were divided into 2 equal groups. The 2 groups were in a similar condition regarding mean age (p = 0.168), sex distribution (p = 0.267), underlying disease (p = 0.414) and alcohol and drug abuse (p = 0.524). Mean pain scores of the patients based on VAS were not significantly different between the 2 groups on admission and 20, 30, 60, 120, and 180 minutes after drug administration. Success rate in reducing the pain by at least 3 points on VAS was equal and 91.1% for both groups on the 20th minute and reached 100% on the 30th minute for both groups. The number of cases that were pain-free on the 20th minute was significantly higher in the morphine groups (31 versus 16 patients, p = 0.004). However, on the 30th minute both groups experienced a similar condition in this regard (39 versus 29, p = 0.063). None of the patients in the 2 groups experienced the studied side effects. It seems that Mg sulfate, as a muscle relaxant agent, can be considered as a safe adjunct medication in controlling the pain of renal colic patients in the ED.

Cervical Length Estimation and Cervicovaginal Fluid for Placental &amp;lt;i&amp;gt;α&amp;lt;/i&amp;gt;-Microglobulin 1 Testing to Screen Women Had Threatened Preterm Labor for Time till Spontaneous Labor

Objectives: Evaluation of diagnostic performance of rapid testing of cervico-vaginal fluid (CVF) for fetal fibronectin (FFN) and placental α-microglobulin 1 (PAMG-1) as screening of women presented by threatened preterm labor (TPTL) with intact membranes for duration till getting spontaneous labor (SL). Patients & Methods: 37 women presenting with TPTL underwent CVF samplings before digital examination and then underwent transvaginal ultrasonography for estimation of cervical length (CL). All women received fluid and anxiolytic therapy and if uterine contractions persisted, all had received tocolytic therapy with oral nifedipine or intravenous magnesium sulphate according to requirements. Incidence of SL within <48 hr, 2 - 7 and 7 - 14 days was recorded and related to CL and result of FFN and PAMG-1 tests. Results: Incidence of SL was 13.5%, 35.2% and 51.3% within 48-hr, 2 - 7 and 7 - 14 days, respectively. Duration till labor after sampling was positively correlated with CL, while was negatively correlated with positive FFN and PAMG-1 tests. Positive FFN test had high specificity, while positive PAMG-1 test had high sensitivity for labor within 7 days. Regression analysis defined short CL and positive PAMG-1 test as significant predictors for short duration till SL. ROC curve analysis defined short cervix and positive PAMG-1 test as significant predictors for labor within 48-hr and within 2 - 7 days respectively and combined negative PAMG-1 test and CL of 20 - 25 mm were significant predictors for labor within 7 - 14 days. Conclusion: PAMG-1 test had high specificity, if positive, for predicting SL and high NPP, if negative, for excluding labor within 7 days, so it can be used as rapid adjuvant to clinical evaluation to help management decision-making. Moreover, PAMG-1 test is recommended screening test for being easy-to-use bedside test, provides rapid results, can be used after vaginal exam and coitus and does not require a speculum examination or specialized equipment to analyze results.

Effect of intravenous magnesium sulphate on hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy: A prospective, double blind study

Background and Aim: Pneumoperitoneum (PP) for laparoscopic surgery is known to induce a pressor response. It can be attenuated by drugs, like opioids, vasodilators, beta blocking agents and alpha-2 agonists, but these drugs have their side effects. This study investigated the efficacy of magnesium sulphate to attenuate hemodynamic response associated with pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.Methodology: This randomized, double blind, prospective study was carried out at Department of Anesthesiology, Maharishi Markandeshwar University, Mullana, Haryana (India). A total of 60 patients of ASA grade I or II, aged 20-60 y, of either sex, undergoing laparoscopic cholecystectomy, were randomly allocated into one of the two groups of 30 each. Standardized general anesthesia was administered to all patients. Group 1 patients received magnesium sulphate (30 mg/kg) intravenously as a bolus before induction of PP and Group 2 patients received same volume of 0.9% normal saline. Hemodynamic variables, e.g. heart rate (HR), systolic (SBP), diastolic (DBP), mean arterial pressures (MAP) were recorded from the start of surgery till extubation. Statistical analysis: SPSS version 17.0 for windows was used and p value of &lt; 0.05 was considered significant.Results: Mean HR was 81.50 ± 8.44 vs. 93.03 ± 6.93/min, SBP was 126.37 ± 13.03 vs. 150.20 ± 10.45 mmHg, DBP was 82.50 ± 11.20 vs. 94.73 ± 8.33 mmHg, and MAP 98.43 ± 10.29 vs.113.27 ± 9.16 mmHg in Group 1 and Group 2, respectively, at 10 min after PP. Statistically significant fall in HR, SBP, DBP, MAP was seen in Group 1 at 10 min after PP till extubation. (p &lt; 0.05).Conclusion: Intravenous magnesium sulphate effectively attenuates the hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy under general anesthesia.Citation: Bansal K, Santpur MU, Garg U, Goel K, Vijay D, Tatineni Bansal. Effect of intravenous magnesium sulphate on hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy: A prospective, double blind study. Anaesth pain &amp; intensive care 2019;23(3):290-294

Effect of magnesium supplementation on lactate clearance in critically ill patients with severe sepsis: a randomized clinical trial.

In this study, changes in lactate clearance following magnesium supplementation were evaluated in critically ill patients with severe sepsis. Fifty-eight patients with severe sepsis were randomly assigned to receive either magnesium (n = 30) or placebo (n = 28). Patients in the magnesium group received intravenous magnesium sulfate to maintain serum magnesium level around 3 mg/dL for 3 days. The placebo group received the same volume of normal saline. Change in lactate clearance was considered primary outcome of the study. Mean increase in the lactate clearance in the magnesium group was significantly higher than the placebo group on day 2 (27.53% vs. 23.79% respectively, p < 0.001) and day 3 (49.83% vs. 37.02% respectively, p < 0.001). Time to lactate clearance was also significantly shorter in the magnesium group than the placebo group (47.28 ± 20.59 vs. 61.20 ± 24.31 h respectively, p = 0.03). Sepsis-related mortality was not significantly different but median length of ICU stay was significantly shorter in the magnesium group than the placebo group (8 vs. 15 days respectively, p < 0.01). Magnesium supplementation increased lactate clearance in critically ill patients with severe sepsis. Optimizing serum magnesium level near the upper limit of the normal range may improve severe sepsis outcomes.

Inhalational versus intravenous magnesium sulfate in management of pulmonary hypertension in neonates

Background: persistent pulmonary hypertension of the newborn (PPHN) is a serious medical emergency in the neonatal period which occurs because of failure of transition of the fetal circulation into the normal circulation. The condition is characterized by persistently elevated pulmonary vascular pressures and carries with it a high rate of mortality and morbidity.Objective: to evaluate the effect of inhaled versus intravenous magnesium sulfate (MgSO4) as a treatment of pulmonary hypertension in neonates.Methodology: this is an observational prospective study done in Sohag university hospital in the neonatal intensive care unit during the period from January 2016 to December 2017 on 50 neonates who were diagnosed to have PPHN by echocardiography. In this study, we compared the effect of intravenous versus the inhalational MgSO4 on reducing the PHN and SILDENAFIL was used as an adjuvant treatment.Results: there was a statistically significant difference between the three studied groups as regard: age, sex, the degree of respiratory distress, the pulmonary artery pressure before treatment, side effects of treatment, duration of treatment and the SpO2 after treatment. Also there was a great difference in SpO2 in the right hand before and after treatment. Pulmonary artery pressure as well differs greatly before and after treatment in the three groups.Conclusion: based on this study we don't recommend the use of nebulized MgSO4 alone as a treatment of PPHN in neonates.

Preemptive analgesic effect of magnesium sulfate on postoperative pain in patients undergoing lumbar fusion surgery

BackgroundReducing postoperative pain can improve patient satisfaction and hospital cost. Intravenous magnesium sulfate is one of the proposed drugs for preemptive analgesia. The study aimed to evaluate the effect of magnesium sulfate on postoperative pain in patients undergoing lumbar fusion surgery.MethodsA double-blind randomized clinical trial was conducted on candidates for vertebral fusion surgery with American Society of Anesthesiologists (ASA) class I-II. One hundred and two patients were randomized into the magnesium sulfate group and control group. The magnesium sulfate group received magnesium sulfate at a dose of 50mg/kg in 20 mL volume and infused during 15-30 minutes pre-operation, while the control group received 20 mL normal saline. The severity of the pain was assessed by the Visual Analogue Scale (VAS) at 2, 4, 6, 12 and 24 hours after patients entering the post-anesthetic care unit. After the operation, the patients’ relaxation rate was assessed based on Ramsay sedation score (RSS).ResultsThere was no significant difference at 2, 4, 6, 12 and 24 hours post-operation between the two groups in the mean severity of pain (p&gt;0.05). There was no significant difference at 2, 4, 6, 12 and 24 hours post-operation between the two groups in the mean of pethidine consumption. There was no significant difference in the relaxation of the patients according to the RSS criteria in the magnesium sulfate and control groups (p=0.162). ConclusionPre-operative administration of magnesium sulfate does not affect reduction in postoperative pain and opioid consumption of patients undergoing lumbar fusion surgery.

Intravenous magnesium sulfate to attenuate hemodynamic changes in laparoscopic surgery: a systematic review protocol.

The objective of this systematic review is to determine the efficacy of intravenous magnesium sulfate when used to attenuate hemodynamic fluctuations associated with the creation of pneumoperitoneum in adults undergoing laparoscopic surgery. Laparoscopic surgery has gained popularity as a result of improved patient outcomes postoperatively, but pneumoperitoneum alters the patient's physiology and hemodynamic profile during the intraoperative period. Magnesium sulfate is a non-opioid agent known for its ability to blunt the physiologic sympathetic response associated with exposure to noxious stimuli. Magnesium sulfate may be efficacious in combating undesirable hemodynamic changes associated with pneumoperitoneum. Studies that included participants 18 years or older undergoing any laparoscopic surgery using pneumoperitoneum with CO2 insufflation will be considered. Studies will be excluded if patients were being treated for pheochromocytoma. Studies can employ any intravenous dosing strategy of magnesium sulfate, administered at any point in the perioperative period for the purpose of blunting the sympathetic response to creation of a pneumoperitoneum. A systematic search of MEDLINE, CINAHL, Cochrane Library, Google Scholar, Trip Database, MedNar, Grey Literature Report and ProQuest Dissertations and Theses will be conducted to identify both published and unpublished studies on the topic of interest. The search will be limited to studies written in English and performed on humans. Studies will be selected for review based on inclusion criteria and will be appraised by two reviewers using a standardized appraisal tool. PROSPERO CRD42019139991.

Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review.

Non-traumatic headaches comprise up to 4% of all emergency department (ED) visits. Current practice is moving toward multimodal analgesia regimens that limit narcotic use. The objective of this systematic review is to address the following research question: In patients with non-traumatic headaches (Population), does administration of intravenous magnesium sulfate (Intervention) compared to placebo, corticosteroids, dopamine antagonists, ergot alkaloids, non-steroidal anti-inflammatory drugs (NSAIDs), triptans, or usual care result in better pain control, lower rate of recurrence at 24hours, lower requirements for rescue analgesia, and less adverse medication effects (Outcomes)? Scholarly databases and relevant bibliographies were searched, as were clinical trial registries and relevant conference proceedings to limit publication bias. Studies were not limited by date, language, or publication status. Inclusion criteria were: (1) randomized clinical trial (RCT), (2) patients age ≥18 years, (3) non-traumatic headache, (4) patients treated in ED or an outpatient acute care treatment center, and (5) magnesium sulfate administered intravenously (IV). Eligible comparison groups included: placebo, conventional therapy, dopamine antagonist, NSAID, corticosteroid, ergot alkaloid, or triptans. Out of 4018 identified references, 7 RCTs (545 participants) that treated migraine headaches (n=6) and benign non-traumatic headaches (n=1) met inclusion criteria. Pain intensity was improved with magnesium sulfate vs comparators at 60-120 minutes, but not at earlier time points. Result for the endpoint of pain reduction by 50% were conflicting as 3 studies reported that headache was improved, unchanged, and less with magnesium sulfate. Complete pain relief was improved with magnesium sulfate in 1 study, and in the migraine with aura (MA) subgroup in another. The need for rescue analgesia at any point was improved with magnesium sulfate in 1 study, and in the MA subgroup in another. Twenty-four-hour headache recurrence was improved with magnesium sulfate in 1 study, but unchanged in a second. The intended meta-analysis was not performed due to the clinical heterogeneity among studies. While we cannot draw a firm conclusion on the efficacy or benefit of intravenous magnesium sulfate in the treatment of acute non-traumatic headaches, the existing evidence indicates potential benefits in pain control beyond 1hour, aura duration, and need for rescue analgesia.