Low Dose MgSO4 Research Articles

The effects of perioperative low-dose magnesium sulfate infusion on postoperative pain in lumbar surgery

This paper aimed at evaluating the effect of low-dose perioperative magnesium sulfate (MgSO4) on postoperative pain in lumbar surgery. Sixty adult patients were included in this randomized controlled double-blind study. After intubation, an infusion of MgSO4 (10 mg/kg/h) and isotonic saline 0.9% (10 mg/kg/h) were administered in groups M and C, respectively. Heart rate and mean arterial pressure were recorded before and during surgery. Serum magnesium levels were recorded before and after the surgery. Perioperative remifentanil consumption and extubation time were recorded. In the post-anesthesia care room (PACU), Agitation-sedation with Richmond Agitation-Sedation Scale (RASS), the pain was evaluated with Visual Analogue Scale (VAS) and recorded at the baseline, at 5th, 10th, 15th and 30th minutes. Patients were transferred to surgical ward with intravenous patient-controlled analgesia (PCA) for postoperative analgesia and received diclofenac sodium for rescue analgesia if VAS >4. Postoperative VAS scores at 2nd, 4th, 6th and 24th hours, opioid consumption after 4 and 24 hours and rescue analgesic consumption for postoperative 24 h were recorded. In the PACU, RASS scores were statistically lower in group M than in group C (p = 0.001), and VAS scores were statistically lower at all measurement times in group M than in group C. In the surgical ward, VAS Scores were statistically lower in Group M at the 6th and 24th hours than in group C (p = 0.015, p = 0.009, respectively). The need for post-operative rescue analgesic was statistically lower in Group M (p < 0.001). The side effect incidence of both groups was similar. Our findings suggest that perioperative low-dose (10 mg/kg/h) MgSO4 infusion reduces early post-op agitation, VAS scores and the need for analgesics up to 24 hours postoperatively. Low dose MgSO4 infusion can be effectively applied for pain management in patients undergoing lumbar surgery.

Effect of Low Dose Intravenous Magnesium Sulphate on Sensory Regression Time in Patients undergoing Spinal Anaesthesia- A Randomised Placebo-controlled Double-blinded Study

Introduction: Adjuvants like intravenous (i.v.) Magnesium Sulphate (MgSO4 ) are used to improve the efficacy and duration of spinal anaesthesia and postoperative analgesia. But it is unclear, whether this prolongation of duration of analgesia is an independent effect of MgSO4 or it is because of increased duration of spinal anaesthesia itself. Aim: To evaluate the effect of intraoperative i.v. low dose MgSO4 on two-segment regression time of sensory block, regression time up to L2 dermatome from the highest level of sensory block and postoperative analgesic requirement. Materials and Methods: This randomised placebo-controlled blinded study was conducted in the Department of Anaesthesia, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India from September 2020 to August 2021. A total of 60 patients, satisfying American Society of Anaesthesiology (ASA) physical status I and status II, aged between 40-70 years, patients undergoing femur fracture surgery under spinal anaesthesia were enrolled in the present study. Patients in the magnesium group (Group M, n=30) received MgSO4 5 mg/kg infusion, and control group (Group C, n=30) received at the same volume of saline during operation. Unpaired t-test was used to test the significance in normally distributed continuous variable and Mann-Whitney U test was used to test the significance of the difference between the quantitative variables. The software Predictive Analytics Software (PASW) 18.0 was used for statistical analysis and the graphs have been generated using the Microsoft Excel 2007. A p-value of less than 0.05 has been considered to be significant. Results: There were no significant differences between the two groups with respect to patient characteristics (age, weight, and height).The mean time for two segment regression in the group M was prolonged by around 13 minutes, as compared to group C (104.96±11.37 minutes versus 91.2±11.86 minutes, respectively, p<0.001). The mean regression time up to L2 dermatome in the group M was prolonged by 15 minutes as compared to the group C. (171.23 minutes versus 156.43 minutes, respectively, p=0.0003). The total consumption of tramadol in the group M was significantly lesser than the control group (192.5±58.03 mg and 245.0±43.74 mg, respectively, p=0.0002). Conclusion: An i.v. infusion of 5 mg/kg MgSO4 prolongs two segment regression time upto L2 dermatome and reduces postoperative opioid consumption without any complication in patients undergoing femur fracture surgery under spinal anaesthesia

Preoperative effects of magnesium sulfate on hemodynamics and muscle relaxation

Background/Aim: Although there are many studies on the effects of magnesium sulfate in the literature, there is no publication on the effects of low doses of magnesium sulfate, as we administered in our study. This prospective randomized study aimed to reveal that the use of low-dose magnesium sulfate (MgSO4) shortens the onset time and prolongs the block duration of neuromuscular blockers (NMBs) without changing the hemodynamics in patients monitored using the train-of-four (TOF) ratio. Methods: This is a prospective randomized study. A total of 60 cases aged between 18–65 years with American Society of Anesthesiologists classifications I–II who were scheduled for elective open cholecystectomy were randomly divided into 3 groups. Notably, 15 minutes before the anesthesia induction, 25 mg/kg MgSO4 in intravenous 0.9% saline (total volume, 100 mL) was administered to the MgSO4 group (MS group), 0.03 mg/kg midazolam was administered to the midazolam group (MD group), and the same volume of 0.9% saline solution was administered to the control group (PSS group). Nerve-muscle conduction monitoring was performed using TOF-Watch® SX (Organon, Ireland) and anesthesia depth was monitored with a BIS® monitor (A-2000; Aspect Medical Systems, USA). Results: NMB onset times were 83.95 (26.8), 111.15 (28.12), and 163.7 (34.16) seconds (P=0.001) in the MS, MD, and PSS groups, respectively. The times until additional rocuronium requirement after the intubation dose were 60.1 (4.19), 50.8 (4.99), and 38.25 (7.27) minutes in the MS, MD, and PSS groups, respectively, which was significantly longer in the MS group compared to the other groups (P 95% was longer in the MS group than in the other groups. No difference was found between the groups in terms of hemodynamic data. Conclusion: Low-dose MgSO4 administration before rocuronium injection significantly reduces neuromuscular agent consumption without altering hemodynamics and causing a residual neuromuscular block.

Low-dose Magnesium Sulfate Versus High Dose in the Early Management of Rapid Atrial Fibrillation: Randomized Controlled Double-blind Study (LOMAGHI Study).

We aim to determine the benefit of two different doses magnesium sulfate (MgSO4 ) compared to placebo in rate control of rapid atrial fibrillation (AF) managed in the emergency department (ED). We undertook a randomized, controlled, double-blind clinical trial in three university hospital EDs between August 2009 and December 2014. Patients>18 years with rapid AF (>120 beats/min) were enrolled and randomized to 9g of intravenous MgSO4 (high-dose group, n=153), 4.5 g of intravenous MgSO4 (low-dose group, n=148), or serum saline infusion (placebo group, n=149), given in addition to atrioventricular (AV) nodal blocking agents. The primary outcome was the reduction of baseline ventricular rate (VR) to 90 beats/min or less or reduction of VR by 20% or greater from baseline (therapeutic response). Secondary outcome included resolution time (defined as the elapsed time from start of treatment to therapeutic response), sinus rhythm conversion rate, and adverse events within the first 24 hours. At 4 hours, therapeutic response rate was higher in low- and high-MgSO4 groups compared to placebo group; the absolute differences were, respectively, 20.5% (risk ratio [RR]= 2.31, 95% confidence interval [CI]= 1.45-3.69) and +15.8% (RR= 1.89, 95% CI= 1.20-2.99). At 24 hours, compared to placebo group, therapeutic response difference was +14.1% (RR= 9.74, 95% CI= 2.87-17.05) with low-dose MgSO4 and +10.3% (RR= 3.22, 95% CI= 1.45-7.17) with high-dose MgSO4 . The lowest resolution time was observed in the low-dose MgSO4 group (5.2±2 hours) compared to 6.1±1.9 hours in the high-dose MgSO4 group and 8.4±2.5 hours in the placebo group. Rhythm control rate at 24 hours was significantly higher in the low-dose MgSO4 group (22.9%) compared to the high-dose MgSO4 group (13.0%, p=0.03) and the placebo group (10.7%). Adverse effects were minor and significantly more frequent with high-dose MgSO4 . Intravenous MgSO4 appears to have a synergistic effect when combined with other AV nodal blockers resulting in improved rate control. Similar efficacy was observed with 4.5 and 9 g of MgSO4 but a dose of 9g was associated with more side effects.

Comparative study of low dose magnesium sulphate regime with Pritchard regime in eclampsia

Introduction: Eclampsia is still a leading cause of maternal mortality and morbidity. Magnesium sulphate despite being an anticonvulsant of choice remains underutilized due to fear of toxicity. Average weight of Indian women is less than the western women due to which lower dose of magnesium sulphate can be used in treatment of eclampsia. The aim of the study was to compare the efficacy of low dose magnesium sulphate regimen with Pritchard regimen, in the control of convulsion in eclampsia. We also compared neonatal and maternal outcome in these two group. Methodology: This randomized control study was carried out at Emergency Labour room, Government Medical College, Nagpur. 160 patients of eclampsia were divided randomly into study group (n=80) receiving low dose MgSO4 and control group (n=80) receiving Pritchard regimen. The recurrence of convulsion, toxicity profile and maternal and fetal outcome was studied. Results: Majority of patients 73.75% were primigravida and 77.5% unbooked cases. 91.5% had antepartum/intrapartum eclampsia. 6 (7.5%) patients in study group had recurrence of convulsion as compared to 11 (13.75%) in Pritchard regimen group (p =0.31). Toxicity of MgSO4 in the form of lost tendon reflexes and respiratory depression was significantly less in those receiving Low dose of MgSO4 (p<0.001). Respiratory depression developed in one patient in control group and none in study group. Maternal mortality was 2.5% in both the groups. Perinatal mortality was 28.75% in the study group and 33.73% in control group. Conclusions: Low dose Magnesium sulphate regimen was equally effective in the control of convulsions in eclampsia and can be safely used in Indian women.

Single Loading Low Dose MgSo4 Regimen: A Simple, Safe and Effective Alternative to Pritchard's Regimen for Indian Women.

Magnesium sulphate is the anticonvulsant of choice in prevention and control of eclamptic convulsions. Pritchard's regimen is the most popular time-tested regimen used. However, owing to concerns of toxicity, several low dose regimens have been introduced considering the lower body mass index of Asian women. To compare the efficacy and safety of a single loading low dose MgSo4 regimen with the Pritchard's regimen. Seventy cases of eclampsia and imminent eclampsia were allocated to the control and study groups each. The former received the Pritchard's regimen while the latter was treated with single loading low dose of magnesium sulphate. Recurrent convulsion rates, maternal and perinatal outcomes of both regimens were evaluated and compared using unpaired t-test and Chi-square test for continuous and categorical variables, respectively. The mean serum magnesium levels were significantly lower in the study group at 30 minutes and 4 hours of initiation of therapy. The single loading low dose regimen was equally efficacious in prevention (96.6% vs 100%, p = 0.934) and control (97.6% vs 97.8%, p = 0.358) of eclamptic fits as compared to the Pritchard's regimen. The feto-maternal outcomes were also comparable. The single loading low dose MgSo4 regimen is an effective and safe alternative to the Pritchard's regimen, especially tailored to the small built Indian women.

Low-dose Magnesium Sulfate Regime for Eclampsia in India

ABSTRACT Introduction Eclampsia is one of the leading causes of maternal mortality. Magnesium sulfate (MgSO4) can be a drug for its management. Objectives To study the safety and efficacy of low-dose MgSO4 for control of convulsions in case of eclampsia and to compare it with Pritchard regimen in terms of its effects and perinatal outcome. Materials and methods This study was conducted in Department of Obstetrics and Gynecology. It was a prospective study and included 78 cases of eclampsia. Thirty-nine cases were given low-dose regime and remaining 39 were given Pritchard regimen. Low-dose regime for eclampsia: Loading dose 4 gm MgSO4 IV diluted in 20 cc of 5% dextrose, slowly over 5 to 8 minutes. Maintenance dose 2 gm IV similarly diluted was given 3 hourly till 24 hours after delivery or after convulsion which ever was later. If recurrence of convulsions occurs, then additional dose 2 gm IV was given and previous dose schedule continued as such. Results Eclamptic convulsions were controlled in 94.87% of cases with low-dose regime, and in the remaining cases were controlled with additional 2 gm IV dose MgSO4 compared to 37.14% with Pritchard regimen. Conclusion Low-dose magnesium regime is highly suitable for women in our setup, and it is as effective as Pritchard regimen for controlling convulsions in eclampsia along with better perinatal outcome and with less MgSO4 toxicity. How to cite this article Garg R, Agrawal N, Kumari SS, Agrawal P. Low-dose Magnesium Sulfate Regime for Eclampsia in India. J South Asian Feder Obst Gynae 2017;9(1):5-8.

Feasibility of low dose magnesium sulphate for eclampsia-a randomized study

Introduction: Eclampsia is a preventable malady, yet remains a leading cause of maternal mortality and morbidity worldwide. Magnesium sulphate despite being the anticonvulsant of choice largely remains underutilized in low resource settings due to various constraints. Tailoring the dose as per local needs has given the scope to adopt a lower dose in these countries. We aimed to compare the efficacy of low dose regimen of magnesium sulphate (MgSO4) with Pritchard’s regimen in patients of eclampsia. Method: A prospective cross sectional study was carried out in the department of Obstetrics and Gynecology at Himalayan Institute of Medical Sciences, Dehradun, India over a period of one year which included a total of 60 patients of eclampsia divided into two groups by randomization. Group A received low dose magnesium sulphate (Dhaka regimen) and Group B patients were managed with Pritchard’s regimen of MgSO4. The recurrence of fits, toxicity profile and feto-maternal outcome was studied. Data generated was analyzed using SPSS version 20. Results: Majority of the patients were primigravida (66.67%) and unbooked (73%). Low dose regimen was equally effective in controlling the seizures and only two patients (6.6%) had recurrent seizures (p=1.00). Incidence of loss of deep tendon reflex was 10% with low dose Mgso4 and 13.3% with standard dose (p=0.69). Mean values of serum magnesium in both the groups was comparable. There was one maternal death in our study. Conclusion: With an efficacy comparable to Pritchard’s regimen in controlling eclampsia, low dose Mgso4 is a viable alternative especially at primary and secondary health care levels. Keywords: Dhaka regimen, eclampsia, low dose magnesium sulphate, Pritchard’s regimen, recurrent convulsion

Convulsions: Eclampsia or Malaria or Both!

ABSTRACT Introduction Prevalence of malaria in pregnancy is 1.4%. A high index of suspicion is most important in the diagnosis of malaria and should be differentiated from other complications like eclampsia, intrauterine sepsis. Case Report Gravida 3 para 2 living 1 (G3P2L1) with 28 weeks gestation was referred with high blood pressure (BP), severe anemia. She was afebrile, severe pallor +, pedal edema +, pulse rate (PR)—110/ min, BP—140/80 mm Hg, per abdomen (P/A)— Ut 28 to 30 weeks size relaxed with fetal heart sounds (FHS) regular. Hemoglobin (HB) 5.3 gm%, platelet count 80,000. After 3 days, patient threw one convulsion. Low dose MgSO4 regime given. Peripheral smear (PS) for malarial parasite (MP) vivax positive and injection quinine 1200 mg in 10% dextrose started. She was induced and delivered. Discussion In pregnancy malaria is more common, more atypical, more severe and more fatal. Once diagnosed treatment should be started immediately and pregnant woman should be given full doses of antimalarials. Both eclampsia and malaria are to be treated. How to cite this article Jaju PB, Bhavi SB. Convulsions: Eclampsia or Malaria or Both! J South Asian Feder Obst Gynae 2015;7(3):245-246.

Effects of intravenous magnesium infusion on in vivo release of acetylcholine and catecholamine in rat adrenal medulla

We applied microdialysis technique to the left adrenal medulla of anesthetized rats and examined the effects of intravenous Mg(2+) infusion on presynaptic acetylcholine (ACh) release and postsynaptic catecholamine release induced by electrical stimulation of splanchnic nerves. The dialysis probes were perfused with Ringer's solution containing neostigmine. Low-dose MgSO4 (25 μmol/kg/min for 30 min i.v.) increased mean plasma Mg(2+) concentration to 2.5mM; the administration suppressed norepinephrine (NE) release by approximately 30% and epinephrine (Epi) release by approximately 20%, but did not affect ACh release. High-dose MgSO4 (50 μmol/kg/min for 30 min i.v.) increased mean plasma Mg(2+) concentration to 3.8mM; the administration suppressed ACh release by approximately 25%, NE release by approximately 60% and Epi release by approximately 45%. Administration of Na2SO4 (50 μmol/kg/min for 30 min i.v.) did not change the release of ACh, NE or Epi. Local administration of nifedipine (200 μM) suppressed NE release by approximately 40% and Epi release by approximately 30%, but did not affect ACh release. In the presence of nifedipine, low-dose MgSO4 did not suppress the release of ACh, or further suppress NE or Epi compared to nifedipine alone, but high-dose MgSO4 suppressed ACh release by approximately 25% and further suppressed NE release by approximately 60% and Epi release by approximately 50% compared to nifedipine alone. In conclusion, intravenous administration of Mg(2+) inhibits both presynaptic ACh release and postsynaptic catecholamine release in the adrenal medulla, but L-type Ca(2+) channel-controlled catecholamine release may be more sensitive to Mg(2+) than non-L-type Ca(2+) channel-controlled ACh release.

English

BACKGROUND: Eclampsia/ Pre-eclampsia are leading causes of maternal mortality. Various mgso4 regimes are used to control convulsions. As the Indian women have less weight low dose mgso4 was used. AIMS OBJECTS: To study comparative efficacy of low dose mgso4 in controlling convulsions in Eclampsia and in preventing convulsions in imminent Eclampsia METHODS A MATERIALS: Randomised Prospective study in which 60 cases were studied with low does mgso4 and 60 cases with Pritchard regime. Serum mg++ levels were studied in every patient. RESULTS: Convulsions were controlled in 90% cases of low dose regime and in 91.60% cases of Pritchard regime in eclampsia. The success rate in seizure Prophylaxis was 100% in both regimes for imminent eclampsia. CONCLUSIONS: Low dose mgso4 regime is equally effective in controlling / preventing convulsions if compared with Pritchard regime

Magnesium Sulfate and Nimesulide Have Synergistic Effects on Rescuing Brain Damage after Transient Focal Ischemia

Magnesium sulfate and nimesulide are commonly used drugs with reported neuroprotective effects. Their combination as stroke treatment has the potential benefits of decreasing individual drug dosage and fewer adverse effects. This study evaluated their synergistic effects and compared a low-dose combination with individual drug alone and placebo. Sprague-Dawley rats underwent 90 min of focal ischemia with intraluminal suture occlusion of the middle cerebral artery followed by reperfusion. The rats were randomly assigned to receive one of the following treatments: placebo, magnesium sulfate (MgSO₄; 45 mg/kg) intravenously immediately after the induction of middle cerebral artery occlusion, nimesulide (6 mg/kg) intraperitoneally before reperfusion, and combined therapy. Three days after the ischemia-reperfusion insult, therapeutic outcome was assessed by 2,3,5-triphenyltetrazolium chloride staining and a 28-point neurological severity scoring system. Cyclooxygenase-2, prostaglandin E₂, myeloperoxidase, and caspase-3 expression after treatment were evaluated using Western blot analyses and immunohistochemical staining, followed by immunoreactive cell analysis using tissue cytometry. Only the combination treatment group showed a significant decrease in infarction volume (10.93±6.54% versus 26.43±7.08%, p<0.01), and neurological severity score (p<0.05). Low-dose MgSO₄ or nimesulide showed no significant neuroprotection. There was also significant suppression of cyclooxygenase-2, prostaglandin E₂, myeloperoxidase, and caspase-3 expression in the combination treatment group, suggesting that the combination of the two drugs improved the neuroprotective effects of each individual drug. MgSO₄ and nimesulide have synergistic effects on ischemia-reperfusion insults. Their combination helps decrease drug dosage and adverse effects. Combined treatment strategies may help to combat stroke-induced brain damage in the future.

Magnesium Sulphate Reverses the Carotid Vasoconstriction Caused by Endothelin-1, Angiotensin II and Neuropeptide-Y, but Not That Caused by NG-nitro-l-Arginine Methyl Ester, in Conscious Rats

1. Magnesium sulphate (MgSO4) has been used for many years in the prevention of eclamptic seizures, but its mechanism of action has never been elucidated. Recent studies suggest that cerebral vasospasm is an important feature of eclampsia and we have developed and tested the hypothesis that MgSO4 can reverse cerebral vasoconstriction. 2. Studies were performed in conscious, male Long Evans rats with pulsed Doppler probes sutured around both common carotid arteries after the external carotid artery had been ligated on the left, thus allowing simultaneous measurement of changes in common and internal carotid blood flow. Intravascular catheters were placed in the abdominal aorta for measurement of systemic blood pressure and in the right jugular vein for administration of drugs. Mean arterial blood pressure and mean Doppler shift signals were used to calculate percentage changes in common and internal carotid vascular conductance. 3. After a period of recovery the animals were infused with endothelin-1, angiotensin II, neuropeptide-Y or NG-nitro-L-arginine methyl ester alone or in combination, and MgSO4 in low or high dose was infused when the effects of the vasoconstrictors had become established. 4. MgSO4 itself, at the low dose, had no effect on carotid vascular conductance. Endothelin-1, angiotensin II and neuropeptide-Y all reduced common and internal carotid vascular conductance and this effect was significantly attenuated by low dose MgSO4. The carotid vasoconstrictor action of endothelin-1 was completely abolished by high dose MgSO4.(ABSTRACT TRUNCATED AT 250 WORDS)