Magnesium Group Research Articles

Comparative study between magnesium sulfate and phenytoin for prevention of eclampsia in severely pre-eclamptic patients with acute kidney injury

Introduction Pre-eclampsia is a pregnancy-specific, multisystem disorder that is characterized by the development of hypertension and proteinuria after 20 weeks of gestation. Acute kidney failure occurs in about 20% of patients with severe pre-eclampsia. Magnesium sulfate is the medication of choice for the prevention of eclamptic seizures in women with severe pre-eclampsia and for the treatment of women with eclamptic seizures. This medication is renally excreted and hence significant renal impairment can result in exaggerated toxicity. Phenytoin was specifically developed as an anticonvulsant and is the most widely prescribed drug for epilepsy worldwide. The aim of this study is to compare magnesium sulfate with phenytoin for prevention of eclampsia in severely pre-eclamptic patients with acute kidney injury. Patients and methods Forty pregnant women were enrolled in the study; all patients had American Society of Anesthesiologists (ASA) physical status of II or III and were proved to have severe pre-eclampsia with acute kidney injury. Patients were allocated randomly into one of two groups (20 patients each). Group A (magnesium sulfate group) included 20 patients who received magnesium sulfate for prophylaxis against eclampsia. Group B (phenytoin group) included 20 patients who received phenytoin for prophylaxis against eclampsia. For each patient, the following data were collected: age, gestational age, body weight, height, occurrence of magnesium or phenytoin toxicity, occurrence of fits, and fetal outcome. Results In terms of the occurrence of fits, we found a statistically significant difference between the magnesium group and the phenytoin group as five patients in the phenytoin group developed fits, whereas none of the patients in the magnesium group developed fits. In this study, we did not find a statistically significant difference between the magnesium group and the phenytoin group in the incidence of magnesium or phenytoin toxicity and fetal outcome. Conclusion The results of this study showed that prophylaxis against eclampsia in severely pre-eclamptic patients with acute kidney injury using magnesium sulfate (adjusted dose) resulted in no toxicity and no fetal effects besides fewer incidences of fits compared with phenytoin.

Effect of intraoperative magnesium intravenous infusion on the hemodynamic changes associated with right lobe living donor hepatotomy under transesophageal Doppler monitoring-randomized controlled trial.

Background:Liver donors are subjected to specific postresection hemodynamic changes. The aim was to monitor these changes and to evaluate the effect of magnesium sulfate infusion (MgSO4) on these changes together with total anesthetic agents consumption.Patients and Methods:A total of 50 donors scheduled for right hepatotomy were divided into two equal groups. Controls (C) received saline and magnesium group (Mg) received MgSO4 10% (30 mg/kg over 20 min) administered immediately after induction of anesthesia, followed by infusion (10 mg/kg/h) till the end of surgery. Hemodynamics, transesophageal Doppler (TED) data and anesthetic depth guided by Entropy were recorded.Results:Postresection both groups demonstrated an increase in heart rate (HR) and cardiac output (COP) in association with lowering of systemic vascular resistance (SVR). The increase in HR with Mg was lower when compared with C, P = 0.00. Increase in COP was lower with Mg compared to (C) (6.1 ± 1.3 vs. 7.5 ± 1.6 L/min, P = 0.00) and with less reduction in SVR compared to C (1145 ± 251 vs. 849.2 ± 215 dynes.s/cm5, P < 0.01), respectively. Sevoflurane consumption was lower with Mg compared to C (157.1 ± 35.1 vs. 187.6 ± 25.6 ml, respectively, P = 0.001). Reduced fentanyl and rocuronium consumption in Mg group are compared to C (P = 0.00). Extubation time, postoperative patient-controlled fentanyl were lower in Mg than C (P = 0.001).Conclusion:TED was able to detect significant hemodynamic changes associated with major hepatotomy. Prophylactic magnesium helped to reduce these changes with lower anesthetic and analgesics consumption and an improvement in postoperative pain relief.

Does magnesium sulfate affect the incidence of respiratory complications in children undergoing esophageal dilatation? An observational pilot study

Background. In this pilot observational study, we aimed to investigate the effect of preoperative magnesium infusion on laryngospasm frequency and other res-piratory complications in children with respiratory findings undergoing esopha-geal dilatation after the ingestion of caustic substances.Methods. Sixty children between the ages of 2 and 12 scheduled for esophageal dilatation were divided into two groups: the magnesium group (Group M), which consisted of children with respiratory symptoms and who received IV 30 mg/kg magnesium sulfate preoperatively, and the control group (Group C), who received the same volume of saline. Anesthesia was induced with fentanyl, propofol, and miva-curium and maintained using a 60% N2O and 2-3% sevoflurane mixture in oxygen. Demographic and hemodynamic data, as well as the incidence of respiratory com-plications (laryngospasm, bronchospasm, apnea, cough, and desaturation) during the perioperative period were recorded until the time of discharge from the recov-ery room.Results. Demographic data and hemody-namics were similar in the two groups. The laryngospasm, bronchospasm, apnea, and cough incidences were also similar between the groups, although the desatu-ration incidence was lower in Group M than in Group C (p=0.013). The number of complications in total was lower in Group M as well (p=0.008), although the number of children who experienced complica-tions in each group was similar.Conclusion. Prophylactic administration of 30 mg/kg of magnesium to children with respiratory symptoms may decrease the frequency of postoperative respiratory complications in children undergoing es-ophageal dilatation.

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

Addition of dexamethasone to magnesium decreases atrial fibrillation following coronary artery bypass grafting surgery

Objective Atrial fibrillation (AF) is a frequent complication that occurs within the first 5 days after cardiac surgery with a reported incidence of 20-40%. It might lead to significant morbidity, such as stroke and myocardial infarction. This prospective study aims to assess the potential benefit of adding a standard dose of dexamethasone to intravenous magnesium (Mg) in the case of AF after coronary artery bypass grafting (CABG). Patients and methods This was a prospective, randomized, parallel group study conducted in Ain Shams University Hospital. One hundred patients scheduled for elective primary isolated CABG were included. All patients had a preoperative sinus rhythm. Patients in the dexamethasone plus magnesium (DMg) group (50 patients) received two doses of intravenous dexamethasone (6 mg each) along with two doses of Mg supplementation (2 g each) within the first postoperative day. Patients in the Mg-only group (50 patients) received two doses of Mg supplementation (2 g each) at the similar time as patients in the DMg group. Continuous ECG recording was carried out for the first 72 h for all patients. Incidence of postoperative complications caused by dexamethasone was recorded. Measurements and main results All patients (50 in each group) completed the study. There was no significant difference between the two study groups with regard to demographic data, preoperative comorbidities, and surgical factors. The incidence of postoperative AF was significantly lower in the DMg group ( P P = 0.7), sternal wound infection ( P = 0.5), and urinary tract infection ( P = 0.6). Conclusion Addition of dexamethasone (12 mg) to MgSO 4 (2 g) seems to decrease the incidence of new-onset AF in primary isolated elective CABG surgery without an increased incidence of complications.

Todetermine the effects of addition of magnesium sulphate to Bupivacaine-fentanyl spinal anaesthesia with respect to sensory and motor blockade

Background: One of the recent additions to the list of adjuvants that are used intrathecally, is Magnesium. It may improve the quality and duration of spinal anaesthesia. It acts by blocking the N-methyl-D-asparate (NMDA) channels in a voltage dependent way, reducing NMDA – induced currents. While the systemic use of Magnesium sulphate (MgSO4) reduces the postoperative opioid requirements, its intrathecal use is not evaluated extensively. Objectives: To determine the effect of addition of magnesium sulphate to Bupivacaine – fentanyl spinal anaesthesia with respect to onset of sensory and motor blockade, duration of analgesia and adverse effects if any. Methods: A prospective non-randomized controlled study was designed to compare the effects of addition of 50 mg of Magnesium sulphate (MgSO4) to Bupivacaine – fentanyl spinal anaesthesia. All adult patients undergoing lower abdominal and lower limb surgeries under Spinal Anaesthesia in the department of anaesthesiology at Vijayanagar Institute of Medical Sciences (VIMS), Bellary were included in the study. Results: The mean onset of sensory and motor blockade, peak sensory time were comparable between the two groups (p>0.05) however there was statistically significant difference between the groups with respect to duration of analgesia (128±8.6 min in fentanyl group and 136±13.1 min in fentanyl magnesium group, p=0.001) and the sedation score (p=0.001). Conclusions: Addition of magnesium sulfate (50 mg) to intrathecal fentanyl (25 ?g) for elective lower abdominal and limb surgeries has prolonged the duration of fentanyl analgesia without any significant side effects. Keywords: Bupivacaine, Fentanyl, Spinal anaesthesia, Sensory and motor blockad

Adding magnesium sulfate to bupivacaine in transversus abdominis plane block for laparoscopic cholecystectomy: A single blinded randomized controlled trial.

Introduction and Aim:Use of transversus abdominis plane block (TAP) in the management of postoperative pain after the laparoscopic cholecystectomy (LC) has been a common anesthetic practice. This study evaluates the effect of adding magnesium sulfate to bupivacaine in TAP block in LC regarding postoperative analgesia and analgesic consumption.Patients and Methods:Ninety patients of American Society of Anesthesiologists I and II was divided into three groups: Control group (C group, n = 30), bupivacaine group (B group, n = 30), bupivacaine magnesium group (M group, n = 30).Results:M group showed better analgesic profile in the 1st postoperative day in the form of lower mean visual analog scale score (2.8 ± 0.6 for C group, 2.1 ± 0.5 for B group, 2.2 ± 0.5 for M group, P < 0.001), longer duration of analgesia (7 ± 2.8 h for C group, 16 ± 2.5 h for B group, 19 ± 2.2 h for M group, P < 0.006), lower morphine consumption (2 ± 0.1 mg for C group, 0.9 ± 0.1 mg for B group, 0.5 ± 0.1 mg for M group, P < 0.011). There was a significant lower incidence of postoperative nausea and vomiting (PONV) (32% for C group, 6% B group, 7% M group, P < 0.004).Conclusion:Adding MgSo4 as an adjuvant to bupivacaine in TAP block; during anesthesia for LC; improved postoperative analgesia in the form of increased duration, decreased analgesic requirements and PONV.

Magnesium Versus Bupivacaine Infiltration in Controlling Postoperative Pain in Inguinal Hernia Repair.

Background:Postoperative pain is one of the most common problems after hernia repair. Decrease in postoperative pain accelerates functional recovery, decreases duration of hospital stay and postoperative morbidity.Objectives:To compare postoperative analgesic effect of infiltration of magnesium versus bupivacaine into incision of inguinal hernia repair.Patients and Methods:In a double blind clinical trial, 80 patients’ candidates for elective inguinal hernia repair were enrolled. Right before closure of incision, in Bupivacaine group 5 mL Bupivacaine 0.5% added to 5 mL normal saline and in Magnesium group, 10 mL Magnesium sulfate 20% was infused subcutaneously. Pain score was measured using numeric rating score (NRS) at 1, 3, 6, 12 and 24 hours postoperatively. If NRS was above 3, 1 mg morphine was administered as rescue analgesic until patient felt comfortable or NRS < 3.Results:Postoperative pain scores at 1 and 3 hours were not significantly different between bupivacaine and magnesium groups (P = 0.21, 0.224; respectively). However, at 6 (P = 0.003), 12 (P = 0.028) and 24 (P = 0.022) hours postoperative, pain score (NRS) was significantly lower in bupivacaine group. Number of patients needed at least 1 dose of rescue morphine (P = 0.001), mean number of episodes asked for morphine during next 24 hours (P = 0.001) and total dose of morphine requirement (P = 0.01) were significantly lower in bupivacaine group.Conclusions:Magnesium infiltration did not decrease total dose and number of episodes needed for morphine rescue analgesic. Bupivacaine infiltration into surgical site was more effective than magnesium sulfate infiltration in postoperative pain control.

The Effect of Systemic Magnesium on Postsurgical Pain in Children Undergoing Tonsillectomies: A Double-Blinded, Randomized, Placebo-Controlled Trial.

Tonsillectomy is a frequently performed surgical procedure in children; however, few multimodal analgesic strategies have been shown to improve postsurgical pain in this patient population. Systemic magnesium infusions have been shown to reliably improve postoperative pain in adults, but their effects in pediatric surgical patients remain to be determined. In the current investigation, our main objective was to evaluate the use of systemic magnesium to improve postoperative pain in pediatric patients undergoing tonsillectomy. We hypothesized that children who received systemic magnesium infusions would have less post-tonsillectomy pain than the children who received saline infusions. The study was a prospective, randomized, double-blinded, clinical trial. Subjects were randomly assigned using a computer-generated table of random numbers to 1 of the 2 intervention groups: systemic magnesium infusion (initial loading dose 30 mg/kg given over 15 minutes followed by a continuous magnesium infusion 10 mg/kg/h) and the same volume of saline. The primary outcome was pain scores in the postanesthesia care unit (PACU) measured by FLACC (Face, Legs, Activity, Cry, Consolability) pain scores. Pain reduction was measured by the decrement in the area under the pain scale versus 90-minute postoperative time curve using the trapezoidal method. Secondary outcomes included opioid consumption in the PACU, emergence delirium scores (measured by the pediatric anesthesia emergence delirium scale), and parent satisfaction. Sixty subjects were randomly assigned and 60 completed the study. The area under pain scores (up to 90 minutes) was not different between the study groups, median (interquartile range [IQR]) of 30 (0-120) score × min and 45 (0-135) score × min for the magnesium and control groups, respectively (P = 0.74). Similarly, there was no clinically significant difference in the morphine consumption in the PACU between the magnesium group, median (IQR) of 2.0 (0-4.44) mg IV morphine, compared with the control, median (IQR) of 2.5 (0-4.99) mg IV morphine (P = 0.25). The serum level of magnesium was significantly lower in the control group than in the treatment group at the end of the surgery (P < 0.001). Despite a large number of studies demonstrating the efficacy of systemic magnesium for preventing postsurgical pain in adults, we could not find evidence for a significant clinical benefit of systemic magnesium infusion in children undergoing tonsillectomies. Our findings reiterate the importance of validating multimodal analgesic strategies in children that have been demonstrated to be effective in the adult population.

Impact of Magnesium L-Lactate on Occurrence of Ventricular Arrhythmias in Patients with Implantable Cardioverter Defibrillators: A Randomized, Placebo-Controlled Trial.

Background:We evaluated the antiarrhythmic efficacy and quality of life (QoL) impact of oral magnesium Llactate on patients with an implantable cardioverter defibrillator (ICD).Methods:This prospective, double-blind, placebo-controlled trial randomized 70 patients with an ICD to receive oral magnesium L-lactate 3 tablets twice daily (504mg elemental magnesium daily) or matching placebo for 12 months. Patients were seen at baseline, 12, 24, 36, and 52 weeks. The primary endpoints were the cumulative occurrence of ICD therapy [either shock or anti-tachycardia pacing (ATP)] or QoL between the groups.Results:Among the 70 randomized patients with a mean ± SD follow-up of 6.4 ± 4.1 months, 10 patients in the placebo group and 8 in the magnesium group experienced either ICD shock or ATP [HR 0.84, 95% CI 0.33 to 2.12; p=0.706]. Without significant arrhythmia suppression, only minimal effects on QoL were seen. Eighty six percent of all patients had serum intracellular magnesium deficiency.Conclusion:In our underpowered trial, patients with ICDs had intracellular magnesium deficiency but oral magnesium Llactate only nonsignificantly reduced the occurrence of ICD therapies and had little impact on HrQoL.

Zircon U–Pb–Hf isotope systematics and geochemistry of Helong granite-greenstone belt in Southern Jilin Province, China: Implications for Neoarchean crustal evolution of the northeastern margin of North China Craton

As one of the major Neoarchean granite-greenstone belts in China, the Helong terrane is located at the northeastern margin (Southern Jilin Province) of the North China Craton (NCC). It is dominated by metamorphic supracrustal rock assemblage and granitoid gneiss. The former contains amphibolite, hornblende plagioclase gneiss, biotite plagioclase gneiss and banded iron formation (BIF), whereas the latter is dominated by the Tonalite–Trondhjemite–Granodiorite (TTG) gneisses. Zircon LA–ICP–MS U–Pb isotopic analyses indicate that the supracrustal rock assemblage was formed at 2683–2654Ma and underwent regional metamorphism (lower amphibolite facies) at 2614–2553Ma before the widespread emplacement of plutonic granitoids at 2551–2532Ma. Both greenstone sequence and plutonic granitoid rocks experienced the subsequent regional metamorphism (greenschist to lower amphibolite facies) at 2508–2400Ma. The supracrustal rocks can be divided into three groups based on their lithological and geochemical characteristics. Detailed petrogenetic and geochemical studies suggest that the Group #1 amphibolite samples were derived from partial melting of depleted upper mantle that had been metasomatized by slab-derived fluids; Group #2 amphibolite samples were derived by partial melting of a depleted mantle wedge that was strongly metasomatized by subduction-derived fluids or melts; and Group #3 hornblende/biotite plagioclase gneiss samples were derived from partial melting of juvenile basalt and minor amounts of older sediments in the lower crust level. The granitoid gneisses in the Helong granite-greenstone belt can be divided into relatively high magnesium group (HMG) and low magnesium group (LMG). The HMG samples were derived from parental magmas generated by partial melting of juvenile basalt and minor amounts of older sediments within the lower crust level, whereas magmatic precursors of the LMG samples were generated by partial melting of a metapelite-dominated source under lower temperature melting conditions.U–Pb dating of inherited or captured zircons, combined with zircon Lu–Hf isotope data, indicates a significant ∼2.9–2.7Ga crustal growth episode, whereas the ∼2.55–2.53Ga magmatism involved crustal recycling in the Helong terrane. Consequently, the Helong terrane preserves a record of Neoarchean tectonic environment of Andean-type active continental margin.

Pre-incisional epidural magnesium provides pre-emptive and postoperative analgesia in lower abdominal surgeries: a comparative study

Background: Magnesium sulphate has been used successfully as a non opioid analgesic adjuvant for postoperative pain management. This prospective controlled study was designed to evaluate the pre-emptive analgesic efficacy of adding magnesium to epidural analgesia in patients undergoing lower abdominal surgeries.Methodology: In a randomized, double- blind study sixty patients undergoing lower abdominal surgery under general anesthesia were assigned to three groups. Pre-magnesium (Group PI), post-magnesium (Group PO) and control (Group C) group. Anesthetic technique was standardized. Patients in pre-magnesium group received bolus of magnesium 50 mg via epidural before induction of anaesthesia followed by boluses of 10 mg h-1 until end of surgery. Post-magnesium group patients received epidural saline during the same time periods plus bolus epidural magnesium 50 mg at the end of surgery. Patients in control group received epidural saline during all three periods. Patients in the magnesium groups received bolus epidural analgesia with Fentanyl 8mcg, Bupivacaine 0.1%, and Magnesium 8mg in a volume of 8 ml after operation, when patient complained of pain and VAS score was more than 4. Patients in the control group received epidural analgesia with Fentanyl 8 mcg and Bupivacaine 0.1% in a volume of 8ml. Blood Pressure, pulse rate, respiratory rate, time to the first request for analgesic, visual analogue scale at rest, 24 hour, opioids consumption and side effect profiles were studied for 24 hours postoperatively.Results: The demographic parameters were comparable. Group PI had significantly lower VAS scores at all times 0,2,4,6,10,14,18 and 24 hours than those in the Group PO or Group C(P&lt;0.05). The groups were similar with respect to haemodynamic, respiratory variables and side effects.Conclusion: Epidural Magnesium sulphate provided preemptive analgesia, and an a analgesic-sparing effect that improved postoperative analgesia without increasing the incidence of side-effects.Journal of Society of Anesthesiologists 2014 1(1): 22-28

Effect of magnesium sulphate on bi-spectral index (BIS) values during general anesthesia in children.

BackgroundMagnesium was reported to reduce both the anesthetic requirements and the period needed to reach a bi-spectral index value of 60 when used intra-operatively (Br J Anaesth 83:302-20, 1999; Anesth Analg 20:1273-5, 1988; Br J Anaesth 89:594-8, 2002; Anesth Analg 87:206-10, 1998; Br J Anaesth 89:594-8, 2002; Br J Anaesth 94:438-41, 2005) and to minimize the emergence agitation (Anaesthesia 61:1058-63, 2006). Previous studies examined the influence of magnesium on the anesthetic requirements while the bi-spectral Index values were kept within a constant range. We evaluated the effect of intraoperative magnesium on the bi-spectral index values during pediatric anesthesia while we kept other anesthetic variables unchanged.MethodsEighty pediatric patients with ASA physical status I, age 2–8 years and scheduled for minor infra-umbilical elective procedures included in a prospective randomized controlled study. We randomly divided patients into two groups. Group I (40 patients); received a bolus dose 50 mg/kg of magnesium sulphate followed by an infusion at rate of 15 mg/kg/h throughout the procedure. Group II (40 patients); received the same amount in the form of ringer acetate for blinding. We compared between the groups regarding: 1) BIS values. 2) Hemodynamic parameters. 3) Arterial oxygen saturation 4) End-tidal CO2 5) Respiratory rate and 6) Tidal volume.ResultsMagnesium group (Group I) showed significantly lower BIS values and shorter time to achieve BIS values below 60. Respiratory parameters (tidal volume and respiratory rate) were significantly lower in the magnesium group. Otherwise, no significant differences between the study group and the control group were detected.DiscussionOur study has the advantage of evaluating the direct effect of magnesium sulphate on the Bi-spectral index scale with keeping other intraoperative factors almost constant (as the type of operations, induction and maintenance techniques, end-tidal anesthetic concentration, analgesia and mode of ventilation) for accurate assessment.ConclusionMagnesium produced significantly lower BIS values, less time to reach BIS values below 60, lower tidal volume and lower respiratory rate during pediatric general anesthesia.Trial registrationPan African Clinical Trial Registry, www.pactr.org, PACTR201312000666231. Registered at 6 October 2013.

Beneficial effect of intravenous magnesium during endoscopic submucosal dissection for gastric neoplasm.

Endoscopic submucosal dissection (ESD) has been revealed as an effective treatment of early gastric neoplasm and should be performed under sedation with adequate pain control. Magnesium sulfate has analgesic, sedative, and sympatholytic properties. This study examined the effects of intravenous magnesium 50 mg/kg administered before ESD for gastric neoplasm on analgesic and sedative consumptions during ESD and pain after ESD. In this randomized, double-blind, and prospective study, patients undergoing ESD randomly received either intravenous magnesium sulfate 50 mg/kg (magnesium group n = 30) or the same volume of normal saline (control group n = 30) over 10 min before the start of sedation. Fentanyl consumption during ESD was the primary end point. Hemodynamics was recorded during the procedure, and abdominal pain was evaluated at 30 min, 6 h, and 24 h after ESD. During ESD, fentanyl consumption was 24% less in the magnesium group than in the control group (96 ± 27 vs. 126 ± 41 μg, mean ± SD; p = 0.002), although there was no significant difference in propofol consumption (p = 0.317). In addition, magnesium attenuated the elevation of mean blood pressure at the time of epinephrine submucosal injection (p = 0.038) and 5 min after submucosal dissection (p = 0.004). Less patients of the magnesium group compared to the control group requested for additional analgesics in the recovery room (14 vs. 38 %, p = 0.043), and the intensity of abdominal pain was lower at 30 min after ESD in the magnesium group (p = 0.034). A single-dose intravenous administration of magnesium 50 mg/kg before sedation reduced analgesic requirements both during and after ESD for gastric neoplasm without adverse effects. In addition, magnesium contributed to stable hemodynamics throughout the procedure.

Comparison of the Effects of Magnesium Sulfate and Remifentanil on Hemodynamic Responses During Tracheal Extubation After Laparotomy: A Randomized Double-blinded Trial.

Background:Because blood pressure and heart rate (HR) elevations during tracheal extubation are common, different medications have been studied to prevent such complications.Objectives:To compare magnesium sulfate, remifentanil, and placebo regarding mean arterial pressure (MAP) and HR changes during/after tracheal extubation, in patients who underwent laparotomy.Materials and Methods:In this randomized double-blinded trial, 120 patients undergoing laparotomy were evenly divided into three groups, including remifentanil (1 mcg/kg), magnesium sulfate (50 mg/kg), or normal saline, as placebo. Hemodynamic responses (MAP and HR) were documented at different times (before operation, during medication administration, immediately before extubation, immediately after extubation, and also 3, 5, and 10 minutes after extubation). The double burst time (DBT) was determined using neuromuscular monitoring, as time interval, between administration of reverse medication and DBT of 100%.Results:The HR was significantly lower, immediately after extubation and 3, 5, and 10 minutes after extubation, in both magnesium and remifentanil groups, compared to normal saline (P < 0.001). The MAP was also lower in magnesium and remifentanil groups, immediately after extubation and 3 minutes after extubation, in comparison to the normal saline group (P < 0.001). Mean (± SD) DBT 100% was significantly higher in magnesium group (30.2 ± 15.3) vs. remifenatnil (13.6 ± 6.8) and normal saline (13.5 ± 8.2) groups (P < 0.001).Conclusions:Both remifentanil and magnesium had favorable outcomes in preventing HR and MAP elevation after tracheal extubation. However, remifentanil was associated with more rapid regaining of consciousness and reversal of muscular relaxation.

The effect of magnesium sulphate on intubating condition for rapid-sequence intubation: a randomized controlled trial

Study objectivesWe compared magnesium sulphate with control, ketamine, rocuronium prime, and large-dose rocuronium (0.9 mg/kg) with regard to intubation conditions during rapid-sequence induction. DesignThis is a prospective, randomized, double-blinded study. SettingThe setting is at an operating room in a university-affiliated hospital. PatientsOne hundred ten patients scheduled for general anesthesia were randomly allocated to the following 5 groups in equal numbers. InterventionsThe control and rocuronium 0.9 groups received rocuronium 0.6 and 0.9 mg/kg, respectively; the ketamine group was given 0.5 mg/kg ketamine 2 minutes before 0.6 mg/kg rocuronium; the rocuronium prime group received 0.06 mg/kg rocuronium 3 minutes before 0.54 mg/kg rocuronium; and the magnesium group received 50 mg/kg magnesium sulphate. Intubation was initiated 50 seconds after the rocuronium injection. MeasurementsIntubating condition (primary outcome), rocuronium onset, rocuronium duration, train-of-four ratio upon intubation, and hemodynamic variables (secondary outcomes) were recorded. Main resultsThe excellent intubating condition was more frequent in the magnesium group (P < .05). Onset of neuromuscular block was shorter in the magnesium group than in the control, ketamine, and rocuronium prime groups (P < .05). No difference in onset time was found between the magnesium and rocuronium 0.9 groups. Block duration was longest in the rocuronium 0.9 group. The train-of-four ratio on intubation was lowest in the rocuronium prime group. The only adverse event was a burning or heat sensation reported by 5 patients in the magnesium group. ConclusionsMagnesium sulphate pretreatment was most likely to provide excellent intubating condition for rapid-sequence intubation compared with the control, ketamine pretreatment, rocuronium prime, and large-dose rocuronium. However, magnesium sulphate administration is associated with a burning or heat sensation.

Low serum magnesium is associated with coronary artery calcification in a Korean population at low risk for cardiovascular disease

Background and aimsPrevious studies suggested an association between low serum magnesium levels and metabolic or cardiovascular disease. Additionally, several studies have shown that low serum magnesium is associated with vascular calcification, but there are no studies exploring its relation to coronary artery calcification (CAC). We investigated the relationship between low serum magnesium and CAC by using health examination data. Methods and resultsWe cross-sectionally analyzed 34,553 participants who underwent coronary multi-detector computed tomography and serum magnesium level measurement in 2010–2012 as part of a health examination program at a tertiary hospital in Korea. CAC was defined as a coronary artery calcium score > 100. Participants were divided into three groups according to their serum magnesium level as follows: low < 1.9 mg/dL (n = 931), normal = 1.9–2.3 mg/dL (n = 32,341), and high > 2.3 mg/dL (n = 1281). The percentages of participants with CAC were 3.7, 1.5, and 2.3 in each group, respectively. According to multivariate analysis, low serum magnesium was associated with CAC after adjustment for age, sex, BMI, diabetes, hypertension, cardiovascular disease, systolic BP, LDL cholesterol, HDL cholesterol, eGFR, serum calcium and phosphorus, hsCRP, current smoking status, alcohol intake and vigorous exercise frequency. The odds ratio for CAC in the low serum magnesium group compared to the normal group was 2.10 (1.40–3.15, P < 0.001). ConclusionLow serum magnesium level is associated with CAC in a Korean population at low risk for cardiovascular disease. Further studies are needed to generalize this finding and to verify the causal relationship between low serum magnesium and CAC.

Preventive effect of continuous cisternal irrigation with magnesium sulfate solution on angiographic cerebral vasospasms associated with aneurysmal subarachnoid hemorrhages: a randomized controlled trial.

OBJECT Although cerebral vasospasm (CV) is one of the most important predictors for the outcome in patients with subarachnoid hemorrhage (SAH), no treatment has yet been established for this condition. This study investigated the efficacy of continuous direct infusion of magnesium sulfate (MgSO4) solution into the intrathecal cistern in patients with an aneurysmal SAH. METHODS An SAH caused by a ruptured aneurysm was identified on CT scans within 72 hours after SAH onset. All patients were treated by surgical clipping and randomized into 2 groups: a control group of patients undergoing a standard treatment and a magnesium (Mg) group of patients additionally undergoing continuous infusion of 5 mmol/L MgSO4 solution for 14 days. The Mg(2+) concentrations in serum and CSF were recorded daily. Neurological examinations were performed by intensive care clinicians. Delayed cerebral ischemia was monitored by CT or MRI. To assess the effect of the Mg treatment on CV, the CVs were graded on the basis of the relative degree of constriction visible on cerebral angiograms taken on Day 10 after the SAH, and transcranial Doppler ultrasonography was performed daily to measure blood flow velocity in the middle cerebral artery (MCA). Neurological outcomes and mortality rates were evaluated with the Glasgow Outcome Scale and modified Rankin Scale at 3 months after SAH onset. RESULTS Seventy-three patients admitted during the period of April 2008 to March 2013 were eligible and enrolled in this study. Three patients were excluded because of violation of protocol requirements. The 2 groups did not significantly differ in age, sex, World Federation of Neurosurgical Societies grade, or Fisher grade. In the Mg group, the Mg(2+) concentration in CSF gradually increased from Day 4 after initiation of the continuous MgSO4 intrathecal administration. No such increase was observed in the control group. No significant changes in the serum Mg(2+) levels were observed for 14 days, and no cardiovascular complications such as bradycardia or hypotension were observed in any of the patients. However, bradypnea was noted among patients in the Mg group. The Mg group had a significantly better CV grade than the control group (p < 0.05). Compared with the patients in the Mg group, those in the control group had a significantly elevated blood flow velocity in the MCA. Both groups were similar in the incidences of cerebral infarction, and the 2 groups also did not significantly differ in clinical outcomes. CONCLUSIONS Continuous cisternal irrigation with MgSO4 solution starting on Day 4 and continuing to Day 14 significantly inhibited CV in patients with aneurysmal SAH without severe cardiovascular complications. However, this improvement in CV neither reduced the incidence of delayed cerebral ischemia nor improved the functional outcomes in patients with SAH.

In vivo evaluation of a magnesium-based degradable intramedullary nailing system in a sheep model

The biocompatibility and the degradation behavior of the LAE442 magnesium-based intramedullary interlocked nailing system (IM-NS) was assessed in vivo in a comparative study (stainless austenitic steel 1.4441LA) for the first time. IM-NS was implanted into the right tibia (24-week investigation period; nails/screws diameter: 9mm/3.5mm, length: 130mm/15–40mm) of 10 adult sheep (LAE442, stainless steel, n=5 each group). Clinical and radiographic examinations, in vivo computed tomography (CT), ex vivo micro-computed tomography (μCT), mechanical and histological examinations and element analyses of alloying elements in inner organs were performed. The mechanical examinations (four-point bending) revealed a significant decrease of LAE442 implant stiffness, force at 0.2% offset yield point and maximum force. Periosteal (new bone formation) and endosteal (bone decline) located bone alterations occurred in both groups (LAE442 alloy more pronounced). Moderate gas formation was observed within the LAE442 alloy group. The CT-measured implant volume decreased slightly (not significant). Histologically a predominantly direct bone-to-implant interface existed within the LAE442 alloy group. Formation of a fibrous tissue capsule around the nail occurred in the steel group. Minor inflammatory infiltration was observed in the LAE442 alloy group. Significantly increased quantities of rare earth elements were detected in the LAE442 alloy group. μCT examination showed the beginning of corrosion in dependence of the surrounding tissue. After 24weeks the local biocompatibility of LAE442 can be considered as suitable for a degradable implant material. Statement of SignificanceAn application oriented interlocked intramedullary nailing system in a comparative study (degradable magnesium-based LAE442 alloy vs. steel alloy) was examined in a sheep model for the first time. We focused in particular on the examination of implant degradation by means of (μ-)CT, mechanical properties (four-point bending), clinical compatibility, local bone reactions (X-ray and histology) and possible systemic toxicity (histology and element analyses of inner organs).A significant decrease of magnesium (LAE442 alloy) implant stiffness and maximum force occurred. Moderate not clinically relevant gas accumulation was determined. A predominantly direct bone-to-implant contact existed within the magnesium (LAE442 alloy) group compared to an indirect contact in the steel group. Rare earth element accumulation could be observed in inner organs but H&E staining was inconspicuous.

Magnesium and Ketamine Gargle and Postoperative Sore Throat.

Background:Postoperative sore throat is one of the most common complications after endotracheal intubation. Both Ketamine and magnesium can block N-methyl-D-aspartic acid (NMDA) receptors and provide central and local analgesia.Objectives:To compare the effect of magnesium sulfate and ketamine gargle on the incidence and severity of postoperative sore throat.Patients and Methods:A total of 100 patients candidate for emergency acute appendicitis surgery were enrolled in the study. Patients in ketamine group received ketamine gargle (0.5 mg/kg) and magnesium group received magnesium sulfate gargle (20 mg/kg up to 30 mL dextrose water 20%) 15 minutes before the operation. Patient complaint of postoperative sore throat, and its severity measured by visual analogue scale (VAS) were recorded at baseline in recovery room, and then 2, 4, and 24 hours after operation.Results:There were no significant differences between age, sex, and body mass index (BMI) between two groups of patients. Hemodynamics of patients, including blood pressure, respiratory rate, oxygen saturation %, and conscious state were not significantly different (P > 0.05). Number of patients with sore throat were significantly lower in magnesium group compared to ketamine group at 2 (P = 0.032), 4 (P = 0.02), and 24 hours (P = 0.01) after the operation. Sore throat pain score (VAS) was significantly lower in magnesium group compared to ketamine group at 2 (P = 0.019), 4 (P = 0.028), and 24 hours (P = 0.014) after the operation.Conclusions:Magnesium at low dose decreases sore throat and pain severity more effectively compared to ketamine gargle.