Magnesium Sulfate Group Research Articles

Evaluation of intravenous infusion of labetalol versus magnesium sulfate on cerebral hemodynamics of preeclampsia patients with severe features using transcranial doppler

PurposeIt is essential to understand the underlying pathophysiological mechanisms of preeclampsia cerebral complications. This study aimed to compare the cerebral hemodynamic effects of magnesium sulfate (MgSO4) and labetalol in pre-eclampsia patients with severe features.MethodsSingleton pregnant women who suffered from late onset preeclampsia with severe features were enrolled and subjected to baseline Transcranial doppler (TCD) evaluation and then randomly assigned to either the magnesium sulfate group or labetalol group. TCD to measure middle cerebral artery (MCA) blood flow indices including mean flow velocity (cm/s), mean end-diastolic velocity (DIAS), and pulsatility index (PI) and to estimate CPP and MCA velocity were performed as basal measurements before study drug administration and at post-treatment one and six hours after administration. The occurrence of seizures and any adverse effects were recorded for each group.ResultsSixty preeclampsia patients with severe features were included and randomly allocated into two equal groups. In group M the PI was 0.77 ± 0.04 at baseline versus 0.66 ± 0.05 at 1hour and 0.66 ± 0.05 at 6 hours after MgSO4 administration (p value < 0.001) also the calculated CPP was significantly decreased from 103.3 ± 12.7mmHg to 87.8 ± 10.6mmHg and 89.8 ± 10.9mmHg (p value < 0.001) at 1 and 6 hours respectively. Similarly, in group L the PI was significantly decreased from 0.77 ± 0.05 at baseline to 0.67 ± 0.05 and 0.67 ± 0.06 at 1 and 6 hours (p value < 0.001) after labetalol administration. Moreover, the calculated CPP was significantly decreased from 103.6 ± 12.6 mmHg to 86.2 ± 13.02mmHg at 1 hour and to 83.7 ± 14.6mmHg at 6 hours (p value < 0.001). In terms of changes in blood pressure and the heart rate, they were significantly lower in the labetalol group.ConclusionBoth magnesium sulfate and labetalol reduce CPP while maintaining cerebral blood flow (CBF) in preeclampsia patients with severe features.Trial registrationThe institutional review board of the Faculty of Medicine, Zagazig University approved this study with the reference number (ZU-IRB#: 6353-23-3-2020) and it was registered at clinicaltrials.gov (NCT04539379).

Effects of magnesium sulfate on periarticular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial

BackgroundTo investigate whether adding magnesium sulfate to a periarticular infiltration analgesia (PIA) cocktail could improve pain control and functional outcomes in patients undergoing total knee arthroplasty (TKA).MethodsNinety patients were randomly assigned to the magnesium sulfate and control groups, with 45 patients in each group. In the magnesium sulfate group, patients were given a periarticular infusion of a cocktail of analgesics consisting of epinephrine, ropivacaine, magnesium sulfate, and dexamethasone. The control group received no magnesium sulfate. The primary outcomes consisted of visual analogue scale (VAS) pain scores, postoperative morphine hydrochloride consumption for rescue analgesia, and time to first rescue analgesia. Secondary outcomes were postoperative inflammatory biomarkers (IL-6 and CRP), postoperative length of stay, and knee functional recovery (assessed by knee range of motion, quadriceps strength, daily mobilization distance, and time to first straight-leg raising). Tertiary outcomes included the postoperative swelling ratio and complication rates.ResultsWithin 24 h of surgery, patients in the magnesium sulfate group had markedly lower VAS pain scores during motion and at rest. After the addition of magnesium sulfate, the analgesic effect was dramatically prolonged, leading to a reduction in morphine dosage within 24 h and the total morphine dosage postoperatively. Postoperative inflammatory biomarker levels were significantly reduced in the magnesium sulfate group compared with the control. There were no considerable differences between the groups in terms of the postoperative length of stay and knee functional recovery. Both groups had similar postoperative swelling ratios and incidences of complications.ConclusionsThe addition of magnesium sulfate to the analgesic cocktail for PIA can prolong postoperative analgesia, decrease the consumption of opioids, and effectively alleviate early postoperative pain after TKA.Trial registration: Chinese Clinical Trial Registry, ChiCTR2200056549. Registered on 7 February 2022, https://www.chictr.org.cn/showproj.aspx?proj=151489.

Evaluation of magnesium sulfate as an adjuvant in sub-Tenon anesthesia for cataract surgery: A prospective, randomized controlled trial.

To evaluate the efficacy, safety, and satisfaction for the use of adjuvant; magnesium sulfate (MgSO4) in sub-Tenon anesthesia for cataract surgery. This single centered randomized, double blind trial was held in 2021 after approval of ethical committee at the Eye Hospital, Riyadh, Saudi Arabia. Cataract patients to be operated using local anesthesia were randomly assigned to two groups; Group magnesium sulfate (MS) received 50 mg/0.5 ml of magnesium sulfate and Group normal saline (NS) received 0.5 ml of normal saline added to the standard mixture, respectively. Absence of eyelid dropping and akinesia of the globe at different time after anesthesia were considered as ineffective anesthesia. The age and sex-adjusted generalized estimating equation (GEE) analysis was carried out. Complications, patient's and surgeon's satisfaction were also compared. Each group had 100 cataract patients. Effectiveness of block was not significantly different in two groups (adjusted odds ratio, 0.90; 95% confidence interval [CI], 0.62, 1.31; P = 0.594). The likelihood of "no eye-opening" significantly increased with time (adjusted odds ratio, 1.26; 95% CI, 1.18-1.34; P < 0.001). Subconjunctival bleeding was significantly higher in the MS versus NS Group (36 of 98 [36.7%] vs. 11 of 102 [10.8%], P < 0.001). Chemosis was not significantly different between the groups (P = 0.95). Patient's satisfaction score was very good (9/10) but slightly higher in NS group than MS (P = 0.001) while surgeon's satisfaction score was similar in both groups (P = 0.149). Although safe, adding 50 mg of magnesium sulfate did not improve the effect of sub-Tenon anesthesia for cataract surgery. Risk of subconjunctival bleeding was higher in cataract patients operated using MgSO4 compared to those managed with the conventional sub-Tenon anesthetic.

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.

EFFECT OF MAGNESIUM SULPHATE PRETREATMENT ON ONSET, DURATION OF ACTION AND RECOVERY OF NEUROMUSCULAR BLOCKADE WITH VECURONIUM

Aim: To determine the effectiveness of magnesium sulphate pretreatment on the onset of action of vecuronium and on the duration of action of vecuronium. 100 patients of aged between 18-55 years of ASA grade I and II undergoing surgery under Material And Methods: general anaesthesia were included and devided in two groups. Fifteen minutes before induction of anaesthesia, patients in Group- I received magnesium sulphate 40mg/kg in 0.9% normal saline 100 ml as an intravenous infusion over 15 minutes, and Group-II received 0.9% normal saline 100 ml without magnesium sulphate. After the end of surgery, when the amplitude of T1 was recovered to 10%, patients in both groups received inj. neostigmine 0.05 mg/kg and inj. glycopyrolate 0.02mg/kg IV. After neostigmin-glycopyrolate administration, T1 was measured up to 10 minutes in both groups. Neuromuscular transmission was assessed by electromyography on the left hypothenar muscle, using trans-cutaneous electrodes. The measurement was done after induction of anaesthesia. reduction in mean onse Result: t time was statistically highly signicant in magnesium sulphate group 171.26±30.97 sec vs control group 281.02 ± 33.22 second, (p&lt;0.0001). The mean duration of action was prolonged in magnesium sulphate group 44.26±9.92min vs control group 28.6±6.83m ,and was statistically highly signicant, (p&lt;0.0001). We used neuromuscular monitoring by train of four (TOF) because the response of neuromuscular blocking drugs is not predictable. Hence, TOF monitoring by NMT provided more predictable and rational approach to the use of muscle relaxants. Ma Conclusion: gnesium hastens the onset of neuromuscular blockade as well as reduces the variability of onset time of neuromuscular blockade and decreases the recovery rate of vecuronium and so prolonges the duration of action of blockade

Effects of perioperative use of two doses of magnesium sulfate infusion on intraoperative blood loss in patients undergoing lumbar spinal fusion surgery

Objective: In general, spinal fusion surgery causes heavy bleeding. The purpose of this study was to evaluate the use of two different doses of magnesium sulfate to control the bleeding in lumbar fusion surgery. Methods: This study was carried out as a randomized double-blinded clinical trial in 2020 in Al-Zahra hospital in Isfahan. The participants were 60 patients selected using inclusion and exclusion criteria and were randomly allocated into three groups. In the first group, 50 mg/kg and in the second group, 40 mg/kg magnesium sulfate was infused. The third group received normal saline. From the beginning of anesthesia, heart rate, diastolic and systolic blood pressure, respiratory rate and blood oxygen saturation percentage were monitored and logged every 30 minutes during the operation and recovery. The volume of bleeding during the operation was calculated by counting the number of gauzes used and the amount of suctioned blood during the operation. Other required information such as the duration of operation, duration of anesthesia, time of intubation and the time period of hospitalization and recovery were determined and recorded in all patients. We used independent t-test and repeated measure ANOVA tests to compare data between different time lines and also different groups. P value&lt;0.05 was considered as significance threshold. The collected data were analyzed by using SPSS software version 23. Results: The group receiving 50 mg/kg magnesium sulfate had a significantly lower systolic blood pressure compared to other groups within 15, 30 and 45 minutes after the injections (P=0.04 for all). The pulse rate was significantly lower in the 50 mg/kg magnesium sulfate group compared to other groups within 15, 30 and 45 minutes after the injections (P&lt;0.05 for all). Patients that received 50 mg/kg magnesium sulfate had a lower duration of surgery (P=0.007), lower duration of anesthesia (P=0.007), lower bleeding volume (P&lt;0.001), lower fluid intake (P=0.01) and also lower transfused blood (P=0.01). The surgeons also had a significantly higher satisfaction with these patients (P=0.001). Conclusion: Injection of 50 mg/kg magnesium sulfate had a correlation with reduced blood pressure as well as bleeding volume compared to 40 mg/kg magnesium sulfate.

Intra-incisional injection of magnesium sulfate for post cesarean pain management

Background and objectives: cesarean section is estimated for about 30% of child births worldwide and it is one of the most common surgical procedures. Pain relief after cesarean delivery is especially important as the consequences of inadequate pain relief are expressed not only by the mother but by the newborn as well. Magnesium has been reported to produce important analgesic effects including the potentiation of morphine analgesia, attenuation of morphine tolerance and the suppression of neuropathic pain. The objectives of this study were to determine the efficacy of intra-incisional injection of magnesium sulfate for post cesarean pain management as in patient underwent elective cesarean section and the reduced need for extra analgesic use postoperatively. Methods: a randomized, placebo controlled, single-blinded study with a total of 200 pregnant participants scheduled for cesarean section in Sulaimani maternity teaching hospital, from 1st of May 2016 to 15th of August 2016. Patients were randomly allocated to two groups, those with odd numbers were assigned to case group (100) received 750mg of magnesium sulfate and patients with even numbers assigned to the placebo group (100) received 20mg of normal saline. Results: The mean Visual Analogue Score after 4 hours, 8 hours, 12 hours and 24hours was significantly less for the intervention (Magnesium sulfate) group when compared with the control (Normal Saline). Conclusions: Subcutaneous administration of magnesium sulfate in post cesarean section pain management can be used as a successful modality or method for pain management.

Intraoperative Analgesia with Magnesium Sulfate versus Remifentanil Guided by Plethysmographic Stress Index in Post-Bariatric Dermolipectomy: A Randomized Study.

Magnesium sulfate reduces pain scores and analgesic consumption. Its use as an analgesic resource in opioid-free or opioid-sparing techniques have also been tested. The evaluation of the antinociceptive potency of drugs and doses indirectly, through hemodynamic oscillations has been questioned. A relatively new algorithm called the plethysmographic stress index has been considered sensitive and relatively specific as a parameter for assessing the need for intraoperative analgesia. The aim of this trial was to assess the intraoperative analgesic capacity of magnesium sulfate compared to remifentanil. The secondary objectives were propofol consumption and its latency, the consumption of opioids, ephedrine, and cisatracurium. Patients and Methods. Forty patients scheduled for post-bariatric dermolipectomy were randomly assigned to two groups to receive total intravenous anesthesia with target-controlled hypnosis induced with propofol. Analgesia was obtained in the remifentanil group with remifentanil at an initial dose of 0.2 μg·kg-1·min-1 and in the magnesium sulfate group with magnesium sulfate 40 mg·kg-1 + 10 mg·kg-1·h-1. There was no statistical hemodynamic difference between the groups before and after orotracheal intubation (p = 0.062) and before and after the surgical incision (p = 0.656). There was also no statistical difference in the variation of mean arterial pressure before and after intubation (p = 0.656) and before and after the surgical incision (p = 0.911). There was similar consumption of cisatracurium, ephedrine, and postoperative opioids between the groups. Some patients in the magnesium sulfate group needed more intraoperative fentanyl and propofol, although the latency of propofol was similar in both the groups. We conclude that using magnesium sulfate in intravenous general anesthesia for post-bariatric dermolipectomy is related to a significant reduction in opioid consumption without compromising hemodynamic stability. Overall, PSI monitoring was helpful in driving the analgesic strategy. The use of magnesium sulfate proved to be an important adjunct in the scenario presented, allowing the use of opioids to be avoided in certain cases. We found no statistical differences in the consumption of neuromuscular blocker and vasoconstrictor. Substituting opioids for magnesium sulfate leads to an increase in propofol consumption in the scenario presented. Studies with a larger sample are needed to corroborate the results presented and evaluate other potential advantages in reducing opioid consumption.

The Effect of the Magnesium Sulfate in Ultrasound-Guided Quadratus Lumborum Block on Postoperative Analgesia: A Randomized Controlled Trial.

Quadratus lumborum block (QLB) has proven to be an effective analgesic technique in various abdominal surgeries. Magnesium sulfate as an adjuvant in different nerve blocks has been reported. The aim of this study was to assess the efficacy of magnesium sulfate as an adjuvant to ropivacaine in an ultrasound-guided QLB for postoperative analgesia in laparoscopic gynecologic surgery. Ninety patients belonging to American Society of Anesthesiologists (ASA) physical statusI or II, aged between 40 and 60years, scheduled for laparoscopic gynecologic surgery were enrolled. Patients were divided into three groups and received bilateral quadratus lumborum block: ropivacaine group (groupN, 0.375% ropivacaine 40ml + normal saline 4ml), magnesium sulfate group (groupM, 0.375% ropivacaine 40ml + 10% magnesium sulfate 4ml), and control group (groupC, normal saline 44ml). Visual analogue scale (VAS) at rest and during activity at 4, 6, 12, 24, and 48h postoperatively, consumption of morphine, the time of first analgesic request, frequency of rescue analgesia, satisfaction with postoperative analgesia, and any side effects were recorded. VAS scores in groupsM and N were significantly lower than in groupC at 4 and 6h postoperatively (P < 0.001). VAS scores were lower in groupM at 12 and 24h postoperatively compared to groupsN and C (P < 0.05). The mean total morphine consumption was significantly lower in groupM than in groupsN and C (P < 0.001). The mean time to the first patient-controlled analgesia (PCA) bolus was significantly prolonged in groupM compared to groupC (P < 0.05). The satisfaction with postoperative analgesia of groupM was superior to that of groupsN and C (P < 0.05). There was no significant difference in side effects among the three groups. Magnesium sulfate as an adjuvant to ropivacaine in ultrasound-guided QLB prolongs the duration of analgesia, decreases analgesic requirements, and improves patient satisfaction without significant side effects. Chinese Clinical Trial Registry, ChiCTR1900027066.

The Effect of Magnesium Sulfate Administration At Day of Embryo Transfer on Improving Subendometrial Blood Flow, Endometrial Receptivity ,Implantation Rate and Clinical Pregnancy Rate.

For successful implantation, a high-quality embryo, receptive endometrium, and tight communication between the two are required. The lack of uterine contractions during embryo transfer is one of the characteristics that greatly affects endometrial receptivity. This is because it has been observed that ET may cause uterine contractions, which may be harmful to embryonic apposition and endometrial blood flow .The aim of this study was to assess how magnesium sulfate administration on the day of embryo transfer improve sub endometrial blood flow, endometrial receptivity, and increase implantation rate and clinical pregnancy rate . Eighty infertile women undergoing ART cycles participated in this prospective. Recombinant FSH (Gonal-F) was used in a controlled ovarian hyperstimulation technique. The first group A (n=40) got a 4gm infusion of magnesium sulfate, while the second placebo control group B (n=40) received 200ml of 5% glucose water as a placebo, respectively. While there were no significant changes in body mass index (BMI), endometrial thickness, number of transferred embryos, or embryo transfer day, significant variations were seen in patient mean age (p&lt;0.001) and mean number of grades I embryo (P=0.003). It was significantly different after magnesium sulfate administration with the lowest value in magnesium sulfate group (P=0.024; P &lt;0.001 and P &lt;0.001 respectively). Implantation rate and clinical pregnancy rate both increased after drugs administration although it was non- significant (P= 0.106 and P= 0.348 respectively). It appears that magnesium sulfate injection before to embryo transfer can significantly increase sub endometrial vascularity and endometrial receptivity and improving implantation rate and clinical pregnancy rate non significantly in ICSI cycles by lowering uterine muscular

Clinical efficacy of magnesium sulfate injection in the treatment of masseter muscle trigger points: a randomized clinical study

ObjectiveMyofascial pain syndrome with trigger points is the most common cause of nonodontogenic pain. Although injection of the trigger points is the most effective pain reduction treatment, many patients exhibit recurrence after a short period. Therefore, the aim of the current study was to evaluate the clinical efficacy of magnesium sulfate injections in the treatment of the masseter muscle trigger points when compared to saline injections.Material and methodThis study randomly (1:1) assigned 180 patients to one of two treatment groups based on whether their trigger points were injected with 2 ml of saline or magnesium sulfate. Pain scores, maximum mouth opening (MMO), and quality of life were measured at the pre-injection and 1, 3, and 6 months post-injection.ResultsThe pain scores were significantly higher in the saline group during all follow-up assessments, whereas the MMO was significantly higher in the magnesium sulfate group up to 3 months of follow-up (p < 0.001). However, the difference in MMO ceased to be statistically significant after 6 months of follow-up (p = 0.121). Additionally, the patient’s quality of life score was significantly higher in the magnesium sulfate group compared to the saline group (p < 0.001).ConclusionInjection of magnesium sulfate is an effective treatment measure for myofascial trigger points. However, further studies with a proper design addressing the limitations of the current study are necessary.ClinicalTrials: org (ID: NCT04742140) 5/2/2021.

Effect of perioperative magnesium sulfate and labetalol infusion on peripheral perfusion and postoperative pain in nasal surgery: a randomized controlled trial

BackgroundMaintenance of adequate peripheral perfusion during controlled hypotension is necessary for patient safety and improved surgical outcomes during controlled hypotension in nasal surgery. The hypothesis of this study was to investigate the effect of perioperative magnesium sulfate and labetalol infusion on peripheral perfusion and postoperative pain in patients undergoing nasal surgery.MethodsA total of 50 patients were randomly assigned into two equal groups in this double-blind clinical study: the magnesium sulfate group; received 40 mg/kg loading dose of intravenous (IV) magnesium sulfate followed by 10–15 mg/kg/h continuous IV infusion and the labetalol group; received 0.25 mg/kg loading dose of IV labetalol followed by 0.5–1 mg/kg/h continuous IV infusion to achieve a mean arterial blood pressure (MABP) of = 55–65 mmHg. The primary outcome was to compare the effect of perioperative magnesium sulfate and labetalol infusion on peripheral perfusion during nasal surgery. The secondary outcomes were the assessment of serum lactate, postoperative pain, time to the first call for pethidine (rescue analgesic) and total pethidine consumption.ResultsPPI was comparable between the groups at baseline, intubation, and 5 min. In contrast, magnesium sulfate group had a significantly higher PPI than the labetalol group. The magnesium sulfate group had a significantly higher MABP and heart rate compared to labetalol group. The time to reach the target MABP was significantly prolonged in magnesium sulfate than the labetalol group [21.6 ± 1.7 vs 6.9 ± 1.5] min. VAS scores were significantly lower for 2 hs postoperatively in the magnesium sulfate group than the labetalol group. The time to first call of pethidine was significantly prolonged in the magnesium sulfate group compared to the labetalol group [113.1 ± 5.2 vs 28.2 ± 1.5] min.ConclusionsMagnesium sulfate maintains wider PPI and offers better postoperative pain relief compared to labetalol during induced hypotension in nasal surgery.Trial registrationInstitutional review board approval (ref: 6601/20–12-2020).Clinicaltrial.gov (ref: NCT04688203, date of registration: 29 -12–2020).

Pain and Multimodal Analgesia in Laparoscopic Cholecystectomy.

Background: The administration of high doses of opioids during surgery can lead to higher postoperative pain scores at rest and when coughing. Multimodal analgesia may lower the need for opioids during surgery and the suffering of postoperative pain. Multimodal analgesia can be achieved by providing non-opioid drugs (lidocaine, ketamine, and magnesium sulfate), three different types of drugs. Each of these drugs as different analgesic effects and they belong to three different pharmacological groups. The aim of this study is to develop a better understanding of the effects of each drug (lidocaine, ketamine, and magnesium sulfate) on postoperative analgesia, the needs for rescue analgesics, and analyze the total amount of fentanyl during the intraoperative period in patients undergoing laparoscopic cholecystectomy. Methods: 120 patients were enrolled in this randomized controlled study. They were classified as ASA 1 and 2 and were scheduled for laparoscopic cholecystectomy. They were further divided into 3 groups. Group 1, or the lidocaine group, had received lidocaine at 1 mg/kg and a continuous intravenous infusion with lidocaine at 2 mg/kg/h. Group 2, or the ketamine group, received ketamine at 0.5 mg/kg. Group 3, or the magnesium sulfate group, received a continuous intravenous infusion of magnesium sulfate at 1.5 gr/kg. The intensity of postoperative pain was assessed using a VAS score at rest and when coughing, with evaluation at 1, 4, 8, 12, and 24 hours, postoperatively. Also, the needs for rescue analgesics and the total amount of fentanyl during the intraoperative period in all groups was also followed. Results: The patients from the lidocaine group had the highest scores of pain in the postoperative period at rest and when coughing, and the ketamine group had the lowest pain scores. Rescue analgesia was given the most to lidocaine group, and less so in the magnesium group. The magnesium group received the highest dose of fentanyl during surgery and the lowest dose was received by patients from the lidocaine group. Conclusion: Multimodal analgesia can lower the need for opioids in the intra- and postoperative period after laparoscopic cholecystectomy.

Comparison of Dexmedetomidine, Lidocaine, Magnesium Sulfate, and Remifentanil in Cough Suppression During Endotracheal Extubation

Abstract Background: This study was undertaken to compare the effects of several drugs on attenuation of stimulatory responses and cough suppression at the end of endotracheal extubation under general anesthesia. Patients and Methods: This trial was conducted on 120 patients who were candidates for general anesthesia in Arak, Iran. The patients were randomly assigned into four groups. All groups received the study drugs 10 min prior to the end of surgery in the following manner: group 1, 0.5 μg/kg intravenous (IV) dexmedetomidine; group 2, 1.5 mg/kg IV lidocaine; group 3, 1 μg/kg IV remifentanil; and group 4, 30 mg/kg IV magnesium sulfate 50%. Laryngospasm, the presence of cough, mean arterial pressure, heart rate (HR), arterial oxygen saturation, and sedation were assessed and recorded. Results: No significant difference was observed in the number of coughs (P = .740) among the study groups. Although the dexmedetomidine group showed more sedation, the lowest increase in HR (P = .001) was observed in lidocaine and dexmedetomidine groups, respectively. The lowest and highest HR was observed in lidocaine and magnesium sulfate groups, respectively. The patients did not have laryngospasm during the assessment. In addition, dexmedetomidine had the highest Ramsay score (P = .019). Conclusion: There was no difference in the amount of laryngospasm and cough in the groups, and due to the lack of no serious complication requiring treatment, the study drugs can be recommended to be used for attenuating and suppressing stimulatory responses during endotracheal extubation.

A Lower Dose of Mgso4 for Control of Convulsions in Bangladeshi Eclamptic Women

Introduction: Eclampsia is the third major cause of maternal death in Bangladesh contributing to 16 percent of total maternal mortality rate (MMR)¹. Standard practice in eclampsia is urgent control of convulsions and prevention of its recurrence with the help of a suitable anticonvulsant, prompt initiation of general and obstetric care and control of hypertension if needed. Methodology: This prospective cross-sectional analytic study was conducted in Dhaka Medical College Hospital (DMCH) eclampsia unit during August 2004 to January 2005 in order to determine whether 8 g of magnesium sulphate heptahydrate is sufficient in controlling convulsion and preventing recurrences in lighter Bangladeshi women instead of 10 g of magnesium sulphate (MgSO4) as loading dose that is now being used. One hundred consecutive eclamptic patients who were eligible for magnesium sulphate therapy were assigned by lottery to receive either 8 g of magnesium sulphate heptahydrate (MgSO4. 7H₂O) (group A) or 10 g of magnesium sulphate (group B). The two groups were well-balanced and comparable on important characteristics. Result: The results show that there was no significant difference between the two groups with respect to recurrent convulsion, time needed to regain consciousness and maternal and perinatal morbidities and mortalities. Conclusion: The results reveal that 8 g magnesium sulphate heptahydrate is as effective as 10 g MgSO4 (as loading dose) in management of eclamptic convulsion of Bangladeshi women. If 8 g of magnesium sulphate heptahydrate can be used, it will be more economic, painful intramuscular injections will be avoided and the risk of toxicity will be reduced

A comparison of magnesium sulfate plus morphine with morphine alone for acute pain reduction in long-bone fractures; a double blind randomized clinical trial

Introduction: Acute pain is a common symptom in patients with bone fractures referring to the emergency department (ED). Objectives: The present study aimed at evaluating the efficacy of intravenous (IV) magnesium sulfate in controlling acute pain of long-bone fractures in EDs. Patients and Methods: The present double-blind, randomized clinical trial was conducted on patients with isolated limb fractures referred to Golestan hospital of Ahvaz from 2019 to 2020. Patients in the intervention group were injected with 0.1 mg/kg morphine plus 30 mg/kg magnesium sulfate and 0.1 mg/kg morphine alone in the morphine group. The patient’s pain scores were measured at 0, 15, 30, 45 and 60 minutes after injection. The patients’ condition was monitored every 10 minutes, including respiratory and pulse rate, blood pressure, and knee reflex. Results: The present study was conducted on 64 patients with long-bone fractures allocated to two groups of IV morphine plus magnesium sulfate and IV morphine alone (each of 32). The hemodynamic factors and mean body temperature did not significantly change after intervention and had a similar level in both groups. Before the intervention, the mean score of pain was measured in the morphine and magnesium sulfate plus morphine groups using a visual analogue scale. Results which were 8.87±0.83 and 8.93±0.94, respectively, showing no significant differences (P=0.69). After 60 minutes, the pain score reduced considerably in both groups. Conclusion: In the study, magnesium sulfate plus morphine could better reduce pain than morphine alone without influencing the respiratory rate. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (IRCT20190617043913N1; https://en.irct.ir/trial/40370, ethical code# IR.AJUMS.REC.1398.143).

Comparing the Effectiveness of Metoclopramide, Low Dose of Propofol, Ondansetron, and Magnesium Sulfate on Propofol Injection Pain: A Double-Blind Clinical Trial

Objectives: Despite a variety of strategies, propofol injection pain (PIP) is still one of the most distressing adverse effects of the drug. This study aimed to compare the effectiveness of metoclopramide, low dose of propofol, magnesium sulfate, and ondansetron in the prevention of PIP. Materials and Methods: This double-blind clinical trial was conducted at Al-Zahra hospital an academic and referral center affiliated with Guilan University of Medical Sciences, Rasht, Iran. A total of 120 eligible women candidates for elective gynecologic surgeries were divided into four equal groups of magnesium sulfate (30 mg/kg), ondansetron (4 mg), metoclopramide (10 mg), and propofol (15 mg). The primary outcome of this study was to decrease the pain severity of propofol injection. Results: The participants’ demographic characteristics, including age, American Society of Anesthesiologists classification, and body mass index, had no significant differences between the four groups. A significant decrease in heart rate and mean arterial pressure were observed in four groups; however, the difference was insignificant. The mean pain intensity in the magnesium sulfate group was 1.57 ± 0.9, ondansetron 1.37 ± 0.89, metoclopramide 0.95 ± 0.93, and in propofol group was 1.25 ± 1.1 (P=0.036). Conclusions: Metoclopramide could appropriately alleviate PIP. Considering some additional advantages, including antiemetic properties, preventing esophageal reflux, and less risk of postoperative ileus, this drug could be a safe and acceptable choice.

Comparison of impact of adjuvant treatment of midazolam, fentanyl, and magnesium sulfate with intrathecal bupivacaine on block characteristics and postoperative analgesia in knee arthroplasty

Objective: To compare the efficacy of midazolam, fentanyl, and magnesium sulfate as adjuvants to intrathecal bupivacaine on both block characteristics and postoperative analgesia in knee arthroplasty. Methods: This randomized double-blind clinical trial recruited spinal anesthesia patients of the American Society of Anesthesiologists class I or II, who needed knee arthroplasty. Patients were stratified into three intervention groups, including the midazolam group, the fentanyl group, and the magnesium sulfate group, and the patients were administered with midazolam, fentanyl, and magnesium sulfate, respectively. Hemodynamic parameters, sensory and motor block, and pain score (Visual Analogue Scale) were measured and compared among the three groups. Results: A total of 105 patients were included in this study with 35 patients in each group. There was no statistically significant difference in terms of oxygen saturation, mean blood pressure, duration of surgery, and postoperative complications, including nausea, vomiting, bradycardia, dizziness, and hypotension, as well as the time of opioid administration among the three groups (P&gt;0.05). Statistically significant differences were found in terms of heart rate at 15, 30, 45, 60, 75, and 105 min after beginning of operation among the three groups, which was lower in the midazolam group (P&lt;0.05). The midazolam group showed a shorter time to achieve sensory block after spinal anesthesia, sensory block to T8 or higher and sensory block to T12 and L1 (P&lt;0.05). Besides, the three groups showed significantly differences in terms of onset of motor block after spinal anesthesia and time to achieve motor block to T8 or higher or Bromage score 3 (P=0.001). No significant difference was noted in pain scores among the three groups (P&gt;0.05). Conclusion: Midazolam resulted in a shorter time to achieve sensory and motor block to T8 or higher, the onset of motor block and sensory block after spinal anesthesia, and time to achieve sensory block to T12 and L1, and the pain scores were not significantly different among the groups. Thus, midazolam can be highly underlined, if a shorter onset of sensory and motor blocks is targeted. [Funded by the research deputy of Arak University of Medical Sciences (No.99258); fa.irct.ir number, IRCT20141209020258N164].

Efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal bupivacaine in pediatric laparoscopic surgery: a randomized clinical trial

BackgroundWe evaluated the efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal (IP) bupivacaine in pediatric laparoscopic inguinal herniorrhaphy. MethodsNinety-seven male children, ASA I–II, 1–6 years old, undergoing laparoscopic inguinal herniorrhaphy, were randomized to receive before peritoneal insufflation, IP 2 mg.kg−1 bupivacaine 0.5% combined with either 1 μg.kg−1 of dexmedetomidine (Group D), 30 mg.kg−1 of magnesium sulfate (Group M), or normal saline (Group C). All tested drugs were diluted to the volume of 10 mL with normal saline. FLACC pain scores, need for rescue analgesics, time to flatus and first stool, emetic events, adverse effects, functional recovery, and parents’ satisfaction were recorded for the first 48 h postoperatively. ResultsFLACC scores were significantly higher in Group C than in the other two groups at 6, 8, 12, 18, 24, and 48 hours after surgery with no differences between Groups D and M. Rescue analgesia was significantly higher in Group C with none of the children in Groups D and M requiring rescue analgesia (p = 0.001). Times to first flatus and stool, emetic events, and adverse effects did not differ among groups. Times to return to normal functional activity were comparable in all groups. Parents’ satisfaction was greater in Groups D and M than in Group C (p = 0.026). ConclusionDexmedetomidine and magnesium sulfate added to IP bupivacaine improved the analgesia afforded by bupivacaine in the first two postoperative days in children scheduled for laparoscopic herniorrhaphy.

Effect of Magnesium Sulphate and Clonidine on Propofol Consumption, Hemodynamics and Postoperative Recovery Using Bispectral Index (BIS) In Elective Surgeries"

The purpose of this placebo-controlled, double-blind study was to see how magnesium sulphate and clonidine affected perioperative hemodynamics, propofol consumption, and postoperative recovery. Ninety ASA I–II patients undergoing elective laparoscopic surgery were randomized into three groups. Group M Patients received Inj. magnesium sulphate (40mg/kg) in 20 ml saline infused over a period of 15 minutes before induction. Group C received Patients received Inj. Clonidine (3mcg/kg) before induction. The Group S (Control group) received 20ml normal saline over 15mind before induction. Propofol was used for induction of anaesthesia and for maintenance propofol infusion was used which was adjusted as per bispectral index along with intermittent fentanyl bolus and vecuronium as muscle relaxant According to type of data, different tests of statistical significance like Chi-square test, Kruskal Wallis test and one-way ANOVA were used. In the presence of magnesium sulphate and clonidine, propofol induction was rapid. The time it took for BIS to reach 60 was significantly shorter in groups M and C (P0.0001), and compared to clonidine and control group post-operative recovery was more delayed in magnesium sulphate group (P0.0001). There was no statistically significant difference between the groups in heart rate or arterial blood pressure. Preoperative use of magnesium sulphate and clonidine resulted in significant reduction in propofol requirements for induction as well as for maintenance (P0.0001).To conclude use of magnesium sulphate caused delayed recovery and hypotension and bradycardia was observed with clonidine, but both can be used as adjuvants with caution.