Magnesium Sulfate In Combination Research Articles

Is Multimodal Anesthesia Effecting Postoperative Nausea and Vomiting in Laparoscopic Cholecystectomy?

Background: Multimodal anesthesia represents a technique that can improve analgesia and lower the occurrence of opioid side effects in the postoperative period, such as postoperative nausea and vomiting (PONV). It can be achieved by providing different types of medication during the intraoperative period which can decrease the need for opioids. PONV happens more often in patients who have received large amounts of opioids during laparoscopic cholecystectomy. In this study, our aim was to observe the occurrence of PONV between three different groups of patients who received lidocaine, ketamine and magnesium sulfate in combination with fentanyl in the intraoperative period. We also observed any additional nausea and vomiting in the three groups as well as the amount of fentanyl given to these groups during operation. Materials and methods: 120 patients aged 20-65 years old were included in this randomized and prospective study, ASA classification 1 and 2, scheduled for laparoscopic cholecystectomy. Patients were classified into three groups randomly: Group 1 (lidocaine group-LG), these patients received lidocaine at 1 mg/kg during induction to general anesthesia and 2 mg/kg/h after intubation in continuous intravenous infusion; Group 2 (ketamine group-KG) these patients received ketamine at 0.5 mg/kg during induction to general anesthesia; and Group 3 (magnesium group-MG) these patients received magnesium sulfate at 1.5 gr/hr as a continuous intravenous infusion after intubation. In all three groups, patients additionally received bolus doses of fentanyl. Postoperative nausea and vomiting were monitored in all three groups at 1, 4, 8, 12, and 24 hours after surgery as a primary objective, and if patients had complainant of vomiting, they were treated with 10 mg of metoclopramid. Between the five control time points, additional nausea and vomiting was recorded as well, as a secondary objective. The third objective was to measure of the total amount of fentanyl given in the intraoperative period. Results: Patients from the lidocaine group experienced less PONV and they received less fentanyl compared to patients of ketamine and magnesium groups. Patients from the ketamine group had more nausea than other groups. In the magnesium group, the rate of vomiting was higher, and they received higher amounts of fentanyl during surgery. Additional nausea and vomiting occurred in 3 patients in the LG, 2 in the KG, and 3 in the MG between the five control time points. The patients from the magnesium group received the highest dose of fentanyl during surgery (307.50 ± 130.4), followed by the patients from the ketamine group (292.50 ± 60.5), and then patients from the lidocaine group (258.75 ± 60.9). The doses of fentanyl that patients received during surgery in all three groups were not statistically significant. Conclusion: Multimodal anesthesia has been shown to lower PONV 24 hours after laparoscopic cholecystectomy and can lower need for opioids during laparoscopic cholecystectomy.

Protective Effects of Intravenous Magnesium Sulfate in Stroke Patients Receiving Amiodarone: A Randomized Controlled Trial.

Anti-arrhythmic agents, like amiodarone, interfere at different stages of the ischemic stroke. However, amiodarone was accompanied with immunological pulmonary complications and adverse neurological effects. We hypothesize that magnesium sulfate in combination with amiodarone holds promise for stroke treatment. Thirty-six patients with confirmed diagnosis of ischemic stroke and atrial fibrillation who received bolus amiodarone were randomly assigned to magnesium sulfate every 24h or similar volume of normal saline (as placebo) for 5days. Various severity test scores were used to evaluate the symptoms. Routing biochemistry were also measured at days 1 and 5. Treatment with MgSO4 results in a significant reduction in serum levels of NGAL, Hb, T.Bill, IL-6, IL-8, SNSE, S100B, EGF, PAF, CRP and IgG. Also, MgSO4 treatment significantly improved the RASS, Candida, SOFA, NIHSS and APACHE scores. Moreover, reduction of IL-6, IL-8, SNSE, EGF and APACHE score and increase in RASS score were significantly higher in MgSO4 group compared with placebo. Intravenous administration of MgSO4 in amiodarone-treated stroke patients improved the inflammatory, immunological and neurological indicators and reduced disability in ICU-admitted AIS patients, suggesting that this treatment scheme may prevent amiodarone-induced complications in these patients.

Magnesium Sulfate in combination with Nifedipine in the treatment of Pregnancy-Induced Hypertension.

Objective:To investigate the effect of magnesium sulfate combined with nifedipine in the treatment of pregnancy-induced hypertension syndrome (PIHS).Methods:Total 118 pregnant women with PIHS who were admitted to our hospital from April 2017 to June 2018 were randomly divided into control group (59 cases) and observation group (59 cases). The observation group was treated by magnesium sulfate in combination with nifedipine, while the control group was treated by magnesium sulfate. The therapeutic effect, serum leukaemia inhibitory factor (LIF), Apelin level, blood pressure, blood viscosity, urinary protein, S/D and Umbilical Artery Resistance Index (UARI) were compared between the two groups.Results:The effective rate of the observation group was 94.9%, higher than 83.1% of the control group, and the difference was statistically significant (P<0.05). The decrease level of systolic and diastolic blood pressure in the observation group was better than that in the control group, and the difference was statistically significant (P<0.05). The decrease of blood viscosity, urinary protein, S/D and UARI in the observation group was greater than that in the control group, and the difference was statistically significant (P<0.05). The improvement of serum LIF and Apelin levels in the observation group was better than that in the control group (P<0.05), and the difference was statistically significant (P<0.05).Conclusion:Magnesium sulfate combined with nifedipine in the treatment of PIHS has a significant effect, which can effectively control edema, blood pressure, proteinuria and protect kidney. It is worth clinical promotion.

Magnesium Sulfate in combination with Nifedipine in the treatment of Pregnancy-Induced Hypertension

Objective: To investigate the effect of magnesium sulfate combined with nifedipine in the treatment of pregnancy-induced hypertension syndrome (PIHS).&#x0D; Methods: Total 118 pregnant women with PIHS who were admitted to our hospital from April 2017 to June 2018 were randomly divided into control group (59 cases) and observation group (59 cases). The observation group was treated by magnesium sulfate in combination with nifedipine, while the control group was treated by magnesium sulfate. The therapeutic effect, serum leukaemia inhibitory factor (LIF), Apelin level, blood pressure, blood viscosity, urinary protein, S/D and Umbilical Artery Resistance Index (UARI) were compared between the two groups.&#x0D; Results: The effective rate of the observation group was 94.9%, higher than 83.1% of the control group, and the difference was statistically significant (P&lt;0.05). The decrease level of systolic and diastolic blood pressure in the observation group was better than that in the control group, and the difference was statistically significant (P&lt;0.05). The decrease of blood viscosity, urinary protein, S/D and UARI in the observation group was greater than that in the control group, and the difference was statistically significant (P&lt;0.05). The improvement of serum LIF and Apelin levels in the observation group was better than that in the control group (P&lt;0.05), and the difference was statistically significant (P&lt;0.05).&#x0D; Conclusion: Magnesium sulfate combined with nifedipine in the treatment of PIHS has a significant effect, which can effectively control edema, blood pressure, proteinuria and protect kidney. It is worth clinical promotion.&#x0D; doi: https://doi.org/10.12669/pjms.36.1.706How to cite this:Xiang C, Zhou X, Zheng X. Magnesium Sulfate in combination with Nifedipine in the treatment of Pregnancy-Induced Hypertension. Pak J Med Sci. 2020;36(1):---------. doi: https://doi.org/10.12669/pjms.36.1.706&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Magnesium sulfate in combination with nimodipine for the treatment of subarachnoid hemorrhage: a randomized controlled clinical study

ObjectiveCerebral vasospasm(CVS) after Subarachnoid hemorrhage (SAH) can cause delayed cerebral ischemia,secondary cerebral infarction, and rehemorrhage, which are the leading causes of mutilation and death. Nimodipine has been shown to prevent CVS. Magnesium ion (Mg2+) can competitively inhibit the influx of calcium (Ca2+) and prevent vasospasm. There is evidence that magnesium sulfate can prevent CVS and reduce infarct volume after SAH. In this study, we evaluated the efficacy and safety of intravenous magnesium sulfate combined with oral nimodipine on CVS, delayed cerebral ischemia, secondary cerebral infarction, and rehemorrhage after SAH.MethodsThis is a prospective randomized, double-blind trial of 120 patients with SAH who were recruited between January 2003 and January 2009. These patients were assigned to two groups and received the same basic treatment and symptomatic treatment. In group A, patients received 14 days of intravenous administration of 1400 mL 0.9% normal saline + 40 mL 25% magnesium sulfate, 1 mL/min, once per day, followed 7 days of intravenous administration of 500 mL 0.9% normal saline + 15 mL 25% magnesium sulfate, 1 mL/min, once per day and oral nimodipine, 20 mg once, four times a day, for 21 days. Patients in group B received identical treatment to that in group A, except that 25% magnesium sulfate was replaced by placebo. On day 22 of treatment, incidences of intracranial CVS, delayed cerebral ischemia, secondary cerebral infarction, rehemorrhage, neurologic deficits, and death were assessed and adverse events were monitored.ResultsCVS occurred in 4, 12 patients, lasting for 11.09 ± 5.38, 13.73 ± 6.24 hours, mean velocity (Vm) of 143.2 ± 12.7, 149.6 ± 18.9 cm/s in group A, B; Delayed cerebral ischemia occurred in 3, 10 patients, lasting for 13.16 ± 4.82, 15.57 ± 5.35 hours in group A, B; Secondary cerebral infarction occurred in 2 and 8 patients in groups A and B; Neurologic deficits occurred in3 and 11 patients in groups A and B, All P < 0.05; Rehemorrhage occurred in 4 and 5 patients; Death occurred in 5 and 8 patients in groups A and B, respectively, P >0.05. No obvious adverse events were found in both groups.ConclusionIntravenous magnesium sulfate in combination with oral nimodipine for the treatment of SAH can help reduce the incidences of CVS, delayed cerebral ischemia, secondary cerebral infarction, and neurologic deficits with good safety, but it does not reduce the incidences of rehemorrhage and death.

Does Magnesium Sulfate as an Adjuvant of Local Anesthetics Facilitate Better Effect of Perineural Nerve Blocks?: A Meta-analysis of Randomized Controlled Trials.

To investigate the efficacy and safety of magnesium sulfate as an adjuvant of local anesthetics in perineural nerve blocks. Randomized controlled trials studying the effect and safety of magnesium sulfate in perineural nerve blocks were retrieved from online databases. The mean difference (MD), risk ratio, and their corresponding 95% confidence intervals (CIs) were calculated using RevMan 5.3 statistical software. Seven trials evaluating 493 patients were included. The pooled results from our meta-analysis showed that a combination of magnesium sulfate and local anesthetics in nerve blocks could result in longer postoperative duration time of analgesia (MD=124.66; 95% CI, 65.09-184.23; P<0.0001), longer duration time of sensory (MD=106.69; 95% CI, 60.93-152.45; P<0.00001) and motor block (MD=89.95; 95% CI, 50.89-129.00; P<0.0001). In addition, magnesium sulfate in nerve blocks was also associated with significantly quick onset of motor block (MD=-1.17; 95% CI, -1.73 to -0.60; P<0.0001). For onset time of sensory block, number of patients requiring supplementary analgesics, and incidence of postoperative nausea and vomiting, no statistically differences were observed between the 2 groups. The present study suggests that combined magnesium sulfate and local anesthetics in perineural nerve blocks provided better analgesic efficacy. For it prolongs the postoperative duration time of analgesia, sensory and motor block without increasing the short-term side effects. Magnesium sulfate may be a promising analgesic for perineural nerve blocks, but further studies are required to validate our results.

Ketamine versus magnesium sulfate with caudal bupivacaine block in pediatric inguinoscrotal surgery: A prospective randomized observer-blinded study.

Introduction:Possible approaches for postoperative analgesia after pediatric inguinoscrotal surgery are caudal block by bupivacaine/ketamine (BK) and bupivacaine/magnesium sulfate (BM).Aim:The purpose of the following study is to compare the analgesic efficacy and safety of ketamine and magnesium sulfate in combination with bupivacaine for caudal blockade in pediatric patients after inguinoscrotal operations.Materials and Methods:Patients randomly received one of the two solutions for caudal epidural injection after induction of general anesthesia. Group-BK: Were given a mixture of 0.25% bupivacaine and 0.5 mg/kg of ketamine. Group-BM: Were given a mixture of 0.25% bupivacaine and 50 mg magnesium sulfate. Postoperatively, a blinded post-anesthesia care unit nurse assessed the quality of analgesia with a visual pain analog scale (VPAS). Significant pain is defined as one that has a VAPS of ≥3.Results:Forty American Society of Anesthesiologists I-II children (20 in each group) completed the study. The two groups were comparable regards age, sex, body mass index, anesthesia and surgery durations, recovery time and sevoflurane concentration. The mean duration of caudal analgesia ± standard deviation was 462 ± 17.2 min versus 398.05 ± 12.9 min for BK and BM groups, receptively (P < 0.001). Supplemental rectal paracetamol within 12 h postoperatively were 15% for BK group versus 25% for BM (P = 0.05). Four patients in BK group only experienced postoperative nausea and vomiting (P = 0.053).Conclusion:Caudal administration of BK is efficient and safe for pediatric inguinoscrotal operations with longer postoperative analgesia than BM sulfate.

Super-Selective Intra-arterial Magnesium Sulfate in Combination With Nicardipine for the Treatment of Cerebral Vasospasm in Patients With Subarachnoid Hemorrhage

To determine the safety and tolerability of super-selective intra-arterial magnesium sulfate in combination with intra-arterial nicardipine in patients with cerebral vasospasm after subarachnoid hemorrhage. Patients were treated in a prospective protocol at two teaching medical centers. Emergent cerebral angiography was performed if there was either clinical, ultrasound, and/or computed tomographic (CT) perfusion deficits suggestive of cerebral vasospasm. Intra-arterial magnesium sulfate (0.25-1 g) was administered via a microcatheter in the affected vessels in combination with nicardipine (2.5-20.0 mg). Mean arterial pressures (MAP) and intracranial pressures (ICP) were monitored during the infusion. Immediate and sustained angiographic and clinical improvement was determined from post-treatment angiograms and clinical follow-up. Angiographic and clinical outcomes were compared to two published case series that has used nicardipine alone. A total of 58 vessels were treated in 14 patients (mean age 42 years; 11 women) with acute subarachnoid hemorrhage. The treatment was either intra-arterial nicardipine and magnesium sulfate alone or in conjunction with primary angioplasty. Forty vessels (69%) had immediate angiographic improvement with intra-arterial nicardipine and magnesium sulfate alone and 18 vessels (31%) required concomitant balloon angioplasty with complete reversal of the vasospasm. Retreatment was required in 13 vessels (22%) and the median time for retreatment was 2 days (range 1-13 days). Nicardipine treatment resulted in the reduction of MAP (12.3 mmHg, standard error [SE] 1.34, P-value <0.0001) without any significant change in ICP. Magnesium sulfate infusion was not associated with change in MAP or ICP. Among 31 procedures, immediate neurological improvement was observed in 22 (71%) procedures. In 12 (86%) patients, there were no infarctions in the follow-up CT scan acquired between 24 and 48 h. No statistical significant difference was observed in angiographic and clinical outcome of patients treated with the combination therapy in comparison with historical controls treated with nicardipine alone. Administration of intra-arterial magnesium sulfate in combination with nicardipine was well tolerated in patients with subarachnoid hemorrhage and cerebral vasospasm without a significant change in MAP and ICP. The efficacy of this combination therapy should be evaluated in a larger, controlled setting.