Injection Of Magnesium Sulfate Research Articles

Evaluation of intravenous magnesium sulphate on haemodynamic responses to laryngoscopy and tracheal intubation in surgeries of ear, nose and throat

Heart rate, arterial blood pressure, and arrhythmias significantly surge during laryngoscopy and intubation. Anesthesiologists constantly look for ways to minimize these unwanted reactions. Several medicinal interventions have been suggested to mitigate these side effects; intravenous magnesium sulphate injection is one such intervention. Magnesium sulphate is a divalent salt widely recognized for its capacity to lower sympathetic nervous system muscle cell excitability, which lowers blood pressure and causes vasodilation. It is approved as a medicine to treat preeclampsia and control blood pressure. Moreover, there is growing recognition of its benefits on hemodynamic parameters in patients suffering from ischemic infective endocarditis and heart disease. Magnesium is an asset for reducing negative cardiovascular reactions occurring at the time of laryngoscopy and intubation because of its capacity to reduce catecholamine synthesis from adrenergic nerve ends and the adrenal medulla. Intravenous magnesium sulphate will be used in this trial to assess its effect on reducing adverse hemodynamic responses in candidates for elective laryngoscopy and intubation for ENT surgeries.

Influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: a case of Rwanda Southern Province

BackgroundStock-outs of some life-saving drugs, such as emergency obstetric drugs, are evident in many health facilities and have been reported to be the leading cause of maternal mortality and morbidity for women from low and middle income countries (LMICs). For many cases, this situation is associated with poor inventory management practices. The aim of this study was to investigate the influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: case of the Rwanda Southern Province. Moreover, to gain a better grasp of the problem and to suggest possible areas for improvement.MethodsAn institutional-based cross-sectional study was carried out in all ten district hospitals (DHs) providing maternal health care and dispensing emergency obstetric drugs namely; Kigeme DH, Munini DH, Kabutare DH, Kibilizi DH, Gakoma DH, Nyanza DH, Ruhango DH, Gitwe DH, Kabgayi DH and Remera Rukoma DH. Both quantitative and qualitative data were collected and analyzed. Oxytocin injection, Misoprostol tablet and Magnesium sulphate injection as recommended emergency obstetric drugs by WHO, UNFPA and Rwanda Essential Medicines list were included in the study.ResultsThe study revealed that keeping logistics management tools up to date is the backbone of inventory management practices in the availability of medicines and medical supplies. The results showed that hospitals with up-to-date logistics tools for their pharmaceutical management were 33.25 times more likely to have their emergency obstetric drugs in stock at all times compared to those that do not regularly update their logistics tools. The proper use of bin cards and electronic software (e-LMIS) contributed greatly to reducing the stock-out rate of emergency obstetric drugs by 89.9% and reduction of unusable to usable stock ratio by appropriate use of simple techniques such as the Min–Max inventory control model by 79%. Over an 18-month period, misoprostol tablet had the highest average days (32) of stock-outs (5.9%), followed by magnesium sulphate injection with an average of 31 days (5.7%), and oxytocin injection with an average of 13 days (2.4%).ConclusionProper use of pharmaceutical management tools within hospitals premises positively influence the availability of life-saving drugs, such as emergency obstetric drugs. Adequate supply chain staffing in health facilities is the most important key to improving inventory management practices and medicine availability.

Novel use of local analgesia prior to intramuscular magnesium sulphate injection compared to mixed local analgesia with magnesium sulphate to reduce pain: a randomised crossover study in patients being managed for eclampsia and preeclampsia.

The World Health Organization (WHO) recommended addition of local anesthetic to reduce the intense pain of intramuscular injection of 50% Magnesium Sulphate (MgSO4) salt solution has been found to be ineffective. We tested whether giving the local anesthetic 5 min before the MgSO4 injection would reduce pain. We conducted a prospective cross-over trial where each participant with pre-eclampsia or eclampsia received sequential and mixed injection methods in random sequence during sequential MgSO4 administrations. Pain and preference were assessed using descriptive words, a numeric pain scale and direct comparison between the two injection methods. Differences were measured using the Wilcoxon signed rank test, risk ratios with 95% confidence intervals and the Chi squared or Fisher's test. The administration techniques were refined based on an initial pilot of 8 participants. We enrolled 49 consented participants and analysed data from 41 post-pilot participants The sequential injection method had a non-significantly lower mean pain score than the mixed injection method (3.1 vs. 3.3, p = 0.44). Severe pain was reported for 3/41 vs. 9/41, p = 0.12. The sequential injection method was perceived to be more painful by 13 (37%) vs. 22 (63%) participants (p = 0.03). The sequential injection was preferred by 21(60%) vs. 14 participants (40%) (p = 0.1). Our results consistently favoured the novel sequential injection method. The lack of statistical significance for most results is not surprising given the small sample size. Given the potential for clinically important benefits to women, a larger study to confirm these results is justified. https://pactr.samrc.ac.za/, Identifier (PACTR202201521544765).

Effect of Intravenous Injection of Magnesium Sulphate on Intraoperative End-Tidal CO2 Level and Postoperative Pain in Laparoscopic Cholecystectomy.

Pain control and stabilizing hemodynamic indices are serious medical challenges, especially in anesthesia. Laparoscopic surgery is increasing in the world, and cholecystectomy surgery is no exception. This study investigated the effect of intravenous (IV) magnesium sulfate injection on intraoperative end-tidal CO2 (ETCO2) levels and postoperative pain in laparoscopic cholecystectomy. This is a clinical trial. The sample size was calculated to be 64 people who were selected among the patients who were candidates for laparoscopic surgery by convenience sampling. They were randomly assigned to intervention and control groups. The intervention group received magnesium sulfate (50 mg/kg) and normal saline (100 mL) within 1 h. The control group only received normal saline (100 mL). Systolic and diastolic blood pressures, ETCO2 level, heart rate, arterial oxygen saturation, pain level, and narcotic analgesics in recovery were measured 2, 6, 12, and 24 h after surgery. The data were analyzed using 1-way analysis of variance (ANOVA) and repeated measures analysis. The mean of systolic blood pressure and ETCO2 during recovery in the intervention group were less than the control group (P = 0.029 and P = 0.015). In the intervention group, analgesic consumption in recovery and 6 h after surgery was less than the control group (P < 0.001). The mean pain score in the intervention group in recovery and 2, 6 (P < 0.001), and 12 h (P = 0.038) after surgery was significantly lower than the control group. Magnesium sulfate can be a suitable and safe supplement to reduce pain after surgery and reduce the use of narcotics. The current conclusion should be investigated on a larger scale of patients, with extended monitoring for postoperative pain over a longer period of time.

Comparative Evaluation of Dexmedetomidine and Magnesium Sulfate for Prevention of Postoperative Atrial Fibrillation in Patients of Coronary Artery Bypass Surgeries.

Introduction The main goal of this study is to compare the effects of dexmedetomidine and magnesium sulfate on preventing atrial fibrillation (AF) after off-pump coronary artery bypass graft (CABG) surgeries. AF is a type of irregular heartbeat that often occurs after heart surgery and can cause serious complications. We want to see which drug is more effective in reducing the risk of AF in patients who have had CABG surgeries without using a heart-lung machine. Materials and methods This was a randomized clinical study, conducted on patients of ASA classes III and IV who were the candidates for off-pump coronary artery bypass graft surgeries, which were conducted in the cardiac operating room from the periodOctober 2020 to April 2021, at the Department of Anaesthesia, Jawaharlal Nehru Medical College, Sawangi, Meghe. All patients were aged between 30 and 85 years and with a left ventricular ejection fraction of above 40%. Results When the two groups were compared, the incidence of arrhythmias was more in group D (a group that received injection dexmedetomidine infusion), predominantly AF with an incidence of 50% more as compared to group M (a group that received injection magnesium sulfate infusion). When hemodynamic parameters were compared, events of bradycardiaand hypotension were significantly higher in group Das compared to group M. The heart rate (HR), when compared between the two groups intraoperatively from the duration before induction of anesthesia till during sternum closure, has a significant p-value (0.0001). Similarly, when the mean arterial pressure (MAP) was compared between the two groups intraoperatively, significant hypotension was noted in group D (p-value = 0.0001). Postoperatively, in the intensive care unit when the HR and MAP were compared for 48 hours, bradycardia and hypotension were noted, but drastic changes in the mean values of the HR and MAP were not seen in both groups D and M. Conclusion When comparing the antiarrhythmic properties of the study drugs, it was observed that intraoperative and postoperative arrhythmias were less with magnesium sulfate as compared with dexmedetomidine. It was also found that there were higher events of hypotension and bradycardia in the dexmedetomidine group as compared to the magnesium sulfate group.

A Clinical Study of Low Molecular Weight Heparin Sodium Injection Combined with Magnesium Sulfate Injection and Labetalol Tablets in the Treatment of Severe Pregnancy-Induced Hypertension

Objective: To investigate the clinical effect of low molecular weight heparin sodium injection combined with magnesium sulfate injection and labetalol in the treatment of severe pregnancy-induced hypertension. Methods: A total of 48 patients with severe pregnancy-induced hypertension admitted from February 2021 to February 2023 were selected, and the patients were divided into two groups by simple sampling, with 24 cases in each group. Patients in the control group received labetalol orally and intravenous infusion of magnesium sulfate, whereas those in the observation group received subcutaneous injection of low molecular weight heparin sodium on the basis of the control group. The two groups of patients underwent 5 days of treatment, and the blood pressure control, vascular endothelial function, renal function, and blood coagulation were compared between the two groups. Results: Before treatment, there were no significant differences in blood pressure readings, endothelin-1 (ET-1) and nitric oxide (NO) levels, serum creatinine (SCr) and blood urea nitrogen (BUN) levels, and the four coagulation indices between the two groups (all P &gt; 0.05). After treatment, the blood pressure readings in the observation group were lower than those in the control group (P &lt; 0.05); ET-1 in the observation group was lower than that in the control group, and the NO level in the observation group was higher than that in the control group (P &lt; 0.05); compared with the control group, the observation group had lower SCr and BUN (P &lt; 0.05), longer prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT), and lower fibrinogen (Fib) level (P &lt; 0.05). Conclusion: Low molecular weight heparin sodium injection combined with magnesium sulfate injection and labetalol in the treatment of severe pregnancy-induced hypertension can help control blood pressure levels, promote the recovery of vascular endothelial function and renal function, and effectively correct coagulation function.

Evaluation of the Efficacy of Magnesium Sulfate in Reducing Blood Loss in Functional Endoscopic Sinus Surgery: A Randomized Double-Blinded Controlled Trial.

Objectives The primary concern in functional endoscopic sinus surgery (FESS) is maintaining a clear and unobstructed surgical field. Achieving this objective necessitates controlled hypotension, which can aid in the surgical dissection process and reduce the overall duration of the operation. This study aims to evaluate the efficacy of a sole bolus injection of intravenous magnesium sulfate in FESS. The outcomes measured include blood loss, surgical field grading, the additional intraoperative requirement of fentanyl, stress attenuation during laryngoscopy and endotracheal intubation, and extubation time. Methods In this prospective, double-blinded, randomized control trial (CTRI/2021/04/033052), 50 patients scheduled for FESS were randomly divided into two groups: Group M received 50 mg/kg MgSO4 in 100 ml normal saline, and Group N received 100 ml plain normal saline 15 min before induction. The study assessed total blood loss, measured by blood collected from the surgical field and weighing gauze. The surgical field grading was assessed by a six-point Fromme and Boezaart scale. We also observed stress attenuation during laryngoscopy and endotracheal intubation, additional intraoperative fentanyl requirements, and time taken for extubation. The sample size was estimated using the G power calculator 3.1.9.2 (http://www.gpower.hhu.de/). Data were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using Statistical Package for Social Sciences version 20.0 (IBM Corp., Armonk, NY). Results The demographic data and duration of the surgery were comparable in both groups. The total blood loss in Group M was 100.40 ml ±60.71 ml, which is lower than Group N (133.80 ml ±59.7 ml) with a p-value of 0.016. In addition, the surgical field grading was also better in Group M. The total vecuronium consumption was significantly lower in Group M, which was (7.23±0.84 mg); in Group N, it was (10.64±1.74 mg) with a p-value of 0.0001, respectively. The dosage of additional fentanyl in Group N was 38.46 mcg ± 8.99 mcg, more than in Group M (33.64 mcg ± 11.20 mcg). The time required for extubation was similar in both groups. The duration of the surgery was significantly more significant in Group M (150.0 ±31.36) than in Group N (205.0 ±32.79), with a p-value of 0.0001, respectively. Furthermore, the mean arterial pressure after induction, at 2 min and 4 min after laryngoscopy, was less in Group M, with p=0.001, p=0.003, and p<0.0001, respectively, when compared with Group N. The heart rate after induction, at 2 min and 4 min after laryngoscopy, was also less in Group M, with p=0.016, p=0.003, and p=0.003, respectively, when compared with Group N. The Ramsay Sedation Score was higher in Group M than in Group N's fourth, eighth, and sixteenth hour, with p=0.001, p=0.021, and p=0.001, respectively, in the postoperative period. The sedation score was statistically insignificant after that. No complications were encountered during the study. Conclusion We conclude that a single bolus dose of MgSO4 reduced surgical blood loss more effectively than in the control group. The surgical field grading was also better in Group M, as was the stress attenuation during laryngoscopy and endotracheal intubation. The intraoperative fentanyl requirement was not statistically significant. The time for extubation was similar between the groups. No other adverse effects were encountered during the study.

Comparison of Intrathecal Nalbuphine and Magnesium Sulphate for Prevention of Shivering in Caesarean Section: A Randomised Clinical Study

Introduction: Nalbuphine and magnesium sulfate are commonly used drugs for the treatment of Perioperative Shivering (POS), but there is a paucity of comparative studies on their intrathecal use in Lower Segment Caesarean Section (LSCS) patients. LSCS is the most commonly performed obstetric surgery, and Spinal Anaesthesia (SA) is advantageous in LSCS. However, shivering has been found to be the most common side-effect of SA. Aim: To compare the effect of intrathecal injection of nalbuphine and magnesium sulfate on the prevention of postspinal anaesthesia shivering during LSCS. Materials and Methods: This randomised clinical study was conducted at the Department of Anaesthesiology, Government Medical College, Kathua, Jammu and Kashmir, India on 60 parturients between the ages of 20-40 years from September 2021 to January 2023. The participants had full-term gestation and an American Society of Anaesthesiologists (ASA) status of I or II, and were scheduled for LSCS under SA. The total sample was divided into two groups of 30 patients each. Group N (n=30) received 0.7 mg nalbuphine intrathecally, while Group M (n=30) received 25 mg of magnesium sulfate intrathecally, both with 0.5% bupivacaine (10 mg). Characteristics of spinal blockade, time to onset of shivering, severity of shivering, and side-effects such as nausea, vomiting, sedation, and hypotension were noted. Student’s t-test, Chi-square test, and Fisher’s exact test were used for data analysis. A p-value of &lt;0.05 was considered statistically significant. Results: Both study groups were comparable in terms of age (p-value=0.081), height, weight (p-value=0.079), ASA grade (p-value=0.072), and duration of surgery (p-value=0.077). In group N, 5 patients (16.67%) had POS, while in Group M, 6 patients (20%) had POS, but the difference was not statistically significant. In Group N, 3 patients (10%) had a shivering score of 3 and 2 patients (6.67%) had a shivering score of 4, while in group M, 3 patients (10%) had a shivering score of 3 and 3 patients (10%) had a shivering score of 4. The difference was statistically insignificant. Perioperative complications (sedation, hypotension, nausea, and vomiting) were comparable in both groups with no statistically significant difference. Conclusion: Intrathecal injection of preservative-free 0.7 mg nalbuphine and 25 mg magnesium sulfate were both effective in reducing the incidence of postspinal shivering. Both drugs had comparable minimum perioperative complications. The intrathecal use of nalbuphine and magnesium sulfate for the prevention of postspinal shivering is encouraged, as both drugs are less expensive and readily available in the operation theaters.

Effects of magnesium sulfate on the heart rate of preterm fetal sheep with intraamniotic inflammation

The specific findings of fetal heart rate (FHR) patterns after drug administrations under intraamniotic inflammation have not been clarified. This study aimed to investigate the effects of fetal magnesium sulfate (MS) injection on the heart rate of preterm fetal sheep with intraamniotic inflammation during increasing and decreasing levels of serum MS concentration.

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.

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

Comparison of intravenous injection of magnesium sulfate and lidocaine effectiveness on the prevention of laryngospasm and analgesic requirement in tonsillectomy.

The aim of the present study is to compare the effect of intravenous (IV)injectionof magnesium sulfate and lidocaine on the prevention of laryngospasm, and analgesic requirement in tonsillectomy surgeries. In this double-blinded clinical trial, 62 children are randomly selected and categorized into two groups. Two minutes after intubation, group A received 15 mg/kg IV magnesium sulfate, while group B received 1 mg/kg IV 2% lidocaine. Laryngospasm frequency, nausea and vomiting, hemodynamic status (in 15 minutes after extubating), sedation score, analgesic requirement, and duration of recovery were compared between the two groups. Data were analyzed using SPSS software version 21 and with a 95% confidence interval. Both groups had no significant difference based on the age and weight means, as well as sex frequency. 10 patients (32.3%) in the lidocaine group and 3 patients in the magnesium group (9.7%) had stridor, and the difference between the two groups was statistically significant (p = 0.026). Laryngospasm only occurred in a patient of the lidocaine group. The frequency of nausea and vomiting, agitation and analgesic requirement in the lidocaine group were higher than the magnesium group (p= 0.001). However, sedation score and recovery time were higher in the magnesium group (p=0.001). No statistically significant difference was seen between the two groups in terms of hemodynamics. Magnesium sulfate and lidocaine had no difference in the incidence of laryngospasm, but magnesium sulfate was associated with a lower rate of stridor, nausea, vomiting, agitation and analgesic requirement in recovery in comparison to lidocaine.

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.

A comparative study between intravenous and intraperitoneal magnesium sulphate for pain management in laparoscopic mini gastric bypass: a randomized clinical trial

Abstract&#x0D; Background: Laparoscopic bariatric surgery has become a regular procedure, and it has largely replaced traditional open surgery. Patients experience postoperative pain even after laparoscopic surgery, although the intensity is low compared to open surgery. We compared the effectiveness of intravenous (IV) vs. intraperitoneal (IP) magnesium sulphate (MgSO4) injection in pain management in laparoscopic mini-gastric bypass surgery. &#x0D; Methodology: We selected 100 patients based on convenient sampling and randomly divided into two groups; the IV group (50 patients) received MgSO4 50 mg/kg in 250 ml normal intravenously, and the IP group (50 patients) received MgSO4 50 mg/kg in 30 ml normal saline intraperitoneally. Nalbuphine was used as rescue analgesic and its total postoperative consumption during the first 24 h was recorded based on VAS score. Postoperative nausea and vomiting (PONV), sedation score and hemodynamic changes with pneumoperitoneum were also assessed.&#x0D; Results: Total nalbuphine consumption postoperatively was more in IV group than IP group (12 ± 3.03 mg vs. 8.3 ± 2.8 mg; P &lt; 0.001). Postoperative pain score was significantly lower in IP group in comparison to IV group (P &lt; 0.001). Intraoperative hypotension and bradycardia were significantly more (P = 0.03) in IV group (21% and 17% respectively) compared to IP group (10% and 7% respectively). Postoperative sedation and nausea and vomiting scores were reduced in IP group compared to IV group, the difference being highly significant (P &lt; 0.001).&#x0D; Conclusion: Intraperitoneal MgSO4 instillation has better results than intravenous infusion in attenuation of postoperative pain and hemodynamic response associated with pneumoperitoneum, and results in less PONV when used in laparoscopic minigastric bypass patients.&#x0D; Key words: Analgesics / administration &amp; dosage; Analgesics / pharmacology; Analgesics / therapeutic use; Bariatric; Magnesium Sulfate / administration &amp; dosage; Magnesium Sulfate / pharmacokinetics; Magnesium Sulfate / therapeutic use; Mini-gastric bypass; Pain management; Pneumoperitoneum&#x0D; Citation: El-Sesy MG, Abdel Hameed AE, Abdelaziz AA, Ahmed IM, Elhennawy AM. A comparative study between intravenous and intraperitoneal magnesium sulphate for pain management in laparoscopic mini gastric bypass: a randomized clinical trial. Anaesth. pain intensive care 2022;26(4):450-457; DOI: 10.35975/apic.v26i4.1947&#x0D; Received: April 18, 2022; Reviewed: June 16, 2022; Accepted: July 10, 2022

Comparative effect of transforaminal injection of Magnesium sulphate versus Ozone on oxidative stress biomarkers in lumbar disc related radicular pain

BackgroundWe aimed to investigate the effect of transforaminal injection of Magnesium sulphate versus Ozone on pain intensity, functional disability and the oxidative stress biomarkers; superoxide dismutase (SOD) and Glutathione (GSH) in patients with lumbar disc prolapse.MethodsThis randomized controlled trial was conducted on 135 patients having symptomatic lumbar disc prolapse, received either transforaminal injection of Magnesium sulphate with steroids, Ozone with steroids, or steroids alone. Assessment of pain severity and functional disability were done before intervention, 2 weeks, 1, 3, and 6 months after intervention. Serum SOD and GSH were measured for all included patients before and 2 weeks after intervention.ResultsThere was a statistically significant improvement in pain intensity and functional disability 2 weeks after intervention in the three groups, but at 1-month and 3-months after intervention, the significant improvement was in Mg sulphate and Ozone groups only. At 6-months follow up, Mg sulphate group only showed a significant improvement. There was a statistically significant increase in SOD and GSH serum levels, 2-weeks after intervention in both Magnesium sulphate (P-value = 0.002, 0.005 respectively) and ozone groups (P-value < 0.001, < 0.001), but there was no statistically significant change in SOD and GSH serum levels in control group.ConclusionTransforaminal injection of Mg sulphate in patients with lumbar disc prolapse causes significant long-term improvement (up to 6 months) in pain intensity and functional disability. The serum levels of SOD and GSH were significantly increased at 2 weeks following both transforaminal injection of Mg sulphate and ozone.

Comparison of Effects of Intravenous Lignocaine and Magnesium Sulphate on the Cardiovascular Response to Laryngoscopy and Intubation

Background and Objective: The patient's heart rate, blood pressure, pulmonary arterial pressure, and capillary wedge pressure will all rise during laryngoscopy and tracheal intubation. These hemodynamic alterations are less noticeable in those with normal blood pressure but have been linked to several diseases. They are well tolerated by those with normal blood pressure. The study's goal is to compare the cardiovascular effects of lignocaine and magnesium sulfate during laryngoscopy and intubation. Methodology: The objective of this randomized controlled trial was to examine the effects of lignocaine and magnesium sulfate on cardiovascular and respiratory responses after endotracheal intubation in ASA I patients. The 60 participants' ages ranged from 15 to 45, and they were all classed as "grade I" by the ASA. Each of these patients underwent elective surgery under general anesthesia voluntarily. The sixty people were divided into two groups of thirty using a random selection method. Neither group was significantly different from the other in terms of demographics or blood-flow parameters. Group L was administered 1.5 mg/kg intravenously of lidocaine three minutes before to induction. Group M received an intravenous injection of magnesium sulfate at a rate of 40 mg/kg over the course of one minute. Results: In both the Magnesium and Lignocaine groups, heart rates increased, but the Lignocaine group's increase was far more dramatic (p value 0.01). Both groups experienced an increase in systolic blood pressure following medication administration (p value 0.05). The results of Group M remained statistically significant for the first minute after the insertion of the tube, but by the fifth minute, they had returned to pre-insertion levels. In Group L, blood pressure increased significantly at 1 and 3 minutes after tube insertion, but by 5 minutes, blood pressure had returned to pre-insertion levels. The SBP of group L individuals increased significantly greater than that of group M participants. (p 0.05). Immediately following intubation, there was a statistically significant (p 0.01) increase in DBP in both groups; however, three minutes later, DBP had returned to pre-intubation levels in both groups (p 0.01). It is five percent as important. (p 0.05). The results revealed that the growth rate of group L members was significantly higher than that of group M members. In the presented situation, p equals 0.01 Conclusion: When it comes to preventing a rise in heart rate, blood pressure, and blood pressure during laryngoscopy and tracheal intubation for patients with an ASA grade I, magnesium sulfate is more beneficial than lidocaine.

Effect of Intraoperative Magnesium Sulfate Administration on Blood Glucose Control following Total Joint Arthroplasty in Patients with Diabetes.

Magnesium deficiency, which is known to be highly prevalent among patients with diabetes, has been associated with insulin resistance and poor glucose control. Here, we aimed to investigate the effects of intraoperative magnesium administration on postoperative glucose control in patients with diabetes. We retrospectively reviewed the medical records of patients with type 2 diabetes who had undergone total joint arthroplasty at a tertiary hospital, where intraoperative magnesium sulfate injections were frequently performed for postoperative analgesia. The patients were grouped based on whether treated with magnesium or not (magnesium vs. control groups). We investigated postoperative blood glucose levels and sliding scale insulin requirements. After propensity matching, 170 patients were allotted to each group. Both the mean glucose level and the incidence of a mean glucose level of >200mg/dL were significantly lower in the magnesium group than in the control group (p = 0.040 and 0.013, respectively). There was also a lower insulin requirement in the magnesium group (p = 0.043). Multivariate logistic regression revealed that magnesium treatment was significantly related to a less frequent incidence of a mean blood glucose level of >200 mg/dL (p = 0.047). This study demonstrated that magnesium sulfate infusion was associated with an improved postoperative blood glucose profile in patients with diabetes.

Magnesium sulphate activates the L-arginine/NO/cGMP pathway to induce peripheral antinociception in mice

In the present study, we investigated whether magnesium sulphate activates the L-arginine/NO/cGMP pathway and elicits peripheral antinociception. The male Swiss mice paw pressure test was performed with hyperalgesia induced by intraplantar injection of prostaglandin E2. All drugs were administered locally into the right hind paw of animals. Magnesium sulphate (20, 40, 80 and 160 μg/paw) induced an antinociceptive effect. The dose of 80 μg/paw elicited a local antinociceptive effect that was antagonized by the non-selective NOS inhibitor, L-NOArg, and by the selective neuronal NOS inhibitor, L-NPA. The inhibitors, L-NIO and L-NIL, selectively inhibited endothelial and inducible NOS, respectively, but were ineffective regarding peripheral magnesium sulphate injection. The soluble guanylyl cyclase inhibitor, ODQ, blocked the action of magnesium sulphate, and the cGMP-phosphodiesterase inhibitor, zaprinast, enhanced the antinociceptive effects of intermediate dose of magnesium sulphate. Our results suggest that magnesium sulphate stimulates the NO/cGMP pathway via neuronal NO synthase to induce peripheral antinociceptive effects.

Association between the prolonged use of magnesium sulfate for tocolysis and fracture risk among infants.

In 2013, the U.S. Food and Drug Administration issued a safety warning that cautioned against using magnesium sulfate (MgSO4) injections for more than 5 to 7 days to stop preterm delivery due to the bone problems subsequently observed in infants. However, the warning was mainly based on case reports, and further investigation is necessary to determine whether prolonged MgSO4 use increased infant fractures.To evaluate whether prolonged MgSO4 use for tocolysis increased the risk of subsequent fractures among infants.A retrospective population-based cohort study was conducted with a new-user study design using the National Health Insurance Database in Taiwan. We included pregnant women aged between 12 and 55 years old who delivered a live-born singleton. The enrollment period was from January 1, 2012 to December 31, 2014. The exposure group was defined as pregnant women who received MgSO4 injection for >5 days during pregnancy, while those not receiving any tocolytics were the reference group. The outcome was any bone fracture among the infants during the 2-year follow-up period. Propensity score matching and Cox proportional hazards regression models were used to estimate the hazard of fractures. We further studied the effect of MgSO4 treatment with varied dosages and durations of treatment in the sensitivity analyses.Among the 4092 pregnant women in the database, 693 (16.9%) of them were included in the exposure group. The hazard ratio of infant fractures among prolonged MgSO4 users was not significantly different from that of tocolytic nonusers in adjusted models (adjusted hazard ratio (aHR) = 1.48; 95% confidence interval (CI) = 0.59–3.71). A similar lack of significance was found in the sensitivity analyses (aHR = 1.45; 95% CI = 0.40–5.28 for larger treatment dosage; aHR = 2.52; 95% CI = 0.49–12.98 for longer treatment duration).Prolonged MgSO4 tocolysis use did not increase the risk of infant fractures. Our findings reconfirmed the safety of MgSO4 as a tocolytic treatment.

Pain, Drug Leakage and Inflammation Associated with Intramuscular Injections of Magnesium Sulfate in Preeclamptic Women: A Descriptive Study

Introduction: Magnesium sulfate (MgSO4) is the drug of choice for preventing and treating convulsions in severe preeclampsia and eclampsia by intramuscular (IM) and IV (IV) regimen. Repeated IM injections of MgSO4 at the same site causes pain, drug leakage, and injection site inflammation. To manage IM injection-related complications, it is important to have an estimation of these adverse effects. Objective: To evaluate the pain, drug leakage, and inflammation associated with IM injections of MgSO4. Material and Methods: A longitudinal descriptive study was carried out in the labor room, PGIMER, Chandigarh. Thirty study participants diagnosed and admitted with preeclampsia were recruited by the total enumeration sampling technique. Each patient received eight IM injections of MgSO4 on the dorsogluteal site as prescribed by the obstetrician. Identification details, clinical, and biophysical characteristics were collected. The pain was assessed by a numerical rating scale (NRS). Sterile blotting paper was used to assess the drug leakage by measuring the wet area of the blotting paper and recording in cm2. A gridded transparent sheet was used for measuring inflammation. The area of the swelling marked and measured by placing the gridded transparent sheet over the swelling and recording in cm2. Results: Pain and drug leakage was significantly increased from the first injection to the eighth injection ( P &lt; .05) and inflammation of 100.60 ± 21.23 (Right), 102.07 ± 21.23 (left) cm2 recorded over the buttocks. Conclusion: Significant increase in pain, drug leakage, and inflammation were recorded during the IM administration of MgSO4. For reducing the pain, drug leakage, and inflammation, nonpharmacological interventions and different techniques of IM injections are recommended.