Magnesium Sulfate In Patients Research Articles

Attenuation of acute postoperative pain and opioid requirement with the use of magnesium sulfate in patients undergoing limb amputations

Objective: To compare the effects of magnesium sulphate on the total dose of intravenous morphine consumption postoperatively following limb amputations along with rescue analgesia requirement, pain scores and side effects. Method: The prospective, triple-blinded, randomised controlled study was conducted from October 2021 to May 2022 at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised patients scheduled for limb amputations. They were randomised into 2 equal groups. The anaesthesia protocol was uniform for all patients. Intervention group A was administered 30mg/kg loading dose and 10mg/kg/hr maintenance dose of magnesium sulphate intravenously, while patients in control group B received the same amount of plain isotonic saline. Morphine consumption was measured for 24 hours postoperatively and included rescue analgesia, if required by the patient in the post-anaesthesia care unit, and patient-controlled analgesia. Numeric rating scale was used for the evaluation of postoperative pain in both groups at 15min, 1h, 2h, at discharge from the post-anaesthesia care unit and at 12h and 24h in the ward. Data was analysed using SPSS 23. Results: Of the 24 patients enrolled, the study was completed by 20(83.33%). There were 10(50%) patients in group A; 8(40%) males and 2(20%) females with mean age 24.8±14.14 years and mean surgery time 130.5±47.86 minutes. There were 10(50%) patients in group B; 8(40%) males and 2(20%) females with mean age 23.2±7.4 years and mean surgery time 117±23.85 minutes (p>0.05). Total morphine used over 24 hours in group A was 16±3.1mg compared to 29.6±11.2mg in group B (p<0.05). The time for first use of patient-controlled analgesia after arriving in the post-anaesthesia care unit was significantly delayed in group A 72.2±24.95 minutes compared to that in group B 25±26.68 minutes (p<0.05). Pain scores were significantly higher in the group B at 15min compared to group A (p<0.05), but not at the rest of the time points (p>0.05). Conclusion: Intravenous magnesium sulphate proved to be effective in lowering postoperative opioid requirement following limb amputations. Key Words: Postoperative pain, Analgesia, Amputation, Surgical amputation, N-methyl-D-aspartate receptors, Magnesium, Magnesium sulphate, Opioid analgesics, Morphine, Patient-controlled analgesia.

Magnesium sulphate in patients with thrombotic thrombocytopenic purpura (MAGMAT): a randomised, double-blind, superiority trial.

Studies have suggested benefits from magnesium sulphate in thrombotic thrombocytopenic purpura (TTP). We aimed to measure the effects of magnesium sulphate supplementation on TTP recovery. In this multicenter, randomised, double-blind, controlled, superiority study, we enrolled adults with a clinical diagnosis of TTP. Patients were randomly allocated to receive magnesium sulphate (6g intravenously followed by a continuous infusion of 6g/24h for 3days) or placebo, in addition to the standard treatment. The primary outcome was the median time to platelet normalisation (defined as a platelet count ≥ 150 G/L). Efficacy and safety were assessed by intention-to-treat. Overall, we enrolled 74 participants, including one who withdrew his/her consent. Seventy-three patients were further analyzed, 35 (48%) allocated to magnesium sulphate and 38 (52%) to placebo. The median time to platelet normalisation was 4days (95% confidence interval [CI], 3-4) in the magnesium sulphate group and 4days (95% CI 3-5) in the placebo group. The cause-specific hazard ratio of response was 0.93 (95% CI 0.58-1.48, p = 0.75). The number of patients with ≥ 1 serious adverse reactions was similar in the two groups. By day 90, four patients in the magnesium sulphate group and two patients in the placebo group had died (p = 0.42). The most frequent adverse event was low blood pressure occurring in 34% in the magnesium sulphate group and 29% in the placebo group (p = 0.80). Among patients with TTP, the addition of magnesium sulphate to the standard of care did not result in a significant improvement in time to platelet normalisation.

Trends in Perioperative Magnesium Sulfate Use in Patients Who Underwent Major Cancer Surgery: A Retrospective Population-Based Cohort Study in South Korea.

Magnesium sulfate is a potential anesthetic adjunct in cancer surgery. However, no definite consensus exists on the use of magnesium sulfate in patients undergoing major cancer surgery. This study aimed to examine the trends and factors associated with magnesium sulfate administration in patients who underwent major cancer surgery in South Korea. In this retrospective and population-based cohort study, we used 5-year health data that were extracted from the National registration database in South Korea from January 1, 2016 to December 31, 2020. All adult patients who underwent major cancer surgery during 2016-2020 in South Korea were included. In total, 253,538 patients were included. Among these patients, 6.6% (16,708/253,538) were administered magnesium sulfate during major cancer surgery. In multivariable logistic regression modeling, older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.02-1.02; P < .001), esophageal cancer surgery (vs lung cancer surgery [OR, 3.04; 95% CI, 2.80-3.30; P < .001]), increased Charlson comorbidity index score (OR, 1.03; 95% CI, 1.02-1.03; P < .001), mild-to-moderate disability (OR, 1.08; 95% CI, 1.03-1.14; P = .003), and severe disability (OR, 1.16; 95% CI, 1.05-1.27; P = .003) were associated with a higher incidence of perioperative magnesium sulfate administration for major cancer surgery. Video-assisted thoracoscopic surgery or laparoscopy (OR, .57; 95% CI, .55-.59; P < .001) and propofol-based total intravenous anesthesia (OR, .86; 95% CI, .82-.89; P < .001) were associated with a lower incidence of perioperative Mg sulfate administration for major cancer surgery. In South Korea, 6.6% of the patients who underwent major cancer surgery were administered magnesium sulfate during surgery. Certain factors, such as old age, thoracic cancer surgery, open laparotomy or thoracotomy, greater comorbid status, and inhalation anesthesia, were potentially associated with magnesium sulfate administration in patients undergoing major cancer surgery.

Myocardial and renal protective effects of Dexmedetomidine vs Magnesium sulphate in patients undergoing elective open abdominal aortic surgery

Myocardial and renal protective effects of Dexmedetomidine vs Magnesium sulphate in patients undergoing elective open abdominal aortic surgery

Application Analysis of Magnesium Sulfate in Patients with Preeclampsia Caused by Elective Cesarean Section

Application Analysis of Magnesium Sulfate in Patients with Preeclampsia Caused by Elective Cesarean Section

Analysis on Clinical Outcomes of Low-Molecular Weight Heparin Combined with Magnesium Sulfate in Patients with Pre-Eclampsia.

We aimed to investigate the clinical effect of low molecular weight heparin (LMWH) combined with magnesium sulfate in patients with severe pre-eclampsia (PE). A total of 70 patients with severe PE admitted in Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, China from Jun 2020 to May 2021 were enrolled and randomized into observation and control groups. The control group was treated with magnesium sulfate only, and the observation group was treated with small-dose LMWH combined with magnesium sulfate. The clinical effects and artery blood flow index were analyzed. The observation group had higher coagulation function than that in the control group. RI, S/D, and PI in the observation group after treatment were lower than those in the control group, with statistically significant differences (P <0.05). In serum and placental tissues, both kininase expression and TGF-1 levels of the observation group were higher than those of the control group, with lower PAPP-A, VCAM-1 and E selectin levels than those in the control group. Small-dose LMWH combined with magnesium sulfate can promote the expression of endogenous kallikrein, weaken the infiltration of cytotrophoblast, and improve the maternal blood clotting state in patients with severe PE. It also improves placental microblood flow and effectively prolong pregnancy, promotes fetal growth, and improves the clinical effects.

Comparative evaluation of incidence of post operative sore throat after nebulization with ketamine and magnesium sulfate in patients undergoing general anaesthesia requiring endotracheal intubation

Post-operative pharyngeal discomfort or sore throat is unavoidable outcome of endotracheal intubation. There are some pharmacological and non-pharmacological methods for prevention of postoperative sore throat. Nebulization is better than gargle or other methods as small volume of drug required for effect, easy way of administration, better patient compliance and most importantly no risk of aspiration as seen with gargle. In our study, 88 patients of ASA grading I- Ⅲ, aged between 18-65 years undergoing general anaesthesia on elective basis were randomly divided into two groups. 44 patients received pre-operative nebulization with 1ml ketamine(50mg) with 1ml normal saline while others received nebulization with 500mg Magnesium sulfate with 1ml normal saline. General anaesthesia was given. Number of intubation attempts, duration of laryngoscopy and duration of surgery were recorded. Patients were evaluated for post-operative sore throat, hoarseness of voice and cough at 0hr, 2hr, 4hr, 12hr, and 24hr in postoperative period. Incidence of post-operative sore throat, cough and hoarseness of voice was reduced statistically significantly with ketamine nebulization when compared to magnesium sulphate nebulization (p=&amp;#60;0.05). There were no systemic side effects with any drug. Ketamine nebulization was superior than magnesium nebulization in prevention of sore throat.

Comparison of Hemodynamic Response after Pneumoperitoneum with Versus without Pre-Emptive Magnesium Sulphate in Patients Undergoing Laparoscopic Cholecystectomy

Objective: To compare the hemodynamic response after pneumoperitoneum with versus without pre-emptive magnesium sulphate in patients undergoing laparoscopic cholecystectomy. Study Design: It was a randomized controlled trial Setting: Research was conducted at Department of Anesthesiology Lahore General Hospital, Lahore. Materials and Methods: This study involved 104 patients of both genders aged between 18-70 years undergoing laparoscopic cholecystectomy which were randomly divided into two treatment groups. Patients in Group-A received pre-emptive magnesium sulphate while patients in Group-B were received normal saline as placebo. Outcome variable was hemodynamic response to pneumoperitoneum. It was assessed in terms of mean heart rate, mean diastolic and systolic blood pressure after 30 minutes of pneumoperitoneum which were measured and compared between the two groups. Results: The mean age of the patients was 44.8±9.2 years while the mean BMI was 25.3±2.7 Kg/m2. There were 31 (29.8%) male and 73 (70.2%) female patients with a male to female ratio of 1:2.4. 63 (60.6%) patients belonged to ASA Class-I while 41 (39.4%) patients belonged to ASA Class-II. The mean heart rate (80.8±4.5 vs. 87.7±5.0 bpm; p-value&lt;0.001), mean diastolic BP (77.6±6.7 vs. 84.9±6.0 mmHg; p-value&lt;0.001) and mean systolic BP (133.3±8.2 vs. 140.6±8.9 mmHg; p-value&lt;0.001) were significantly lower after 30 minutes of pneumoperitoneum in patients receiving magnesium sulphate as compared to normal saline. Conclusion: Pre-emptive magnesium sulphate attenuated the hemodynamic response of pneumoperitoneum evident from significantly lower mean heart rate and means diastolic and systolic blood pressure after 30 minutes of pneumoperitoneum as compared to controls which advocate its preferred use in future practice. Keywords: Pneumoperitoneum, Hemodynamic Response, Magnesium Sulphate

Pre-emptive Analgesic Efficacy of Low Dose Ketamine versus Magnesium Sulfate in Patients Undergoing Major Abdominal Surgeries Under General Anaesthesia: A Randomised Clinical Study

Introduction: Pre-emptive analgesia has been proposed to result in better pain management, reduced analgesic consumption, and improved patient satisfaction. Aim: To evaluate pre-emptive analgesic efficacy of intravenous ketamine and intravenous magnesium sulfate in patients undergoing major abdominal surgeries under general anaesthesia by administering it 10 min before the incision. Materials and Methods: This randomised, double-blind, clinical study, was conducted in JLN Medical College, Ajmer, Rajasthan, India, from November 2019 to November 2020. The study included 100 patients, aged 18-60 years of American Society of Anesthesiologists (ASA) physical status I and II were randomly allocated into two groups. Group K (n=50) received intravenous (i.v.) ketamine infusion 0.3 mg/ kg in 100 mL normal saline over 10 minutes. Group M (n=50) received i.v. magnesium sulfate (mgso4) infusion 30 mg/ kg in 100 mL normal saline over 10 minutes. The duration of analgesia, total amount of rescue analgesic consumed in 24 hours, haemodynamics, and side-effects were noted. The quantitative data was presented as mean±standard deviation and were compared by student’s t-test. Results: Duration of analgesia was significantly prolonged in group K (67.96±9.20 min) as compared to group M (30.60±6.44 min) (p-value&lt;0.001). The total dose of rescue analgesic consumption in 24 hours was lesser in group K (1180±388.09) as compared to group M (1280±453.56) (p-value=0.236). Haemodynamics and side-effect profile were comparable in the two groups. Conclusion: In major abdominal surgeries under general anaesthesia, patients getting ketamine have longer duration of analgesia compare to magnesium sulfate, have an improved quality of recovery after surgery and less serious adverse events in the Postanesthesia Care Unit (PACU). Ketamine reduces the need for intraoperative opioids and could suppress the pressure response to endotracheal intubation.

Comparison Between Epidural Bupivacaine with and without Magnesium Sulphate in Patients Undergoing Elective Total Abdominal Hysterectomy: A Double-blinded Randomised Clinical Trial

Introduction: The effectiveness of a local anaestheticis increased by the addition of an adjuvant. Magnesium sulphate along with bupivacaine is effective in reducing the pain and extending the analgesia period. Aim: To compare the duration of analgesia among subjects receiving plain bupivacaine and bupivacaine with magnesium sulphate among patients undergoing total abdominal hysterectomy. Materials and Methods: This double-blinded randomised clinical trial was conducted in Department of Anaesthesiology at Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu, India, (tertiary care center) between November 2019 and October 2021. The study was done among 50 subjects undergoing elective total abdominal hysterectomy. The subjects were divided into two groups, one group received only bupivacaine while the other group received bupivacaine with 500 mg magnesium sulphate. Onset and duration of blocks were observed. Haemodynamic parameters were monitored intraoperatively and postoperatively. Data was analysed using Chi-square test, Fischer’s exact test. Results: Demographic variables like age (p-value=0.17), height (p-value=0.62), weight (p-value=0.14) and BMI (p-value=0.24) were comparable between the two groups. The mean duration of analgesia was significantly more among the bupivacaine and magnesium sulphate group (416.72±93.6) in comparison to the bupivacaine alone group (204.56±71.25). The bupivacaine and magnesium sulphate group required two doses of rescue analgesia in 24 hours, while the other group required four doses of analgesia. Significantly more side-effects were noted among the bupivacaine alone group (12 vs 6) (p-value=0.04). Conclusion: The study showed that bupivacaine and magnesium sulphate group showed less intraoperative side effects, reduced postoperative VAS score increased duration of analgesia, decreased requirement of analgesia required in 24 hours and reduced postoperative side-effects.

Effect Of Pre-Emptive Magnesium Sulfate In Pain Relief After Elective Cesarean Sections

One of the most important things concerning surgeries is pain and its consequences on the patient and his general condition. So, we have to decrease pain following surgeries as much as we can to achieve optimum pain relief for the patients passing surgeries. A lot of studies and researches have been focused on the usage of magnesium sulfate (MgSo4) preoperatively to assess its effect in decreasing pain postoperatively to elective cesarean sections. To assess the analgesic efficacy in decreasing pain post-operatively by a preoperative single dose of intravenous magnesium sulfate in patients undergoing elective cesarean sections by the usage of two pain scales. A sixty pregnant women who underwent elective cesarean section were randomly separated into two groups. Before the induction of the anesthesia, the magnesium sulfate group (group A) received magnesium sulfate 50 mg/kg intraveneously (i.v) in bolus dose in 100 ml isotonic saline. The control group(group B) received the same volume of isotonic saline 0.9%(100ml). The pain score was taken at rest and movement for up to 12 hours post-operatively. There were no statistical differences regarding patients characteristics. Magnesium sulfate was very effective(statistically highly significant) in decreasing pain according to visual analogue scale and overall the four readings that detected in this clinical research and also the numeric pain scale showed that magnesium sulfate group was very effective (statistically highly effective) in three readings and effective (in the last reading). Pre-operative magnesium sulfate causes a significant reduction in pain intensity elective cesarean section.

Dexmedetomidine versus magnesium sulfate for induced hypotension during functional endoscopic sinus surgery: A randomized, double-blind study

Background: Bleeding during functional endoscopic sinus surgery (FESS) can compromise surgical field quality. Intraoperative controlled hypotension by various hypotensive agents can reduce blood loss and improves surgical field visibility with less need for intraoperative blood transfusions. This study compared the hypotensive effectiveness and safety of dexmedetomidine and magnesium sulfate in patients undergoing elective FESS. Patients and Methods: Sixty adult patients posted for elective FESS were randomly assigned to two groups. Group A received a loading dose of dexmedetomidine 1 μg/kg, followed by infusion of 1 μg/kg/h, and Group B received a loading dose of magnesium sulfate 40 mg/kg, followed by 15 mg/kg/h infusion. Surgical field quality, emergence time, sedation score, Visual Analog Scale score, recovery profile, and vital signs were recorded. Mean arterial pressure (MAP) was kept above 65 mmHg during induced hypotension. Results: Both the groups achieved the target MAP (65–70 mmHg) and improved the surgical field visibility with reduced blood loss. Hemodynamics was superior in the dexmedetomidine group with the additional advantage of postoperative conscious sedation and analgesia (P 0.05). Conclusions: Both dexmedetomidine and magnesium sulfate are safe agents for controlled hypotension for improving surgical field quality. Dexmedetomidine provides an additional benefit of reducing the analgesic requirements and providing postoperative sedation.

Comparative study of subarachnoid injection of dexmedetomidine versus magnesium sulfate as adjuvants to bupivacaine in patients undergoing classical repair surgery

Background Spinal anesthesia has several benefits over general anesthesia. Addition of adjuvants to local anesthetics improves the quality of the subarachnoid block. Objective We attempted to improve the quality of spinal anesthesia by the addition of magnesium sulfate or dexmedetomidine to intrathecal bupivacaine in patients undergoing classical repair surgery as regards primary outcome (quality of spinal anesthesia) and secondary outcomes (effect on hemodynamics and incidence of complications). Patients and methods This prospective randomized double-blinded controlled clinical study was carried out on 75 adult female patients scheduled for classical repair surgeries under spinal anesthesia who were assigned into three equal groups. Group D: 15 mg of 0.5% hyperbaric bupivacaine plus 10 μg dexmedetomidine was given to the patients. Group M: patients received 15 mg of 0.5% hyperbaric bupivacaine plus 0.5 ml magnesium sulfate (50 mg). Group C: patients received 15 mg of 0.5% hyperbaric bupivacaine plus 0.5 ml normal saline as control. The comparison was made among the three groups in regards to onset time of sensory and motor block, degree of postoperative pain relief, effect on hemodynamic stability, and total postoperative morphine consumption, and complications were recorded. Results There was a statistical difference among the three groups as regards the onset time of both sensory and motor block, which was faster in group D than in group C, and both were faster than group M. The duration of postoperative analgesia was significantly prolonged in D and M groups compared with the control group. The requirements of morphine sulfate in the first 24 h were significantly lower in the D and M groups compared with the control group. Conclusion Subarachnoid dexmedetomidine supplementation of spinal block was found to be a better option than intrathecal magnesium sulfate in patients undergoing classical repair surgeries, as it provides rapid onset of sensory and motor block; also, it improves the quality of postoperative analgesia and reduces postoperative analgesic requirements.

THE EFFICACY OF MAGNESIUM SULPHATE ON EMERGENCE AGITATION IN ADULTS FOLLOWING NASAL SURGERIES

Background: Emergence agitation (EA), although short-lived, is potentially harmful to the patient and the recovery staff. In the postoperative care unit, an agitated patient requires more nurses to control his abnormal movement and apply restrains that could result in bruises of his extremities. Objectives: The objective of the study was to investigate efficacy of intraoperative magnesium sulphate on prevention of EA in adults undergoing nasal surgeries under sevoflurane anesthesia. Primary outcome of the study was to compare incidence of EA between magnesium and control group. The secondary outcome was to assess pre-operative hemodynamic parameters, sedation scores, emergence time and quality of recovery in both study groups. Patients and Methods: The present study was conducted in the Al-Hussein University Hospital, following approval from the Ethics Committee of the hospital. This study included 70 adult patients of American Society of Anesthesiologists physical status I and II between 20 and 40 years of age of both sexes, non-smokers, with BMI less than or equal to 30, posted for nasal surgery under general anesthesia in which nasal packing on each side was used postoperatively. Thorough pre-anesthetic evaluation was done. Results: In patients undergoing nasal surgeries, intraoperative administration of magnesium decreased the incidence and severity of postoperative agitation, ameliorated postoperative pain and shortened stay in the PACU Conclusion: The intraoperative administration of magnesium sulphate in patients undergoing nasal surgeries decreased postoperative agitation, pain intensity and pethidine consumption in the early postoperative period. Intraoperative administration of saline did not decrease post operative agitation, pain intensity and pethidine consumption in the early postoperative period.

A comparative study of epidural bupivacaine and epidural bupivacaine with magnesium sulphate for perioperative analgesia in patients undergoing lower limb surgery

Aims and objectives: The aim of the study was to compare epidural plain bupivacaine and plain bupivacaine with magnesium sulphate in patients undergoing elective lower abdominal surgery. Methodology: This Randomized parallel group double-blind controlled study was conducted on 60 patients of elective lower limb surgery. Group B received 0.5% bupivacaine +normal saline1ml of 0.9% and Group BM received 0.5% bupivacaine+ magnesium sulphate (1ml) containing 50mg Bupivacaine.Results: Both the drugs provided post-operative analgesia. Time for onset of sensory block in the two groups and there was significant difference between two groups in respect of onset of sensory block. The onset of block was significantly less in group BM compared to group B. The mean onset of sensory block (mean ± SD) was Group B-15.57±2.27 minutes and Group BM-12.93±1.14 minute. The time for onset of motor block, duration of sensory block, duration of motor block and duration of analgesia in the two groups and there was no significant difference. Visual analogue scale (VAS) score, Verbal rating scale (VRS) score and no of rescue analgesia by the patients in the two groups and there was no significant difference.Conclusion: Single dose epidural administration of 0.5% bupivacaine hydrochloride with 50mg magnesium sulphate produces predictable rapid onset sensory block with less side effect than plain 0.5% bupivacaine hydrochloride.

Efficacy of Simultaneous Administration of Nimodipine, Progesterone, and Magnesium Sulfate in Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial.

Objective:To investigate the safety and efficacy of simultaneous administration of nimodipine, progesterone, magnesium sulfate in patients suffering from severe traumatic brain injury (TBI).Methods:Overall, 90 patients with blunt head trauma who were admitted to the Besat hospital, Hamadan University of Medical Sciences, Iran through the Emergency Department in 2017 to 2018 were randomly assigned to the study or control groups each containing 45 patients. In the study group, intravenous nimodipine 60 mg every 12 hours for 5 days, intramuscular progesterone 1 mg/kg daily for 5 days, and magnesium sulfate 5 grams stat followed by 2.5 grams every 4 hours for 21 days were administered. Daily GCS and jugular venous oxygen saturation (SjvO2) of the patients were measured on admission day (day 0) through hospitalization day 4 at the intensive care unit. Then, all patients were visited at three months after discharge.Results:The mean age of the patients was 31.4 ± 12.8 years including 59 (65.6%) men with no significant difference between the groups. The baseline GCS and SjvO2 of the patients were comparable in both groups, however, GCS of the patients in the study group were significantly higher in the next 4 hospitalization days compared to the controls. Whereas, the SjvO2 of the patients were not significantly different between the groups during these days. Three-month mortality rate of the patients in the study group was significantly lower than the three-month mortality rate of the patients in the control groups (22.2% vs. 42.2%, p=0.042).Conclusion:Administration of combined protocol of magnesium sulfide, progesterone and nimodipine may be safe and effective in patients suffering from severe TBI.Clinical Trial Registry:IRCT201210229534N2

The perioperative effect of magnesium sulfate in patients with concentric left ventricular hypertrophy undergoing cardiac surgery: A double-blinded randomized study.

Objective:The objective of this study was to assess the cardioprotective effect of magnesium sulfate in patients with left ventricular concentric hypertrophy undergoing cardiac surgery.Design:The study was a double-blinded randomized study.Setting:This study was conducted at a cardiac center.Patients:The study included 250 patients.Intervention:The study included two groups (each = 125): Group M – the patients who received magnesium sulfate infusion (15 mg/kg/h). The infusion was started 20 min before induction, during surgery, and the first postoperative 24 h. Group C – the patients who received an equal amount of normal saline.Measurements:The variables included troponin I level, creatinine kinase-MB (CK-MB) level, electrocardiograph (ECG) with automatic ST-segment analysis (leads II and V), E/A peak ratio, end-diastolic volume, cardiac index (CI), heart rate, mean arterial blood pressure (MAP), mean arterial pulmonary pressure (mPAP), pulmonary and systemic vascular resistances, and pharmacological and mechanical support.Main Results:The troponin I level, CK-MB, and ECG changes were lower in Group M than Group C (P < 0.05). The E/A peak ratio and end-diastolic volume increased in Group M than Group C (P < 0.05). There was a significant increase in the CI and a decrease in the heart rate, mPAP, pulmonary vascular resistances, and pharmacological and mechanical support in Group M compared to Group C (P < 0.05). There were minimal changes in the MAP and systemic vascular resistance in Group M compared to Group C (P < 0.05).Conclusion:The magnesium sulfate provides a cardioprotective effect in patients with concentric ventricular hypertrophy undergoing cardiac surgery. It decreases the incidence of perioperative myocardial infarction and arrhythmia. Furthermore, it decreases the requirement of pharmacological and mechanical support.

Comparison of Intra-Peritoneal Instillation of Bupivacaine and Morphine Hydrochloride versus Bupivacaine and Magnesium Sulfate for Post-Operative Pain Relief after Laparoscopic Cholecystectomy, A Randomized Double-Blind Comparison Study

Background: Surgical and laparoscopic techniques are two different methods for the removal of gall bladder. Today, laparoscopic cholecystectomy is a preferred method for short-term hospitalization and early return to function related to minimal invasive surgical technique. However, patients still complain of significant postoperative pain, secondary inflammation of the diaphragm and the nociceptive genus of the annoying membrane's peritoneum. Multimodal analgesia is necessary for managing pain after laparoscopic cholecystectomy. Magnesium sulfate is a new emerging medication for the management of acute pain. There are no previous reports to compare the analgesic effect of intraperitoneal instillation of bupivacaine plus morphine hydrochloride and bupivacaine plus magnesium sulfate for postoperative pain after laparoscopic cholecystectomy. Aim: The purpose of this study is to compare the analgesic effect of intraperitoneal instillation of bupivacaine plus morphine hydrochloride versus bupivacaine plus magnesium sulfate in patients undergoing laparoscopic cholecystectomy under general anesthesia for better pain relief and less opioid consumption during the first 24 hours. Methods: Following the approval of the Institutional Review Board of An-Najah National University and written informed consent from patients undergoing laparoscopic cholecystectomy, hundred patients between 18 and 60 years old, American Society of Anesthesiologist (ASA) Grades I and II, were randomized to one of the following groups by the sealed envelope: (Mo group) (n=50) receiving intraperitoneal instillation of 30 ml 0.25% bupivacaine and 3 mg morphine and (Mg group) (n=50) receiving intraperitoneal instillation of 0.25% bupivacaine plus 50 mg/kg magnesium sulfate to a total volume of 30 ml. Medications were given after peritoneal wash and suctioning through intraperitoneal instillation. A drug solution is prepared by a doctor who does not participate in the study. All patients received the same anesthesia method, general anesthesia was administered. The induction protocol was standard for all patients. Patients were monitored for electrocardiogram (ECG), heart rate, blood oxygenation (SpO2%) and noninvasive blood pressure (NIBP). Postoperative pain was evaluated using visual analog scale (pain score of 0-10). The participants were evaluated for 24 hours after the operation with the registration of abdominal pain. The postoperative pain outcome was reported at 0 and 30 min, 1, 4, 8, 12, 16 and 24 hours. The cut-off value for VAS is 4 for indication of rescue medication. At VAS ≥ 4, rescue analgesics were administered on request (20 mg of pethidine) intravenously in Post Anesthetic Care Unit (PACU) and 50 mg intramuscularly in the surgical ward. Results: Patients' characteristics of age, gender and BMI were comparable in the two groups. There was no significant difference between the groups regarding the duration of the surgery. The demographic parameters (age, gender and BMI) have no effect on the mean of VAS (p value>0.05). There are significant differences between Mo and Mg groups in the total VAS score (p value<0.05). In the Mo group, the mean of total VAS (2.09) was significantly lower than the mean of total VAS in the Mg group (2.71); which means that patients in the Mo group had significantly less intensity of pain than patients in the Mg group (p=0.006). There is a significant difference between the number (percent) of patients complaining of moderate to severe postoperative pain in Mo group 15/50 (30%) compared to Mg group 25/50 (50%) (p=0.0423). When estimating the size of the treatment effect of morphine hydrochloride plus bupivacaine, found that the relative risk reduction of moderate to severe pain postoperatively is 0.40. There is also a significant difference between the number (percent) of patients complained of drowsiness in Mo Group 7/50 (14%) compared to Mg group 18/50 (36%) (p=0.0115). There are no significant differences between the two study groups regarding nausea, vomiting, dizziness and urinary retention. Patients in Mo group consume less rescue analgesic dose M (± SD) (64.29 mg+22.04) compared to patients in Mg group M (± SD) (74.40 mg+25.67) without significant relationship between both doses (p-value=0.163). Blood pressure, heart rate and oxygen saturation were examined as hemodynamic parameters. The result showed that no significant relationship between these parameters and VAS (p-value>0.05). Conclusion: Intraperitoneal instillation of combination of bupivacaine with morphine hydrochloride is superior to bupivacaine plus magnesium sulfate to reduce the intensity and incidence of postoperative pain in patients undergoing laparoscopic cholecystectomy surgery without significant increase of side effects. This peripheral effect of opioid provides a new approach to pain relief that can have major clinical benefits. Recommendation: Based on the results of this study, it is recommended to consider the intraperitoneal instillation of morphine hydrochloride with bupivacaine as a standard application for laparoscopic cholecystectomy surgery to reduce postoperative pain.

Magnesium Sulfate for Prophylaxis against Postoperative Atrial Fibrillation after Isolated Cardiac Valve Replacement Surgery in Adult Patients with Rheumatic Heart Disease: A Randomized Controlled Trial

Objectives: To evaluate the role of prophylactic magnesium sulfate administration in preventing postoperative atrial fibrillation (POAF), attenuating the inflammatory response and promoting myocardial protection after isolated cardiac valve replacement surgery in adult patients with rheumatic heart disease. Design: Prospective randomized, double-blind placebo-controlled trial. Methods: Sixty-four adult patients undergoing isolated cardiac valve replacement surgery were divided into two equal groups (32 patients in each). Patients in magnesium group (group M) received 2.5 gm of magnesium sulfate (dissolved in 100 mL of isotonic saline and infused over 2 h), twelve h preoperatively, within the first hour of ICU arrival, and on the 2nd and 3rd postoperative days (group M). Patients in the control group (group C) received a placebo of isotonic saline at the same time periods. Results: Prophylactic magnesium sulfate significantly decreased the incidence of POAF compared to the placebo group (P=0.005). White blood cell (WBC) count showed no significant difference between the two groups. C-reactive protein (CRP) level showed significant reduction during the 3rd, 4th, and 5th postoperative days in group M compared to group C (P=0.001, 0.001 & 0.012 respectively). Serum level of interleukin-6 (IL-6) showed a significant reduction on the 5th postoperative day in group M compared to group C (P=0.001). Both groups showed no significant differences in serum levels of troponin I during the study. Conclusion: Prophylactic use of magnesium sulfate in patients with rheumatic heart disease undergoing isolated cardiac valve replacement surgery can decrease the incidence of POAF. It may play a role in attenuating the inflammatory process associated with the use of cardiopulmonary bypass (CPB).

Role of magnesium sulphate in ischemic stroke

Objective: To evaluate the role of magnesium sulphate in patients presenting with ischaemic stroke. Methods: This experimental type of interventional study was carried out at Mayo Hospital, Lahore. Within 24 hours of onset of clinically diagnosed stroke, which was later confirmed by CT scan, patients were randomized to receive either magnesium sulphate (16mmol IV over 15 minutes and 65mmol over 24 hours) or placebo. Their disability was measured by Barthel score at presentation and outcome measured after three months by death and disability and the results were compared between the two groups. Those patients who had a Barthel score of = 12 at three months were considered independent and those with a score of &lt; 12 were considered disabled. The results were analyzed by SPSS. Results: Fifty patients were recruited in the study. 25 patients were randomized to receive MgSO4 and 25 received placebo. The Barthel score improved from 5.13.3 at presentation to 13.53.4 after three months in all the patients so the re was improvement whether MgSO4 was given or not. Patients who were randomized to receive MgSO4 had a lower Barthel score of 4.22.9 as compared to controls 5.9 3.5, but after three months they improved more than the controls gaining a score of 15.71.9 versus 11.33.2 (p=0.000). The mortality rate was not statistically different in the two groups. 88% patients had a Barthel score of &gt; 12 at three months in the MgSO4 and 30% in the control/placebo group. Combined death and disability was 8% in MgSO4 group and 60% in the control group. Moreover MgSO4 was well tolerated. Conclusion: Magnesium sulphate therapy was safe in patients presenting with ischaemic stroke irrespective of the site of infarct. It improves prognosis regarding Barthel score at three months as well as the difference in the Barthel score at presentation and at three months. A greater percentage of magnesium treated patients led independent lives after three months.