Use Of Magnesium Sulfate Research Articles

Premature rupture of the amniotic membrane: what’s new in its management and delivery tactics?

Background. Premature rupture of the amniotic membranes (PRAM) is a spontaneous rupture before the onset of labor at 22-37 weeks. The main complications of PRAM for mother and fetus include infection, premature birth, asphyxia of the fetus during labor, and the increased frequency of cesarean sections. Deformations of extremities, face and lungs are observed in case of a long oligohydramnion (>3 weeks).
 Objective. To describe the features of the management of pregnant women with PRAM.
 Materials and methods. Analysis of literature sources on this topic.
 Results and discussion. Gynecological and extragenital pathology of mother, genetic predisposition, adverse environmental factors and infections are risk factors for PRAM. Prevention of PRAM includes detection and treatment of urogenital infections, quitting of smoking and alcohol intake, screening for bacteriuria and bacteriological culture for β-hemolytic streptococcus (BHS) at 35-37 weeks of pregnancy. From 22 to 34 weeks of pregnancy, pregnant women with PRAM are hospitalized to the tertiary level hospitals, since 35 weeks care can be provided in secondary level hospitals. The management algorithm is the following: 1) history taking; 2) establishment of gestational age; 3) establishment of the approximate time of PRAM; 4) general physical examination; 5) external obstetric examination; 6) cardiotocogram (CTG), tests of fetal movements (TFM), ultrasonography (US); 7) blood test with leukocyte formula, determination of C-reactive protein; 8) bacterioscopic examination of vaginal discharge; 9) collection of amniotic fluid for microbiological examination, study of rectogenital smear for BHS; 10) sanitation of the vagina with a solution of antiseptic decamethoxine after collection of vaginal secretions and amniotic fluid. PRAM management involves active or waiting tactics. Waiting tactic includes monitoring of the fetus and mother (thermometry and pulsometry, the number of leukocytes and C-reactive protein, bacterioscopy of vaginal discharge, CTG, TFM, US). Antibiotic prophylaxis (semi-synthetic penicillins + macrolides, reserve – second-generation cephalosporins) in PRAM significantly prolongs the latent phase of delivery, reduces the incidence of infections in both mother and newborn, reduces the need for surfactant and oxygen therapy. In the presence of chorioamnionitis, delivery should be performed within <12 hours. In case of PRAM in the term of 24-34 weeks the course of corticosteroids is administered. Delivery delay for 48 h for steroid prophylaxis is the main indication for tocolysis in PRAM. In general, the tactics of pregnancy management in PRAM at 24-34 weeks include monitoring of the mother and fetus, steroid prophylaxis, tocolytic therapy and the use of magnesium sulfate. Waiting tactic should be followed until 34 weeks. In women with PRAM without contraindications to prolonging pregnancy, the waiting tactic is accompanied by better results for both mother and fetus. Signs of infection or other complications of pregnancy indicate the need for termination of the waiting tactic and delivery management according to the clinical situation. Within 34-37 weeks, the waiting tactic is followed for 24 hours. Antibiotic prophylaxis is prescribed after 18 hours of anhydrous interval, and in case of BHS – immediately after PRAM. In the absence of active labor process, an internal obstetric examination is performed to decide the tactics of delivery. Other procedures include cervix preparation, induction of labor and washing of the vagina with decamethoxine solution. Cesarean section is indicated for PRAM at 26-32 weeks and immaturity of the birth canal.
 Conclusions. 1. Hospitalization and delivery in women with PRAM is carried out in hospitals of secondary and tertiary level. 2. Routine use of antibiotics in PRAM prolongs the latent phase of delivery and reduces the incidence of neonatal sepsis. 3. Waiting tactic in pregnant women with PRAM in the period of 24-34 weeks is accompanied by good outcomes for both mother and child. 4. Pregnant women with PRAM in 24-34 weeks should be treated with corticosteroids to prevent acute respiratory distress syndrome in neonates.

Dexmedetomidine versus MgSo4 in Hemodynamic Stability in Laparoscopic Cholecystectomy Cases

Laparoscopic surgery is associated with an elevation of cardiac parameters as well an elevation in blood pressure due to effects of catecholamine activity and vaso constriction. Due to the widespread use of laparoscopic techniques in modern day surgical practice it has become imperative for the anaesthetist to maintain a stable hemodynamic environment in the patient in the operative and post operative period. The use of dexmedetomidine and magnesium sulphate has been done with successfully in practice. The present study aimed to ascertain whether the comparative efficacy of both these drugs is equal or different. The study employed a subject pool of 60 subjects. The study found that there were no statistically significant differences between the two drugs when used in the corresponding sample population.

Correction of metabolic disorders in patients with aneurysmal intracranial hemorrhages

The article presents data assessment of the severity of the clinical condition and a number of biochemical parameters in 51 patients with aneurysmal intracranial hemorrhage on the 10th day, on average, after the rupture of the arterial aneurysm and after treatment with the additional use of magnesium sulfate to standard therapy in the postoperative period. It is shown, that at the time of hospitalization, 75 % of patients in the control group and 50 % of patients in the main group had cerebral vascular spasm according to transcranial dopplerography; activation of lipid peroxidation processes, a decrease in superoxide dismutase activity, an increase in the content of vascular endothelial growth factor and highly sensitive C-reactive protein (CRP) with a decrease in the level of stable nitrogen monoxide exchange products were detected. A statistically significant improvement in the clinical condition of patients on the Hunt-Hess scale, the modified Fisher scale, and an increase in the score on the Glasgow coma scale with normalization of pro- and antioxidant status of the blood were revealed in the main group after neurosurgical treatment and course use of magnesium sulfate. At the same time, high levels of highly sensitive CRP and low levels of nitrates/nitrites in the patients blood of both groups are maintained. Consequently, the additional use of magnesium sulfate improves the clinical condition of patients with intracranial hemorrhage and increases the antioxidant potential of the blood in the postoperative period.

Effectiveness of intravenous magnesium sulfate to attenuate hemodynamic changes in laparoscopic surgery: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to determine the effectiveness of intravenous magnesium sulfate when used to attenuate hemodynamic fluctuations associated with the creation of pneumoperitoneum in adults undergoing laparoscopic surgery. Laparoscopic surgery has gained popularity as a result of improved patient outcomes postoperatively, but pneumoperitoneum alters the patient's physiology and hemodynamic profile during the intraoperative period. Magnesium sulfate is a nonopioid agent known for its ability to blunt the physiologic sympathetic response associated with exposure to noxious stimuli. Magnesium sulfate may be efficacious in promoting anesthetic management that optimizes a patient's cardiopulmonary function while minimzing opioid use. Studies with participants at least 18 years old undergoing any elective laparoscopic surgery using pneumoperitoneum with CO2 insufflation were included. Studies were excluded if patients were being treated for pheochromocytoma. Studies eligible for inclusion employed any intravenous dosing strategy of magnesium sulfate, administered at any point in the perioperative period for the purpose of blunting the sympathetic response to creation of a pneumoperitoneum. The comparator utilized was normal saline. A systematic search of MEDLINE, CINAHL, Cochrane Library, Google Scholar, Trip Database, MedNar, Grey Literature Report, ClinicalTrials.gov, and ProQuest Dissertations and Theses was conducted to identify both published and unpublished studies. The search was limited to studies written in the English language and performed on human subjects. Studies were selected for review based on inclusion criteria and were appraised by two reviewers using the appropriate JBI standardized appraisal tool. Data extraction was performed for all outcome variables. Data were pooled using the JBI System for the Unified Management, Assessment and Review of Information. Mean differences (95% confidence interval) were calculated for all continuous variables. Meta-analysis using a fixed effects model was performed at various time points for heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure. Standard GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) evidence assessment was also reported. A total of six randomized controlled trials were included in the review. Meta-analysis of data for biophysical parameters (heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure) at five minutes, 10 to 15 minutes, 30 minutes after pneumoperitoneum, and at the end of surgery showed a consistent reduction in the magnesium groups compared to placebo. Support for all outcome variables was determined to be high using the GRADE criteria. The administration of magnesium sulfate consistently demonstrated improved hemodynamic measurements during laparoscopic surgery. All doses administered in the included studies proved beneficial compared to placebo. Magnesium sulfate should be considered as an adjunct agent in laparoscopic surgery to blunt the sympathetic nervous system response to surgical stimulation. The quality of the included studies was high, but small sample sizes and selection of healthy participants may limit the generalizability of the results. The use of magnesium sulfate may have improved effects on patients with significant health comorbidities, but the limitations of the included studies related to sample demographics make the evidence inconclusive. PROSPERO (CRD42019139991).

Alternative Hysterotomy Technique for the Reduction of Prenatal Complications of Intrauterine Myelomeningocele Repair

Introduction: The main aim of the fetal surgery of myelomeningocele (MMC) is the improvement in prognosis for children with this defect and at the same time high safety of the procedure for mother and fetus. Objective: The aim of the study was to determine the effectiveness of alternative hysterotomy technique for fetal surgery of MMC in prevention of essential perinatal complications. Methods: Forty-nine pregnant women diagnosed with fetal MMC (fMMC) who underwent classic hysterotomy without the use of stapler formed the study cohort. Two cases of intrauterine fetal death or neonatal death in the immediate perioperative period in the study group (SG) were excluded from further analyses. In the historical control group (46 patients) from our center hysterotomy was performed according to Management of Myelomeningocele Study (MOMS) protocol. The study cohort’s outcomes were compared with the historical controls and with post-MOMS results in Children’s Hospital of Philadelphia (CHOP) and Vanderbilt University Medical Center (VUMC). Results: In the SG we did not observe delivery before 30 weeks of gestation (0/47; 0%) and the incidence of chorionamniotic membrane separation (CMS, 3/47; 6%) and preterm premature rupture of membranes (PPROM, 7/47; 15%) was lower compared to the other groups. Preterm delivery as a result of uterine contractions occurred significantly less frequently in the SG (8/47; 17%). Fetal surgery with classic hysterotomy resulted in rare use of magnesium sulfate (3/47; 6%). Conclusions: The alternative hysterotomy technique for fetal surgery of MMC results in low occurrences of CMS, PPROM, preterm delivery, and the rare use of tocolytics.

Plasma angiotensin II levels in women with severe preeclampsia under magnesium sulfate regimen.

The role of Renin-Angiotensin-System (RAS) in the pathogenesis of preeclampsia and eclampsia is still unclear. Our aim was to investigate plasma angiotensin II concentration [Ang II] in women with normotensive pregnancies (NP, n=22) and severe preeclampsia in use of magnesium sulfate (SPE, n=29). Despite no difference between the groups (SPE: 47.8pg/ml vs NP: 39.7pg/ml, p=0.195), lower maternal age (p=0.007) and primigravida (p=0.028) were associated with lower [Ang II]. Plasma [Ang II] increased over the 24h of magnesium sulfate administration (r=0.48, p=0.009). Our findings suggest that RAS may be involved with the mechanism of magnesium protection against eclamptic seizure.

Effect of Magnesium Sulfate on Prevention of Preterm Labour and Perinatal Outcome

Background: Preterm labour is a major cause of maternal mortality in our country. Hypomagnesaemia during pregnancy could be an indirect cause of preterm labour. Magnesium has a role on uterine smooth muscle relaxation, which is the basis for the use of magnesium sulphate as a tocolytic agent.
 Objective: This study was done to see the effect of magnesium sulfate to prevent preterm labour and perinatal outcome.
 Materials and Methods: This study was carried out in Comilla Medical College & Hospital, from December 2011 to May 2012. Fifty pregnant women, both primi and multi with preterm labour were selected for the study.
 Results: Study showed labour delayed >24 hours in 86% cases. And the majority of newborn (96%) had Apgar score in 5 minute was 8-10, 4% had Apgar score 7-8. The mode of delivery was vaginal in 70% cases and by c/s in 16% cases; among subject whose labour delayed more than 24 hours.
 Conclusion: Intravenously administration of magnesium sulfate is safe, well tolerated and effective tocolytic agent for prolongation of pregnancy in preterm labour. It produces minimal harmful effects on mother and fetus.
 KYAMC Journal Vol. 11, No.-3, October 2020, Page 145-149

Morbimortalidad asociada al parto prematuro y su relación con el uso de corticoides y sulfato de magnesio

IntroductionPreterm labour is associated with multiple complications, with an increased risk of perinatal morbidity and mortality. Nevertheless, many studies support the use of corticosteroids and magnesium sulphate to improve outcomes in preterm birth. The objective of this study is to describe the morbidity and mortality incidence in preterm birth in a Spanish hospital and how the use of corticosteroids and magnesium sulphate has improved the short-term prognosis in these newborns. Material and methodsObservational retrospective study of 564 preterm births between the years 2018 to 2019, in the hospital area Juan Ramón Jiménez (Huelva). The treatment with corticosteroids and magnesium sulphate was performed based on current protocols of the Spanish Society of Gynaecology and Obstetrics. ResultsThe incidence of prematurity in this study was 7.9%. Twin pregnancies and hypertensive pregnancy disease were the most common obstetric disorders. The most common type of delivery was caesarean section in all prematurity groups, except late prematurity. Respiratory distress syndrome was the most frequent pathology (more than 33%) in all groups. Overall neonatal mortality was 1.8‰. As regards the use of corticosteroids, the main outcome was a decrease in neonatal morbidity and mortality, which was statistically significant in respiratory distress syndrome and preterm retinopathy. The use of magnesium sulphate caused a decrease in the incidence of intraventricular haemorrhage, periventricular leukomalacia, and bronchopulmonary dysplasia. There were no significant differences in neonatal mortality. ConclusionsMorbidity and mortality registered in this study were similar to that described in the literature. Although the use of corticosteroids reduced neonatal morbidity and mortality in this study, it was only statistically significant in premature retinopathy and respiratory distress syndrome. The use of magnesium sulphate also showed an improvement in some pathologies and in mortality, but were not statistically significant.

Preliminary evaluation of the efficacy of intravenous magnesium sulfate for the treatment of ventricular arrhythmias in 16 dogs.

To evaluate the efficacy of IV magnesium sulfate in decreasing the number of ventricular ectopic beats or convert ventricular tachyarrhythmia to sinus rhythm in dogs. Prospective, observational feasibility study. Private referral center. Sixteen client-owned dogs exhibiting 1 or more of the following: (1) sustained or paroxysmal ventricular tachycardia (heart rate>180/min), (2) single or multiform ventricular complexes at>60 ectopies/min. Pretreatment (T1) blood creatinine and electrolyte concentrations were measured. A 60-second lead II ECG strip and systolic arterial blood pressure (SABP) were recorded. Magnesium sulfate 0.1mmol/kg (0.2 mEq/kg) was administered IV over 5 minutes. Five minutes after completion of the magnesium sulfate injection (T2), electrolyte concentrations were measured again. A second 60-second lead II ECG strip and SABP were recorded. The number of ectopic ventricular and supraventricular beats (sinus beats) that occurred in 60 seconds during the T1 and T2 ECG recordings was compared. T1 and T2 electrolytes and SABP were also compared. There was an increase in the ionized magnesium concentration, a decrease in the heart rate and the number of ventricular ectopic beats, and an increase in the number of supraventricular beats at T2. Two dogs converted to a sinus rhythm at T2 that was not sustained. Intravenous administration of 0.1mmol/kg (0.2 mEq/kg) magnesium sulfate in dogs with ventricular ectopy decreased the number of ventricular beats and heart rate. However, a specific conclusion regarding the use of magnesium sulfate as a first-line therapy for dogs with ventricular tachyarrhythmias at the investigated dose cannot be made.

Effect of magnesium sulphate nebulization on the incidence of post-operative sore throat

Background: Research trials have been conducted on various pharmacological and non-pharmacological measures for ameliorating POST with a varied success rate. Magnesium has antagonistic property towards NMDA receptors and hence it acts as anti-nociception and anti-inflammatory agent and so when used as premedication before surgery the incidence of POST could be reduced. Aim: To assess the efficacy of magnesium sulphate nebuliser in reducing the incidence of post-operative sore throat. Methodology: A total of 100 patients with ASA grade 1 & 2 in the age group of 18-60 years of either sex posted for elective surgeries lasting for the duration of 2hrs or more and requiring tracheal intubation were taken as our study subjects. The Patients in group A (n=50) were nebulised with 3ml of normal saline for 15 minutes, 5 minutes before induction of anaesthesia and similarly patients in group B (n=50) were nebulised with 3ml of solution containing 50 mg/mL of magnesium sulphate. Presence of sore throat was assessed at rest and at swallowing on immediate extubation, and at 2, 4 hours and 24 hours post extubation. In the postoperative ward, patients were also monitored for any drug related side effects. Results: The incidence of POST was measured at 0hr, 2 hr, 4 hrs and at the end of 24 hrs post-operatively both at rest and at swallowing. It was found that the incidence of sore throat at rest among the normal saline group during was 80%, 80%, 70% and 66% during the above said period and among the magnesium sulphate group it was 44%, 30%, 8% and 0%. Similarly the incidence of sore throat during swallowing was found to be 88%, 84%, 76% and 70% in the normal saline group and in the magnesium sulphate group it was 50%, 32%, 10% and 0% and a statistical significant difference was observed in the incidence of POST between the two groups. The incidence was found to be significantly lesser in the MgSo4 group when compared to the normal saline group. Conclusion: The use of magnesium sulfate in the form of nebulization as a pre-medication agent significantly reduces the incidence of POST compared to normal saline.

Factors associated with attendance at the postpartum blood pressure visit in pregnancies complicated by hypertension.

Women with hypertensive disorders of pregnancy should have a blood pressure evaluation no later than 7-10 days after delivery. The objective of this study was to identify the factors associated with patient attendance at the postpartum blood pressure follow-up visit. This was a retrospective cohort study of postpartum women who had a hypertensive disorder of pregnancy. Postpartum follow-up rates were recorded, and characteristics of women who attended a postpartum visit for blood pressure evaluation were compared to women who did not return for the visit. Multiple logistic regression was performed. Characteristics of women who returned for a blood pressure visit. There were 378 women who met inclusion criteria; 193(51.1%) attended the blood pressure visit. Women who returned were older and more likely to have preeclampsia, severe features, magnesium sulfate use, or severe hypertension during hospitalization. They were less likely to have gestational hypertension. Adjusted analysis demonstrated that black/non-Hispanic women (OR 0.53, 95% CI 0.34-0.83), the presence of any preeclampsia diagnosis (OR 2.19, 95% CI 1.03-4.81), and whether the woman underwent a cesarean delivery (OR 3.06, 95% CI 1.85-5.14) remained significant factors in predicting adherence. Women who returned for a blood pressure visit were more likely to have had significant hypertensive disease or a cesarean delivery. Non-Hispanic black women had the lowest rate of follow-up. Given black women have the highest rates of maternal morbidity and mortality nationwide, effective interventions to increase follow-up for them are needed.

The cost-utility of intravenous magnesium sulfate for treating asthma exacerbations in children.

Although evidence supports the use of intravenous magnesium sulfate (MS) in asthma exacerbations, MS continues to be considered a second-line drug for managing pediatric asthma exacerbations. This study aimed to evaluate the cost-utility of MS in asthma exacerbations. We used a decision tree model to estimate the cost-utility of MS compared to treatment without MS (control group) in children with asthma exacerbations. Cost data were obtained from a retrospective study from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. Probabilistic sensitivity analysis was carried out using the Monte Carlo technique with a simulation of a hypothetical cohort of 10 000 patients to generate expected cost utilities with 95% confidence intervals. We used a cost-effectiveness acceptability curve to evaluate the uncertainty surrounding the cost-utility of MS. The model showed that MS had a lower total cost than the control group (US $1149 vs US $1598 average cost per patient) and higher quality-adjusted life years (0.60 vs 0.52 average per patient), showing dominance. The probability that MS provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness-to-pay thresholds. Intravenous MS was less expensive and more effective than treatment without intravenous MS in children with asthma exacerbations. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate its results in other middle-income countries.

The impact of the definition of preeclampsia on disease diagnosis and outcomes: a retrospective cohort study

The diagnostic criteria for preeclampsia have evolved from the traditional definition of de novo hypertension and proteinuria to a broader definition of hypertension with evidence of end-organ dysfunction. Although this change is endorsed by various societies such as the International Society for the Study of Hypertension in Pregnancy and the American College of Obstetricians and Gynecologists, there remains controversy with regard to the implementation of broader definitions and the most appropriate definition of end-organ dysfunction. This study aimed to assess the impact of different diagnostic criteria for preeclampsia on rates of disease diagnosis, disease severity, and adverse outcomes and to identify associations between each component of the different diagnostic criteria and adverse pregnancy outcomes. We performed a retrospective cohort study of singleton pregnancies at Monash Health between January 1, 2016 and July 31, 2018. Within this population, all cases of gestational hypertension and preeclampsia were reclassified according to the International Society for the Study of Hypertension in Pregnancy 2001, American College of Obstetricians and Gynecologists 2018, and International Society for the Study of Hypertension in Pregnancy 2018 criteria. Differences in incidence of preeclampsia and maternal and perinatal outcomes were compared between the International Society for the Study of Hypertension in Pregnancy 2001 group and the extra cases identified by American College of Obstetricians and Gynecologists 2018 and International Society for the Study of Hypertension in Pregnancy 2018. Outcomes assessed included biochemical markers of preeclampsia, a composite of adverse maternal outcomes, and a composite of adverse perinatal outcomes. Multiple logistic regression analysis was also performed to assess each component of the American College of Obstetricians and Gynecologists 2018 and International Society for the Study of Hypertension in Pregnancy 2018 criteria and their associations with adverse maternal and perinatal outcomes. Of 22,094 pregnancies, 751 (3.4%) women had preeclampsia as defined by any of the 3 criteria. Compared with International Society for the Study of Hypertension in Pregnancy 2001, the American College of Obstetricians and Gynecologists 2018 criteria identified an extra 42 women (n=654 vs n=696, 6.4% relative increase) with preeclampsia, and International Society for the Study of Hypertension in Pregnancy 2018 identified an extra 97 women (n=654 vs n=751, 14.8% relative increase). The additional women identified by International Society for the Study of Hypertension in Pregnancy 2018 exhibited a milder form of disease with lower rates of severe hypertension (62.4% vs 44.3%; P<.01) and magnesium sulfate use (11.9% vs 4.1%; P<.05) and a trend toward lower rates of adverse maternal outcomes (9.8% vs 4.1%). These women also delivered at a later gestation, and their babies had a lower number of neonatal intensive care unit admissions and adverse perinatal outcomes. Objective features such as fetal growth restriction, thrombocytopenia, renal and liver impairment, and proteinuria were associated with an increased risk of adverse maternal and perinatal outcomes, whereas subjective neurologic features demonstrated poorer associations. Implementation of broader definitions of preeclampsia will result in an increased incidence of disease diagnosis. However, because women who exclusively fulfill the new criteria have a milder phenotype of the disease, it remains uncertain whether this will translate to improved outcomes.

Let's Avoid Opioids in Aesthetic Surgery.

Opioid-free anesthesia is a new technique that enhances surgical recovery and reduces opioid consumption during the postoperative period.1 For decades, opioid use has continued to dramatically improve the development of modern anesthesia. Opioid use, however, is also often associated with adverse events such as nausea, vomiting, urinary retention, ileus, pruritus, an altered mental status, and respiratory depression. Opioid-free anesthesia avoids opioids through the use of multimodal anesthesia, including hypnotics, N-methyl-d-aspartate antagonists, alpha-2-agonists, lidocaine, magnesium sulfate, dexamethasone, and nonopioid analgesic drugs such as nonsteroidal antiinflammatory drugs and acetaminophen.1 At the end of 2016, we began the implementation of new opioid-free protocols in our seven-bed aesthetic clinic. Most of the procedures were carried out in a single operating room under monitored anesthesia care using the propofol-ketamine protocol developed by Barry Friedberg.2 The minor part of our procedure is performed under general anesthesia using the opioid-free anesthesia technique inspired by Jan Mulier.3 Consecutively, we have been reviewing the administration of perioperative sufentanil and postoperative morphine from 2016 (last non–opioid-free year) and gone completely opioid free in the latter years (reviewing stopped in October of 2019). Although the number of anesthetized patients and cosmetic procedures by type have not differed greatly over the years, less than 20 percent of the annual average of 240 patients were given general anesthesia. Eighty-four percent of our cases were female American Society of Anesthesiologists class 1 and 2 patients, with an average age of approximately 46 years, and the operations included facial aesthetics (47 percent), breast aesthetics (32 percent), body contouring (21 percent), and liposuction. We noticed that consumption of sufentanil also decreased dramatically, from 4000 μg per year in 2016 to less than 125 μg in 2019, and no patients required morphine to manage postoperative pain in the past 2 years (Fig. 1). Our nurses noticed a real change, with just a few patients having postoperative nausea and vomiting and needing antiemetic drugs, usually associated with a shorter surgical recovery time, thus allowing ambulatory management in most cases. Through this brief communication, we would like to set out that the use of opioid-free anaesthesia not only avoids the undesirable side effects of opioids but also dramatically enhances the postoperative recovery time without worsening the associated pain.Fig. 1.: Global intraoperative sufentanil (micrograms per year) and postoperative morphine (milligrams per year) consumption from January of 2016 to October of 2019. The opioid-free protocols began in 2017. The global annual opioid consumption decreased dramatically, and no postoperative rescue morphine was needed during the past 2 years.We were initially drawn toward the adoption of opioid-free anesthesia because the sedation procedure remains a primary part of our practice. We also maintain that avoiding opioid use completely during the sedation procedure is far safer, as opioid-free anesthesia can help avoid opioid-related respiratory depression. Opioid-related respiratory depression is well known to be a serious adverse event during the sedation procedure. This is because the airways are not protected by a tracheal tube or a laryngeal mask. Likewise, because the evidence-based proof in this area is still weak, the anesthetic community has been waiting and watching the results of a (400 patients) randomized study with much interest. This study observed and evaluated the effect of opioid-free anesthesia on severe postoperative opioid-related adverse events.4 We therefore collectively maintain that opioid-free anesthesia in our daily procedural experience has proven to be a safe and effective routine that adapts very well to our particular practice. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

To compare abbreviated regimens of single dose and 12 hours magnesium sulphate administration with the conventional 24 hours postpartum in severe preeclampsia: A randomized clinical trial

Introduction: Preeclampsia and eclampsia have remained a major global public health threat in contributing significantly to maternal and perinatal morbidity and mortality with incidence of 2.16% and 0.28% respectively. The treatment modalities of eclampsia and severe pre-eclampsia include initial stabilization, rational use of antihypertensives, anticonvulsants and planning for delivery. Magnesium Sulphate, as anticonvulsant is drug of choice for convulsion prophylaxis but its benefit should always outweigh its adverse effects. Traditionally the use of magnesium sulphate has been recommended for 24 hour postpartum. By reducing the duration of therapy, the frequency of postpartum maternal monitoring may be curtailed and the possibility for the women to ambulate early and care for her newborn may be increased. The purpose of present study is to compare the effectiveness, side effects and maternal outcome of magnesium sulphate administration as single dose and 12 hours postpartum with the conventional 24 hours in the cases of severe preeclampsia. Aims and Objectives: To compare abbreviated regimens of single dose and 12 hours magnesium sulphate administration with the conventional 24 hours postpartum in severe preeclampsia.Material and Methods: A randomized prospective clinical trial was conducted on pregnant women presenting with severe preeclampsia. The patients were randomly allocated into group I (single dose), group II (12hour) and group III (24hour) postpartum MgSO4. The dosage and the route of administration of magnesium sulphate was similar in all three groups before delivery as per Prichard regimen. After delivery, a single maintenance dose of magnesium sulphate was given in group I, 12 hours group II and for 24 hours postpartum in group III. During the study period, the patients were assessed for various outcome parameters such as seizures, clinical outcomes such as time to return to ambulation in hours, duration of indwelling urinary catheter in hours, time until contact with the newborn infant in hour, urine output, adverse effects and evidence of toxicity in mother.Results: All patients in three groups were comparable with regards to demographic as well as obstetric characteristics. None of the patient in group I had any of the signs of MgSO4 toxicity, however in group II, one patient had loss of patellar reflex and in group III, two patients had loss of patellar reflexes and another two had oliguria. None of the patient had respiratory depression or convulsion in any of the three groups. The patients in group I and group II, ambulated much earlier as and had less duration of catheter as compared to group III. However there was no significant difference in the average time until contact with the newborn between the three groups. Conclusion: Magnesium sulphate for 24hrs is the drug of choice for seizure prophylaxis in patients with severe preeclampsia and eclampsia but benefits of magnesium sulphate should outweigh its adverse effects. But there was increase in the feeling of wellbeing in shorter regimens with early ambulation, lesser duration of indwelling catheter and early breastfeeding leading to better capability of the mother to take care of newborn. The present study suggests that the abbreviated postpartum MgSO4 regimens can be effective alternatives to the conventional 24 hours regimen for postpartum seizure prophylaxis in severe preeclampsia.

Comparative Study of the Tocolytic Effects of Magnesium Sulfate and Indomethacin on Pregnancy Duration and Neonatal Outcomes in Preterm Labor: A Clinical Trial

Introduction: Preterm labor is still one of the most serious complications of pregnancy. Many drugs have been used to control preterm labor, but their definitive effect is not known. Hence, this study was conducted to compare the tocolytic effects of magnesium sulfate and indomethacin on pregnancy duration and neonatal outcomes in preterm labor. Methodology: The present study was a randomized clinical trial study conducted at Kamali Hospital of Alborz Province. Research samples included 211 mothers with singleton pregnancy, healthy amniotic membrane, gestational age over 25 and less than 32 weeks, regular uterine activity as contraction in 20 minutes or cervical changes of 1 cm/h or effacement equal or more than 80. Sampling was performed using convenience and randomized method through a random number table. Accordingly, both groups received the initial neuroprotection of magnesium sulfate at doses of 6 mg. Then, subjects of one group received 50 mg of indomethacin suppository at 8-hour intervals so that they could finally receive 4 doses. The subjects of another group received magnesium sulfate 2 g/h as intravenous infusion for at least 12 hours after discontinuation of contraction. Then, two groups were compared in terms of difference of gestational age at hospitalization and discharge times, neonatal Apgar score, and rate of neonatal hospitalization in ICU though SPSS software. Results: The results of independent t-test showed that there was no significant differences between two groups in terms of gestational age at discharge and hospitalization times (p <0.8). Also, the rate of neonatal hospitalization in sulfate group was lower than that of the indomethacin group and this difference was statistically significant (p <0.03). The most common cause of hospitalization in ICU was respiratory distress that was higher in the indomethacin group. Conclusion: Magnesium sulfate reduced neonatal hospitalization in ICU compared to indomethacin. The use of tocolytic magnesium sulfate and indomethacin increased the duration of pregnancy, but no difference was seen between these tocolytics. © 2020, Advanced Scientific Research. All rights reserved.

A comparative study between two doses of magnesium sulphate as sedative during awake fiberoptic intubation for patients undergoing maxillofacial surgery: A prospective RCT

Background and objectives: Awake fiberoptic intubation (AFI) is the technique of choice for anticipated difficult intubation via nasal/oral route depending on the type of surgery. Various anesthetic techniques have been used to facilitate AFI, including regional anesthesia, topical anesthesia and sedation. There are few studies regarding the use of magnesium sulphate for this purpose. The aim of our study was to find the efficacy of magnesium sulphate as sedative in patients with maxillofacial trauma undergoing AFI and to establish the dose that provides better sedation.

COVID-19 infection during pregnancy: fetus as a patient deserves more attention.

The novel coronavirus disease 2019 (COVID-19) pandemic is causing concern also for the management and outcome of COVID-19-positive pregnant women and their offspring, as reported cases are rare. Current evidence suggests the association of COVID-19 infection in pregnancy with both severe maternal morbidity requiring intensive care and perinatal complications (preterm birth with consequent neonatal morbidity and even perinatal death). Most of the reported cases focused specifically on the maternal outcomes and possible vertical transmission, but less attention has been paid to fetus as a patient in such pregnancies. The use of antenatal steroids and fetal neuroprotection with magnesium sulfate is clearly underreported. Several recently issued guidelines suggest lowering the upper gestational age for antenatal steroid administration and also advocate extreme caution or even restraining from the use of magnesium sulfate. Also, the rate of cesarean deliveries among COVID-19 women is unacceptably high. Here we provide arguments for NOT changing the existing guidelines and caution against cesarean delivery that was the prevalent delivery mode in the reported cases and case series.

Antenatal Corticosteroids and Magnesium Sulfate for Improved Preterm Neonatal Outcomes: A Review of Guidelines.

In cases of anticipated preterm delivery, corticosteroids for fetal lung maturation and magnesium sulfate for fetal neuroprotection may improve neonatal outcomes. The aim of this study was to summarize and compare published guidelines from 4 leading medical societies on the administration of antenatal corticosteroids and magnesium sulfate. A descriptive review of major national guidelines on corticosteroids and magnesium sulfate was conducted: National Institute for Health and Care Excellence on "Preterm labour and birth," World Health Organization on "WHO recommendations on interventions to improve preterm birth outcomes," American College of Obstetricians and Gynecologists on "Antenatal corticosteroid therapy for fetal maturation" and "Magnesium sulfate use in obstetrics," and Society of Obstetricians and Gynecologists of Canada on "Antenatal corticosteroid therapy for improving neonatal outcomes" and "Magnesium sulphate for fetal neuroprotection." A variation in the appropriate timing of administration exists, whereas repeated courses are not routinely recommended for corticosteroids or magnesium sulfate. In addition, the recommendations are the same for singleton and multiple gestations, and no specific recommendation exists according to maternal body mass index. Finally, a variation in guidelines regarding the administration of corticosteroids before cesarean delivery exists. The adoption of an international consensus on corticosteroids and magnesium sulfate may increase their endorsement by health care professionals, leading to more favorable neonatal outcomes after preterm delivery.

Magnesium Sulphate For Tetanus, review of two cases

&lt;div class="WordSection1"&gt;&lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;Tetanus is critically ill disease with long term hospitalization period. It need to be carefully monitored, usually in intensive care unit and involves critical care physicians. Benzodiazepine is preferred by World Health Organization (WHO) for muscle spasm control in tetanus, but it will be less costly if magnesium sulphate can be used alone to control spasm and autonomic dysfunction in tetanus. We report a series of 2 tetanus cases that were treated using magnesium sulphate to provide a brief clinical description about the use of magnesium sulphate in tetanus. We also give a brief review on epidemiology, pathophysiology, clinical findings, diagnosis, and treatment of tetanus to provide implications for intensive care physicians. Methods : Case series report&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results : &lt;/strong&gt;Two patients with tetanus was given magnesium sulphate infusion to control muscle spasm and autonomic dysfunction with good results as expected. Both of them were survive and discharged home in healthy condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions :&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Magnesium sulphate can also be used to control muscle spasm and autonomic dysfunction although WHO recommend benzodiazepines for controlling muscle spasm. Intensive care physicians should have enough knowledge about tetanus and how it should be managed adequately to ensure survival from tetanus.&lt;/p&gt;&lt;/div&gt;