Role Of Magnesium Sulfate Research Articles

Role of magnesium sulfate in prolonging the analgesic effect of spinal bupivacaine for cesarean section in severe preeclamptics

Background: Magnesium sulfate, N‑methyl‑d‑aspartate receptor antagonist, has both analgesic and sedative properties. Aim : The aim was to evaluate the analgesic efficacy of perioperative intravenous (i.v) magnesium sulfate in severe preeclamptic patients scheduled for cesarean section under spinal anesthesia. Subjects and Methods : A double blind prospective randomized controlled study was designed conducted on 80 patients randomly allocated into two equal groups (n = 40) to receive either bupivacaine heavy intrathecally – Group B (control group) or bupivacaine heavy intrathecally along with i.v magnesium sulfate – Group BM (study group). Magnesium sulfate 40 mg/kg diluted in 100 ml of normal saline was administered over 15 min about 30 min prior to surgery followed by continuous infusion at the rate of 10 mg/kg/h for the next 24 h while the other group received similar volume of normal saline in the same manner. Intraoperatively, patients were monitored for hemodynamic perturbations, respiratory rate, urine output, Apgar score, uterine tonicity, and any other adverse effects. Postoperatively, duration of analgesia, number of rescue analgesics, signs of any magnesium toxicity, and incidence of postpartum eclampsia in the first 24 h were recorded. Data were analyzed using SPSS version 16. Results: At different time intervals, patients in Group BM had less pain than Group B when compared on visual analog scale. Patients in Group BM were significantly more sedated as compared to Group B patients. None of the patients demonstrated bradycardia, hypotensive episodes, hypoxia, or hypoventilation in the postoperative period in the recovery room. There was no significant respiratory depression, Apgar score was comparable, and uterine tonicity was adequate in both the groups. Postoperatively, time required for first analgesic dose was significantly more in Group BM 270 (35.1) min than Group B 223 (31.4) min. There was a significant decrease in total rescue analgesic requirement in Group BM 2.5 (0.4) compared to Group B 3.6 (0.4). Incidence of postpartum eclampsia in study group (one patient) was less than the control group (four patients). Conclusion : Preoperative i.v magnesium sulfate, in severe preeclampsia not only reduces the probability of developing peripartum eclampsia, but also significantly prolongs the duration of analgesia and reduces postoperative analgesic consumption without any significant side effects. Keywords : Intravenous magnesium sulphate, preecclempsia, spinal anaesthesia

The role of magnesium sulfate in acute asthma

The role of magnesium sulfate (MgSO4) in the treatment of acute asthma is not clear. Four recent systematic reviews suggest a limited role of intravenous (i.v.) and inhaled nebulized treatment. The purpose of this review is to summarize the current literature, focus on two recent large multicenter randomized controlled trials, and discuss future research directions. The Magnesium Nebulized Trial In Children (MAGNETIC) trial has shown little benefit to routine use of nebulized MgSO4 in children with acute asthma, but there may be a benefit in those with severe exacerbations and a shorter duration of symptoms. The 3Mg trial has shown no role for nebulized MgSO4 in adults and, at best a limited role for i.v. MgSO4 in only the most severe exacerbations. This is the only study with direct comparison of nebulized and i.v. MgSO4. MgSO4 has a role in severe exacerbations of acute asthma and there is no evidence of benefit outside this clinical situation. Both nebulized and i.v. treatments are well tolerated and inexpensive. In adults, the most effective route of administration is i.v. There are no direct comparison studies in children. Further research should focus on more severe exacerbations.

Sensitivities of rat primary sensory afferent nerves to magnesium

Contrasting findings have been published regarding the role of magnesium sulphate used as an additive to local anaesthetics in peripheral nerve blocks. To clarify the effect of magnesium sulphate on nerve excitability. C and Aβ compound action potentials were recorded extracellularly in vitro in saphenous nerves from adult rats. Saphenous nerves (n = 30) from male Wistar rats (n = 19), 12 to 16 weeks old. Primary sensory afferents were tested with a computerised threshold tracking program (QTRAC) with a supramaximal 1 ms current pulse either alone or after 300 ms of conditioning polarising ramp currents in the presence and absence of 10 mmol l magnesium sulphate, 80 μmol l lidocaine and a combination of both. Changes in current thresholds to elicit compound action potential amplitudes of 40% of the maximal response. Magnesium sulphate increased excitability thresholds to a greater extent in Aβ fibres than in C fibres. It enhanced the effects of lidocaine in both Aβ fibres [mixture 0.470 mA (SD 0.105) versus lidocaine 0.358 mA (SD 0.080), P < 0.001] and C fibres [mixture 2.531 mA (SD 0.752) versus lidocaine 2.385 mA (SD 0.656), P = 0.008]. Preconditioning experiments also showed that magnesium sulphate had an enhancing effect with lidocaine in Aβ fibres [mixture 0.620 mA (SD 0.281) versus lidocaine 0.543 mA (SD 0.315), P = 0.005], but not in C fibres [mixture 2.412 mA (SD 0.641), lidocaine 2.461 mA (SD 0.693), P = 0.17]. These results suggest that the binding of magnesium ions depends on both the type and conformational state of voltage-gated sodium channels. They also may help to explain the conflicting reports regarding the clinical effects of magnesium sulphate as an additive to lidocaine in peripheral nerve blocks.

Magnesium

Magnesium

Role of magnesium sulfate in neuroprotection in acute ischemic stroke.

Aims:To study the effect of intravenous magnesium sulfate infusion on clinical outcome of patients of acute stroke.Materials and Methods:Sixty consecutive cases of acute ischemic stroke hospitalised within 24 h of an episode of stroke were taken as subjects. All subjects underwent a computed tomography head, and those found to have evidence of bleed/space-occupying lesions were excluded from the study. The subjects taken up for the study were divided into two groups of 30 subjects each. Both the groups received the standard protocol management for acute ischemic stroke. Subjects of Group 1 additionally received intravenous magnesium sulfate as initial 4 g bolus dose over 15 min followed by 16 g as slow infusion over the next 24 h. In all the subjects of the two study groups, serum magnesium levels were estimated at the time of admission (Day 0), Day 1 and Day 2 of hospitalization using an atomic absorption spectrometer.Statistical Analysis Used:Scandinavian stroke scores were calculated on Day 3, day of discharge and Day 28. Paired t-test was employed for comparison of stroke scores on Day 3, day of discharge and Day 28 within the same group and the unpaired t-test was used for the intergroup comparison, i.e. comparison of stroke scores of control group with corresponding stroke scores of magnesium group.Results:Comparison of stroke scores on Day 3 and day of discharge, on the day of discharge and Day 28 and on Day 3 and Day 28 in the magnesium group produced a t-value of 5.000 and P <0.001, which was highly significant. However, the comparison of the mean stroke scores between the magnesium and the control groups on Day 3, day of discharge and Day 28 yielded a P-value of >0.05, which was not significant.Conclusions:The study failed to document a statistical significant stroke recovery in spite of achieving a significant rise in serum magnesium level, more than that necessary for neuroprotection, with an intravenous magnesium sulfate regime.

The Role of Magnesium Sulfate in the Prevention of Cerebral Palsy

Magnesium sulfate (MgSO4) has been widely used in the perinatal arena for many decades. It has been used for tocolysis in the U.S. for more than 60 years. Estimations of MgSO4 use for preterm labor (less than 34 weeks of gestation) run as high as 80 percent. Magnesium sulfate is a smooth, skeletal, and cardiac muscle depressant. It is used for preterm labor because of its potential to decrease muscle contractility by interfering with calcium uptake in the cells. Thousands of moms and babies have been exposed to this medication even though tocolysis remains an off-label use, the exact mechanism of action is not completely understood, and there are studies that show that it is ineffective for this indication, and no evidence that it improves perinatal outcomes.1-3 Additionally, it is a high alert medication because of its narrow therapeutic window and the risk of causing an immediate life-threatening condition (acute respiratory failure) if an error in administration occurs.4.

Role of magnesium sulfate in aneurysmal subarachnoid hemorrhage management: A meta-analysis of controlled clinical trials.

Background:There has been longstanding controversy over the use of magnesium sulfate infusion in the medical management of aneurysmal subarachnoid hemorrhage (SAH). Several clinical trials evaluating the beneficial effects of magnesium on cerebral vasospasm and their poor outcome have been published. However, results from the majority of these studies have been inconclusive. This meta-analysis was performed to evaluate the effectiveness of magnesium on patient outcomes after aneurysmal SAH.Materials and Methods:PubMed and the Cochrane library were searched for controlled clinical trials assessing the efficacy of magnesium sulfate infusion after aneurysmal SAH. Eight studies consisting of 936 patients were included.Results:There was a decreased risk of poor outcome at 3–6 months after SAH in magnesium treatment groups when compared to placebo [0.78 (95% CI 0.66–0.93)]. Poor outcome was defined as severe disability, persistent vegetative state, or death, as measured by the Glasgow outcome scale (GOS), extended Glasgow outcome scale (GOSE) or modified Rankin scale (mRS). The risk of mortality after SAH was unaffected by magnesium treatment [RR 0.68 (95% CI 0.58–1.27)].Conclusion:Magnesium sulfate infusion decreases risk of poor outcome after aneurysmal SAH. Current studies in the literature do not suggest a role for magnesium sulfate in mortality reduction after SAH.

The role of magnesium sulfate in prevention of seizures induced by pentylenetetrazole in rats

Magnesium sulfate (MgSO₄) has been used to prevent seizures in eclampsia. This study examined the central effects of MgSO₄ on different types of pentylenetetrazole (PTZ)-induced seizures. Male Wistar rats were submitted to intracerebroventricular (ICV) administration of MgSO₄ at different doses followed by intraperitoneal administration of PTZ. The latency to the onset of the first seizure induced by PTZ was significantly increased by ICV administration of MgSO₄ at a dose of 100 µg compared to the control treatment. In addition, the total period during which animals presented with seizures was significantly reduced at this dose of MgSO₄. Furthermore, the latency to the onset of the first partial complex seizure was significantly increased by the lowest dose of MgSO₄. However, a high dose of MgSO₄ had no effect or even potentiated the effect of PTZ. These results suggest that, depending on the dose, MgSO₄ may be important in prevention of epileptic seizures.

Retrospective analysis of parenteral magnesium sulfate administration in decreased incidence of clinical and neuroradiological cerebral vasospasm: a single center experience

Objective: Experimental work suggests a neuroprotective role for magnesium sulfate in aneurysmal subarachnoid hemorrhage. We retrospectively review the incidence of clinically relevant vasospasm in patients treated or not with continuous magnesium infusion after onset of subarachnoid hemorrhage.Methods: All patient records in Albany Medical Center with the diagnosis of SAH between January 1999 and June 2004 were reviewed. Patients who presented to the emergency department within 72 hours of onset were entered in the study. Patients were defined as in clinical vasospasm if there was an acute neurological change in association with abnormal trancranial Doppler (TCD), CT angiogram (CTA) or digital subtraction angiography (DSA).Results: A total of 85 patients were selected. Magnesium sulfate was infused in 43 patients. When compared with patients who did not receive MgSO4, there was a statistically significant lower incidence of clinical and radiological vasospasm in those who had the continuous infusion of magnesium sulfate (p<0.01). There was no statistically significant difference between patients who were coiled or clipped.Conclusion: Continuous magnesium sulfate infusion for the management of clinically significant cerebral vasospasm is safe and reduces the incidence of clinically significant cerebral vasospasm. Large, multicenter, controlled studies should be performed in order to determine the true effectiveness of the treatment in a controlled setting.

Cerebral Vasospasm: New Strategies in Research and Treatment

Cerebral Vasospasm: New Strategies in Research and Treatment

The role of magnesium sulfate in the acute and chronic management of asthma

Acute asthma is common and severe exacerbations may result in hospitalization, need for endotracheal intubation and, rarely, death. Standard emergency care includes systemic corticosteroids and bronchodilators, but additional treatments may be required in severe cases. We summarize the substantial evidence regarding the role of MgSO4 in acute asthma and comments on the potential benefit in chronic asthma. Inhaled and intravenous MgSO4 agents are used in the treatment of acute asthma, but only the intravenous formulation is effective. In severe asthma exacerbations, a single bolus dose of intravenous MgSO4 reduces admissions and improves pulmonary functions. Inhaled MgSO4 is more effective than placebo as a bronchodilator, but performs no better than salbutamol and there is no apparent synergy when the two are combined. Whereas intravenous MgSO4 treatments appear to be effective, long-term 'replacement' therapy with magnesium does not appear to affect chronic asthma. Evidence suggests that intravenous MgSO4 is beneficial in acute asthma, while the evidence for inhaled MgSO4 is less convincing. Moreover, the role of replacement therapy with oral magnesium remains to be clarified. The use of intravenous MgSO4 remains uncommon, with emergency physicians appropriately restricting its use to patients with severe exacerbations.

Role of Magnesium Sulfate in Postoperative Pain Management for Patients Undergoing Thoracotomy

The purpose of this study was to investigate the effect of magnesium sulfate on pain management for post-thoracotomy patients. A prospective, randomized, controlled clinical study. University hospital. Twenty-four patients undergoing thoracotomy. After thoracotomy operations, patients were assigned to 2 groups. The control group received intravenous morphine (0.5 mg/h infusion, 0.3 mg patient-controlled anesthesia dose, 15-minute lockout time) via patient-controlled analgesia, and the magnesium group received magnesium sulfate (30-mg/kg bolus, 10 mg/kg/h infusion for 48 hours) plus the same patient-controlled analgesia protocol. Visual analog scale for pain score, sedation score, mean arterial pressure, heart rate, and valid and invalid analgesic demand were recorded. Serum magnesium levels were determined at postanesthesia care unit admission, at 24 hours, and at 48 hours. Side effects were also recorded. There were no significant differences between groups with respect to demographics, sedation score, and pain score. Cumulative mean morphine consumption was found to be higher in the control group compared with the magnesium group at 4, 8, and 48 hours (5.6 +/- 1 mg v 3.2 +/- 0.6 mg [p < 0.0001], 10.2 +/- 1.8 mg v 7.2 +/- 1.6 mg [p = 0.0003), and 40.2 +/- 4.5 mg v 34.8 +/- 6.3 mg [p = 0.02], respectively). Postoperative use of magnesium sulfate reduced opioid consumption for pain after thoracotomy operations.

Role of magnesium sulphate in hypertensive disorders of Pregnancy

Role of magnesium sulphate in hypertensive disorders of Pregnancy

Role of Magnesium sulfate in hypertensive encephalopathy

Role of Magnesium sulfate in hypertensive encephalopathy

Role of Magnesium Sulfate in Postoperative Analgesia

BackgroundN-methyl-D-aspartate antagonists may play a role in the prevention of pain. An assessment was made of the effect of the physiologic N-methyl-D-aspartate antagonist magnesium on analgesic requirements, pain, comfort, and quality of sleep in the postoperative period.MethodsIn a randomized, d

Role of magnesium sulfate in seizure prevention in patients with eclampsia and pre-eclampsia.

Eclampsia is a leading cause of maternal mortality. The prevention of seizure activity in pre-eclampsia and recurrent seizures in eclamptic patients is an essential aspect of management. Many drugs with anticonvulsant properties have been used to treat patients with pre-eclampsia and eclampsia. Magnesium sulfate is a significantly better drug than either diazepam or phenytoin for preventing recurrent seizures in eclamptic patients. Magnesium sulfate has diverse cardiovascular and neurological effects and also alters calcium metabolism. Although the drug crosses the placenta and may affect the fetus, these effects are clinically small and fetal morbidity has been shown to be reduced in randomised studies comparing magnesium sulfate to either phenytoin or benzodiazepines. Dosage regimens of magnesium sulfate are empirical. Because adverse effects of this agent are related to toxicity, the establishment of greater efficacy by using higher dosage regimens needs to be tested against a greater risk of adverse effects. The most serious toxicity related to magnesium sulfate use is magnesium sulfate use is neuromuscular blockade that may result in respiratory arrest. Magnesium sulfate is now the drug choice for treating eclamptic patients. However, further studies are required to establish the role of this agent as a prophylactic agent in the prevention of eclampsia.

Established role of magnesium sulfate as prophylactic anticonvulsive agent in preeclampsia/eclampsia.

Established role of magnesium sulfate as prophylactic anticonvulsive agent in preeclampsia/eclampsia.