Epidural Magnesium Sulfate Does Increase Cerebrospinal Fluid Ionized Magnesium Concentration of Rabbit: An Experimental Study

Yıl 2021, Cilt: 2 Sayı: 3, 50 - 57, 30.07.2021

Halil Can Canatan Necati Gökmen , Elvan Öçmen , Osman Yılmaz

Öz

Aim: This study was designed to investigate the ability of
MgSO4, administered by epidural catheter, to pass into cerebrospinal
fluid (CSF), and to evaluate motor block effect in rabbits.
Methods: Group 150 (n= 6): 150 mg/mL MgSO4 was administered
via epidural catheter, then the catheter was flushed using
0.20 mL of saline. Group 300 (n= 6): 300 mg/mL MgSO4 was
administered via epidural catheter, then the catheter was flushed.
Group 450 (n=6): 450 mg/mL MgSO4 was administered via epidural
catheter, then the catheter was flushed. Rabbit ear arteries
were cannulated for arterial blood samples. 0.1 mL CSF sample
was taken from cisterna magna. The motor block was scored
using Drummond Moore scale. After administration of drug,
motor block was evaluated and CSF and plasma were taken at
0, 240, 360 and 480. minutes. Pharmacokinetic parameters were
also calculated and statistically evaluated.
Results: In our study, spinal CSF ionized magnesium levels were
increased compared to basal Mg2+ levels in each group respectively
as follows; by 25% for 150 mg, 60% for 300 mg, and 127%
for 450 mg. Moreover compared to basal Mg2+ levels the plasma
ionized Mg2+ levels in each group were shown to increase by 13%
for 150 mg, 87% for 300 mg, 200% for 450 mg. 450 mg magnesium
sulphate administered epidurally generated motor block.
Conclusion: This study has established that epidural administration
of MgSO4 increases the spinal CSF ionized Mg2+ concentration,
epidural MgSO4 passes through systemic circulation,
and epidural administration of 450 mg MgSO4 generates motor
block in rabbits.

Anahtar Kelimeler

Epidural, magnesium sulphate, cerebrospinal fluid, blood-brain barrier, rabbit.

Tavşanlarda epidural kateter yolu ile verilen magnezyum sülfatın spinal beyin omurilik sıvısına geçişinin araştırılması

Öz

Amaç: Bu çalışma, tavşanlarda epidural kateter ile verilen magnezyum
sülfatın (MgSO4) beyin omurilik sıvısına (BOS) geçiş kabiliyetini araştırmak ve motor blok etkisini değerlendirmek için tasarlanmıştır.
Yöntem: Grup 150 (n= 6): Epidural kateter yoluyla 150 mg/mL MgSO4
uygulandı, ardından kateter 0.20 mL salin ile yıkandı. Grup 300 (n= 6):
Epidural kateterden 300 mg/mL MgSO4 verildi, ardından kateter yıkandı. Grup 450 (n=6): Epidural kateterden 450 mg/mL MgSO4 verildi, ardından kateter yıkandı. Arteriyel kan örnekleri için tavşan kulağı arterleri
kanülize edildi. Cisterna magna'dan 0.1 mL BOS örneği alındı. Motor
blok, Drummond Moore ölçeği kullanılarak skorlandı. İlaç verildikten
sonra motor blok değerlendirildi ve 0, 240, 360 ve 480. dakikalarda BOS
ve plazma alındı. Farmakokinetik parametreler hesaplandı ve istatistiksel
olarak değerlendirildi. Bulgular: Çalışmamızda spinal BOS iyonize magnezyum seviyeleri her
grupta bazal Mg2+ seviyelerine göre sırasıyla şu şekilde arttı; 150 mg için
%25, 300 mg için %60 ve 450 mg için %127. Ayrıca bazal Mg2+ seviyeleri
ile karşılaştırıldığında,her gruptaki plazma iyonize Mg2+ seviyelerinin
150 mg için %13, 300 mg için %87, 450 mg için %200 arttığı gösterilmiştir.
450 mg magnezyum sülfatın epidural uygulaması motor blok oluşturdu.
Sonuç: Bu çalışma tavşanlarda epidural MgSO4 uygulamasının spinal
BOS’un iyonize Mg2+ konsantrasyonunu arttırdığı, epidural MgSO4'ün
sistemik dolaşımdan geçtiğini ve 450 mg MgSO4 epidural uygulamasının
motor blok oluşturduğunu ortaya koymuştur.

Anahtar Kelimeler

Epidural, magnezyum sülfat, beyin omurilik sıvısı, kan-beyin bariyeri, tavşan.

Kaynakça

• 1. Kaye AD, Grogono AW: Fluid and electrolyte Physiology: in: Miller RD. (ed) Anaesthesia. 5th Ed.USA. Churchill Livingstone Inc 2000.1586-1612.
• 2. Diba A, Doberenz D. Magnesium sulphate spinal anesthesia. Anaesthesia.1997; 52: 187-8
• 3. Allsops TF, Pauli JV. Magnesium concentrations in the ventricular and lumbar cerebrospinal fluid of hypomagnesaemic cows. Res Vet Sci.1985;38:61-4.(Abstract)
• 4. Sun L, Kosugi Y, Kawakami E, Piao YS, Hashimoto T, Oyanagi K. Magnesium concentration in the cerebrospinal fluid of mice and its response to changes in serum magnesium concentration. Magnes Res. 2009;22:266-72.
• 5. Macdonald RL, Curry DJ, Aihara Y, Zhang ZD, Jahromi BS, Yassari R. Magnesium and experimental vasospazm. J Neurosurg 2004;100:106-10
• 6. Ko SH, Lim HR, Kim DC, Han YJ, Vhoe H, Song HS. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology.2001;95:640-6
• 7. Brewer RP, Para A, Borel CO, Hopkins MB, Reynolds JD. Intravenosus magnesium sulfate does not incrase ventricular CSF ionized magnesium concentration of patients with intracranial hypertension. Clin Neuropharmacol. 2001;24:341-5
• 8. Kafadar AM, Sanus GZ, Is M, Coskun A, Tanriverdi T, Hanimoglu H, Uzan M. Prolonged elevation of magnesium in the cerebrospinal fluid of patients with severe head injury. Neurol Res. 2007;29:824-9.
• 9. Fuchs-Buder T,Tramer MR, Tassonyi E. Cerebrospinal fluid passage of intravenosus magnesium sulfate in neurosurgical patients. J Neurosurg Anesthesiol. 1997;9:324-8
• 10. Buvanendran A, McCarthy RJ, Kroin JS, Leong W, Perry P,Tuman JS. Intrathecal magnesium prolongs fentanyl analgesia: A prospective, randomized, controlled trial. Anesth Analg 2002;95:661-6
• 11. Dror A, Henriksen E. Accidental epidural magnesium sulfate injection. Anesth Analg 1987; 66: 1020-1
• 12. Goodman EJ, Haas AJ, Kantor GS. Inadvertent administration of magnesium sulfate through the epidural catheter: report and analysis of a drug error. Int J Obstet Anesth. 2006; 15: 63-7
• 13. Konakci S, Kucukguclu S, Gokmen N, Akhisarlıoglu M, Idiman F, Balkan BK, Gokel E, Ocmen E. Epidural administration of magnesium sulphate in the rabbit: are there any effects on motor and sensory blockade? In print
• 14. Arkan A, Küçükgüçlü S, Küpelioğlu A, Maltepe F, Gökel E. New technique for catheterization of the sacral canal in rabbits. Contemp Top Lab Anim Sci. 1996;35:96-98
• 15. Drummond JC, Moore SS. The influence of dextrose administration on neurologic outcome after temporary spinal cord ischemia in the rabbit. Anesthesiology 1989;70:64–70
• 16. W.J.Conover. Practical Nonparametric Statistics 2ed p:230-233, Wiley&Sons 1980.
• 17. Taber EB, Tan L, Chao CR, Beall MH, Ross MG. Pharmacokinetics of ionized versus total magnesium in subjects with preterm labor and preeclampsia. Am J Obstet Gynecol. 2002; 186: 1017-21
• 18. Frosini M, Gorelli B, Matteini M, Palmi M, Valoti M, Sgaragli GP. HPLC determination of inorganic cation levels in CSF and plasma of concious rabbits. JPM 1993;29(2):99-104.
• 19. Oppelt WW, MacIntyre I, Rall DP: Magnesium exchange between blood and cerebrospinal fluid. Am J Physiol 1963; 205:959–962
• 20. Hallak M, Berman RF, Irtenkauf SM, Evans MI & Cotton DB. Peripheral magnesium sulfate enters the brain and increases the threshold for hippocampal seizures in rats. American Journal of Obstetrics and Gynecology 1992;167: 1605-1610
• 21. Tsuda T, Kogure K, Nishioka K,Watanabe T. Mg2+ administered up to twenty-four hours following reperfusion prevents ischemic damage of the CA1 neurons in the rat hippocampus. Neuroscience, 1991; 44: 335-341
• 22. Feria M, Abad F, Sanchez A, Abreu P. Magnesium sulphate injected subcutaneously suppresses autotomy in peripherally deafferented rats. Pain. 1993;53:287-93
• 23. McKee JA, Brewer RP, Macy GE, Phillips-Bute B, Campbell KA, Borel CO, Reynolds JD,Warner DS. Analysis of the brain bioavailability of peripherally administered magnesium sulfate: A study in humans with acute brain injury undergoing prolonged induced hypermagnesemia. Crit Care Med. 2005;33: 661-6
• 24. McCarthy R, Kroin JS, Tuman KJ, Penn RD, Ivankovich AD. Antinociceptive potentiation and attenuation of tolerance by intrathecal co-infusion of magnesium sulphate and morphine in rats. Anesth Analg 1998;86:830-6
• 25. Kim YJ, McFarlane C, Warner DS, Baker MT, Choi WW, Dexter F. The effects of plasma and brain magnesium concentrations on lidocaine-induced seizures in the rat. Anesth Analg. 1996; 83: 1223-8
• 26. Dacey MJ. Hypomagnesemic disorders. Crit Care Clin 2001; 17: 155–73
• 27. Akutagawa T, Kitahata LM, Saito H, Collins JG, Katz JD. Magnesium enhances local anesthetic nerve block of frog sciatic nerve. Anesth Analg. 1984; 63:111-6.
• 28 Gunduz A, Bilir A, Gulec S. Magnesium added to prilocaine prolongs the duration of axillary plexus block. Reg Anesth Pain Med. 2006;31:233-6.
• 29. Thurnau GR, Kemp DB, Jarvis A: Cerebrospinal fluid levels of magnesium in patients with preeclampsia after treatment with intravenous magnesium sulfate: A preliminary report. Am J Obstet Gynecol 1987; 157:1435–1438
• 30. Lejuste MJ. Inadvertant intrathecal administration of magnesium sulfate. S Afr Med J. 1985 14; 68: 367-8.
• 31. Karasawa S, Ishiazaki K, Goto F. The effect of intrathecal administration of magnesium sulphate in rats. Anaesthesia, 1998; 53:879-6
• 32. Bahar M, Chanimov M, Grinspun, I. Koifman E,Cohen ML:Spinal anesthesia induced by intrathecal magnesium sulphate.Anaesthesia 1996;51:627- 633
• 33. Chanimov M, Cohen M.L., Grinspun Y., Herbert M.,.Reif, R Kaufman I., Bahar M. Neurotoxicity after spinal anesthesia induced by serial intrathecal injections of magnesium sulphate. Anaesthesia 1997; 52:223-8
• 34. Simpson JI, Eide TR, Schiff GA, Clagnaz JF, Hossain I, Tverskoy A, Koski A. Intrathecal magnesium sulfate protects the spinal cord from ischemic injury during thoracic aortic cross-clamping. Anesthesiology 1994; 81:1493-1499
• 35. Saeki H, Matsumoto M, Kaneko S, Tsuruta S, Cui YJ, Ohtake K, Ishida K, Sakabe T. Is intrathecal magnesium sulfate safe and protective against ischemic spinal cord injury in rabbits? Anesth Analg. 2004; 99: 1805-12
• 36. Jellish WS, Zhang X, Langen KE, Spector MS, Scalfani MT, White FA. Intrathecal magnesium sulfate administration at the time of experimental ischemia improves neurological functioning by reducing acute and delayed loss of motor neurons in the spinal cord. Anesthesiology. 2008;108:78-86.
• 37. Taira Y, Marsala M. Effect of proximal arterial perfusion pressure on function, spinal cord blood flow, and histopathologic changes after increasing intervals of aortic occlusion in the rat. Stroke 1996; 27:1850–8.