Preoperative effects of magnesium sulfate on hemodynamics and muscle relaxation

Yıl 2021, , 862 - 866, 01.09.2021

Funda Atar Helin Şahintürk , Murat Ünsel , Cengiz Yumru

https://doi.org/10.28982/josam.954330

Öz

Background/Aim: Although there are many studies on the effects of magnesium sulfate in the literature, there is no publication on the effects of low doses of magnesium sulfate, as we administered in our study. This prospective randomized study aimed to reveal that the use of low-dose magnesium sulfate (MgSO4) shortens the onset time and prolongs the block duration of neuromuscular blockers (NMBs) without changing the hemodynamics in patients monitored using the train-of-four (TOF) ratio.
Methods: This is a prospective randomized study. A total of 60 cases aged between 18–65 years with American Society of Anesthesiologists classifications I–II who were scheduled for elective open cholecystectomy were randomly divided into 3 groups. Notably, 15 minutes before the anesthesia induction, 25 mg/kg MgSO4 in intravenous 0.9% saline (total volume, 100 mL) was administered to the MgSO4 group (MS group), 0.03 mg/kg midazolam was administered to the midazolam group (MD group), and the same volume of 0.9% saline solution was administered to the control group (PSS group). Nerve-muscle conduction monitoring was performed using TOF-Watch® SX (Organon, Ireland) and anesthesia depth was monitored with a BIS® monitor (A-2000; Aspect Medical Systems, USA).
Results: NMB onset times were 83.95 (26.8), 111.15 (28.12), and 163.7 (34.16) seconds (P=0.001) in the MS, MD, and PSS groups, respectively. The times until additional rocuronium requirement after the intubation dose were 60.1 (4.19), 50.8 (4.99), and 38.25 (7.27) minutes in the MS, MD, and PSS groups, respectively, which was significantly longer in the MS group compared to the other groups (P<0.001). The recovery time to TOF of 0.9 and time to T1 height of >95% was longer in the MS group than in the other groups. No difference was found between the groups in terms of hemodynamic data.
Conclusion: Low-dose MgSO4 administration before rocuronium injection significantly reduces neuromuscular agent consumption without altering hemodynamics and causing a residual neuromuscular block.

Anahtar Kelimeler

Magnesium sulfate, Muscle relaxant, Bispectral index

Kaynakça

• 1. Jee D, Lee D, Yun S, Lee C. Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy. British journal of anaesthesia. 2009;103(4):484-9.
• 2. Herroeder S, Schoenherr ME, De Hert SG, Hollmann MW, Warner DS. Magnesium—essentials for anesthesiologists. The Journal of the American Society of Anesthesiologists. 2011;114(4):971-93.
• 3. Czarnetzki C, Lysakowski C, Elia N, Tramer M. Time course of rocuronium‐induced neuromuscular block after pre-treatment with magnesium sulphate: a randomised study. Acta anaesthesiologica scandinavica. 2010;54(3):299-306.
• 4. Bom A, Hope F, Rutherford S, Thomson K. Preclinical pharmacology of sugammadex. Journal of critical care. 2009;24(1):29-35.
• 5. Kim M, Oh AY, Jeon YT, Hwang J-W, Do S. A randomised controlled trial comparing rocuronium priming, magnesium pre‐treatment and a combination of the two methods. Anaesthesia. 2012;67(7):748-54.
• 6. Kim M-H, Oh A-Y, Han S-H, Kim J-H, Hwang J-W, Jeon Y-T. The effect of magnesium sulphate on intubating condition for rapid-sequence intubation: a randomized controlled trial. Journal of clinical anesthesia. 2015;27(7):595-601.
• 7. Rotava P, Cavalcanti IL, Barrucand L, Vane LA, Verçosa N. Effects of magnesium sulphate on the pharmacodynamics of rocuronium in patients aged 60 years and older: A randomised trial. European Journal of Anaesthesiology (EJA). 2013;30(10):599-604.
• 8. Yoshida A, Itoh Y, Nagaya K, Takino K, Sugawara J-i, Murakami T, et al. Prolonged relaxant effects of vecuronium in patients with deliberate hypermagnesemia: time for caution in cesarean section. Journal of anesthesia. 2006;20(1):33-5.
• 9. Aissaoui Y, Qamous Y, Serghini I, Zoubir M, Salim JL, Boughalem M. Magnesium sulphate: an adjuvant to tracheal intubation without muscle relaxation–a randomised study. European Journal of Anaesthesiology (EJA). 2012;29(8):391-7.
• 10. Singh S, Malviya D, Rai S, Yadav B, Kumar S, Sharma A. Pre-treatment with magnesium sulphate before non depolarizing muscle relaxants: effect on speed on onset, induction and recovery. Int J Med Sci Public Health. 2014;3:1238.
• 11. Elsharnouby N, Elsharnouby M. Magnesium sulphate as a technique of hypotensive anaesthesia. BJA: British Journal of Anaesthesia. 2006;96(6):727-31.
• 12. Hans GA, Bosenge B, Bonhomme VL, Brichant JF, Venneman IM, Hans PC. Intravenous magnesium re-establishes neuromuscular block after spontaneous recovery from an intubating dose of rocuronium: a randomised controlled trial. European Journal of Anaesthesiology (EJA). 2012;29(2):95-9.
• 13. Sadhasivam S, Ganesh A, Robison A, Kaye R, Watcha MF. Validation of the bispectral index monitor for measuring the depth of sedation in children. Anesthesia & Analgesia. 2006;102(2):383-8.
• 14. Dong J, Gao L, Lu W, Xu Z, Zheng J. Pharmacological interventions for acceleration of the onset time of rocuronium: a meta-analysis. PloS one. 2014;9(12):e114231.
• 15. Altan A, Turgut N, Yıldız F, Türkmen A, Üstün H. Effects of magnesium sulphate and clonidine on propofol consumption, haemodynamics and postoperative recovery. British journal of anaesthesia. 2005;94(4):438-41.
• 16. Seyhan T, Tugrul M, Sungur M, Kayacan S, Telci L, Pembeci K, et al. Effects of three different dose regimens of magnesium on propofol requirements, haemodynamic variables and postoperative pain relief in gynaecological surgery. British journal of anaesthesia. 2006;96(2):247-52.
• 17. Czarnetzki C, Tassonyi E, Lysakowski C, Elia N, Tramèr MR. Efficacy of Sugammadex for the Reversal of Moderate and Deep Rocuronium-induced Neuromuscular Block in Patients Pretreated with Intravenous MagnesiumA Randomized Controlled Trial. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2014;121(1):59-67.
• 18. Abdulatif M, Ahmed A, Mukhtar A, Badawy S. The effect of magnesium sulphate infusion on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia. Anaesthesia. 2013;68(10):1045-52.
• 19. Bondok RS, Ali RM. Magnesium sulfate reduces sevoflurane-induced emergence agitation in pediatric patients. Ain-Shams Journal of Anaesthesiology. 2014;7(3):282.
• 20. Abu-Sinna R, Talat SM. The effect of a pre-induction bolus dose of magnesium sulphate on emergence agitation after sevoflurane anesthesia in children undergoing adenotonsillectomy. Ain shams J Anaesthesiol. 2011;4(1):75-83.
• 21. Na H-S, Lee J-H, Hwang J-Y, Ryu J-H, Han S-H, Jeon Y-T, et al. Effects of magnesium sulphate on intraoperative neuromuscular blocking agent requirements and postoperative analgesia in children with cerebral palsy. British journal of anaesthesia. 2010;104(3):344-50.
• 22. Kussman B, Shorten G, Uppington J, Comunale M. Administration of magnesium sulphate before rocuronium: effects on speed of onset and duration of neuromuscular block. British journal of anaesthesia. 1997;79(1):122-4.
• 23. Claudius C, Skovgaard L, Viby‐Mogensen J. Acceleromyography and mechanomyography for establishing potency of neuromuscular blocking agents: a randomized‐controlled trial. Acta anaesthesiologica scandinavica. 2009;53(4):449-54.
• 24. Ryu J-H, Kang M-H, Park K-S, Do S-H. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. British Journal of Anaesthesia. 2008;100(3):397-403.
• 25. Lee D, Kwon I. Magnesium sulphate has beneficial effects as an adjuvant during general anaesthesia for Caesarean section. British journal of anaesthesia. 2009;103(6):861-6.
• 26. Kotake Y, Ochiai R, Suzuki T, Ogawa S, Takagi S, Ozaki M, et al. Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesthesia & Analgesia. 2013;117(2):345-51.
• 27. Fuchs-Buder T, Claudius C, Skovgaard L, Eriksson L, Mirakhur R, Viby-Mogensen J. 8th International Neuromuscular Meeting. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007;51(7):789-808.
• 28. Kopman A, Kopman D. An analysis of the TOF-watch algorithm for modifying the displayed train-of-four ratio. Acta anaesthesiologica scandinavica. 2006;50(10):1313.
• 29. Germano Filho P, Cavalcanti I, Barrucand L, Verçosa N. Effect of magnesium sulphate on sugammadex reversal time for neuromuscular blockade: a randomised controlled study. Anaesthesia. 2015;70(8):956-61.
• 30. Orliaguet GA, Lambert FB, Chazot T, Glasman P, Fischler M, Liu N. Feasibility of closed-loop titration of propofol and remifentanil guided by the bispectral monitor in pediatric and adolescent patientsa prospective randomized study. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2015;122(4):759-67.
• 31. Malviya S, Voepel-Lewis T, Tait AR, Watcha MF, Sadhasivam S, Friesen RH. Effect of age and sedative agent on the accuracy of bispectral index in detecting depth of sedation in children. Pediatrics. 2007;120(3):e461-e70.
• 32. Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, et al. Anesthesia awareness and the bispectral index. New England Journal of Medicine. 2008;358(11):1097-108.
• 33. Bruhn J, Myles PS, Sneyd R, Struys MM. Depth of anaesthesia monitoring: what's available, what's validated and what's next? BJA: British Journal of Anaesthesia. 2006;97(1):85-94.
• 34. Manaa EM, Alhabib AF. Effect of magnesium sulfate on the total anesthetic and analgesic requirements in neurosurgery. Journal of Neurology & Neurophysiology. 2013:1-6.
• 35. Samarkandi A-H. The bispectral index system in pediatrics—Is it related to the end-tidal concentration of inhalation anesthetics. Middle East J Anesthesiol. 2006;18(4):769-78.
• 36. Vickovic S, Pap D, Pjevic M, Uvelin A. Magnesium sulphate as an adjuvant to anaesthesia in patients with arterial hypertension: 1AP7-4. European Journal of Anaesthesiology (EJA). 2013;30:25-.
• 37. Do S-H. Magnesium: a versatile drug for anesthesiologists. Korean journal of anesthesiology. 2013;65(1):4.
• 38. Albrecht E, Kirkham K, Liu S, Brull R. Peri‐operative intravenous administration of magnesium sulphate and postoperative pain: a meta‐analysis. Anaesthesia. 2013;68(1):79-90.
• 39. De Oliveira GS, Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative Systemic Magnesium to Minimize Postoperative Pain: A Meta-analysis of Randomized Controlled Trials. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2013;119(1):178-90.
• 40. Han D, Chun DH, Kweon T, Shin YS. Significance of the injection timing of ephedrine to reduce the onset time of rocuronium. Anaesthesia. 2008;63(8):856-60.