Effect of intraoperative magnesium intravenous infusion on the hemodynamic changes associated with right lobe living donor hepatotomy under transesophageal Doppler monitoring-randomized controlled trial

Abstract

Background:Liver donors are subjected to specific postresection hemodynamic changes. The aim was to monitor these changes and to evaluate the effect of magnesium sulfate infusion (MgSO4) on these changes together with total anesthetic agents consumption.Patients and Methods:A total of 50 donors scheduled for right hepatotomy were divided into two equal groups. Controls (C) received saline and magnesium group (Mg) received MgSO4 10% (30 mg/kg over 20 min) administered immediately after induction of anesthesia, followed by infusion (10 mg/kg/h) till the end of surgery. Hemodynamics, transesophageal Doppler (TED) data and anesthetic depth guided by Entropy were recorded.Results:Postresection both groups demonstrated an increase in heart rate (HR) and cardiac output (COP) in association with lowering of systemic vascular resistance (SVR). The increase in HR with Mg was lower when compared with C, P = 0.00. Increase in COP was lower with Mg compared to (C) (6.1 ± 1.3 vs. 7.5 ± 1.6 L/min, P = 0.00) and with less reduction in SVR compared to C (1145 ± 251 vs. 849.2 ± 215 dynes.s/cm5, P < 0.01), respectively. Sevoflurane consumption was lower with Mg compared to C (157.1 ± 35.1 vs. 187.6 ± 25.6 ml, respectively, P = 0.001). Reduced fentanyl and rocuronium consumption in Mg group are compared to C (P = 0.00). Extubation time, postoperative patient-controlled fentanyl were lower in Mg than C (P = 0.001).Conclusion:TED was able to detect significant hemodynamic changes associated with major hepatotomy. Prophylactic magnesium helped to reduce these changes with lower anesthetic and analgesics consumption and an improvement in postoperative pain relief.

Preventive Multimodal Analgesia Versus Morphine in Cancer Patients Undergoing Major Abdominal Surgeries

“…This is in agreement to the results of a meta-analysis done by Oliveira et al, in 2013 [16] who stated that perioperative use of magnesium decreases post-operative pain and can lead to reduction of post-operative opioid consumption. This was supported by the results of more recent studies in different surgical procedures as hepatectomy, laparoscopic gastrectomy and laparoscopic gynecological surgeries [17][18][19] . Using perioperative magnesium has a promising role in reducing post-operative opioid consumption [20] .…”

Pain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations

“…A placebo-controlled study compared a loading dose of magnesium sulfate 30 mg/kg followed by a continuous infusion of 10 mg/kg/hour, showing significantly reduced pain scores and opioid requirements. 14 Basic analgesics were not administered in the control group.…”