Effect of magnesium sulphate on bleeding during lumbar discectomy

Abstract

SummaryWe assessed the effect of magnesium on the amount of bleeding, coagulation profiles and surgical conditions during lumbar discectomy under general anaesthesia. Forty patients, of ASA physical status 1-2 and aged 18-65 years, undergoing single-level microscopic lumbar discectomy, were randomly assigned to magnesium sulphate (50 mg.kg )1 in 100 ml saline over 10 min followed by a continuous infusion of 20 mg.kg.h )1 ) or saline. The mean (SD) estimated blood loss was 190 (95) and 362 (170) ml in the magnesium and saline groups, respectively (mean difference = 172 ml; 95% CI 84-260 ml). The median (IQR [range]) Fromme's scale score for surgical conditions for the magnesium and saline groups were 2 (2-3 [2-3]) and 3 (2-3 [3-4]), respectively (p < 0.05).The bleeding time, haemoglobin, platelet count, prothrombin time, international normalised ratio and fibrinogen levels were similar in the two groups. The activated partial thromboplastin time was prolonged in the magnesium group immediately postoperatively and at 6 h after surgery. After the bolus of magnesium, the heart rate was higher and the mean arterial pressure lower in the magnesium group. The use of magnesium sulphate during lumbar discectomy decreases blood loss, and provides better surgical conditions without marked haemodynamic effects.

Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage

“…10 In a randomized controlled study of 40 patients undergoing singlelevel microscopic lumbar discectomy, bolus infusion followed by continuous infusion of magnesium sulfate resulted in significantly less surgical blood loss. 25 Warfarin-induced coagulopathy and aspirininduced platelet dysfunction have been associated with hematoma expansion and worse outcome in ICH. 3,4 In light of the evidence supporting magnesium's role in hemostasis, we speculate that the effect of low magnesium on outcomes in patients with spontaneous ICH is mediated through accelerated prehospital hematoma growth, leading to larger initial hematoma volumes and in-hospital hematoma expansion.…”

Comparative induction of controlled circulation by magnesium and remifentanil in spine surgery

“…Although we needed to supplement our patients with intravenous NTG in 25% of patients to attain the preset target MAPs down to the 60-70 mmHg range, there was no difference between the REM and MGS groups in the amount of surgical bleeding. Similarly, Göral et al [26] demonstrated that magnesium significantly decreased the amount of surgical bleeding following lumbar discectomy surgery and improved the surgical exposure compared to normal saline controls. These authors used normal saline as a control, a strategy that we could not establish for both therapeutic and ethical reasons.…”

Comparative Evaluation of Dexmedetomidine and Magnesium Sulphate on Propofol Consumption, Haemodynamics and Postoperative Recovery in Spine Surgery: A Prospective, Randomized, Placebo Controlled, Double-blind Study

“…Goral N, et al 13 also noted that toxic level of serum magnesium concentration is not reached even after using magnesium sulfate in the dose of bolus (50mg/kg) and continuous infusion (20 mg/kg/hr). In the present study, we administered magnesium sulfate bolus dose (50 mg/kg), and the maintenance dose (15 mg/kg/hr) based on previous studies.…”