Intraoperative magnesium sulphate decreases agitation and pain in patients undergoing functional endoscopic surgery

Elsersy, Hazem E.; Metyas, Magdy Ch.; Elfeky, Hana A.; Hassan, Ahmed

doi:10.1097/eja.0000000000000642

Cited by 33 publications

(37 citation statements)

References 31 publications

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“…The authors speculated that the neuroprotective and anticonvulsant potential of magnesium sulfate may have reduced the incidence of EA. Similarly, in a randomized double-blind placebo-controlled trial in adult patients (20 -60 years old) undergoing endoscopic sinus surgery, magnesium sulfate administered throughout the surgery was effective in preventing EA [105].…”

Section: Magnesium Sulfatementioning

confidence: 95%

“…Magnesium sulfate is a noncompetitive NMDA receptor antagonist, which has central sedative, neuroprotective, and analgesic-sparing effects [104,105]. In a study of pediatric patients (3 -16 years old), magnesium sulfate (30 mg/kg) administered 10 minutes prior to the end of surgery did not reduce EA after sevoflurane anesthesia [106]; in contrast, a 30 mg/kg bolus with continuous infusion of 10 mg/kg/h (from the start of surgery to the end of surgery) reduced the incidence and severity of EA in pediatric patients (4 -7 years) undergoing the same surgery (adenotonsillectomy) under sevoflurane anesthesia [53].…”

Section: Magnesium Sulfatementioning

confidence: 99%

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Emergence agitation: current knowledge and unresolved questions

Lee

Sung

2020

Korean J Anesthesiol

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This article is protected by copyright of Korean Journal of Anesthesiology. All rights reserved. Emergence agitation (EA), which is also referred to as emergence delirium, can lead to clinically significant consequences. The mechanism of EA remains unclear. Proposed contributors to EA include age, male sex, type of surgery, emergency operation, use of inhalational anesthetics with low blood-gas partition coefficients, long duration of surgery, anticholinergics, premedication with benzodiazepines, voiding urgency, postoperative pain, and the presence of invasive devices. If preor intraoperative objective monitoring could predict the occurrence of agitation during emergence, this would help to reduce the adverse consequences of EA. Several tools are available for assessing EA; however, its incidence varies considerably according to the assessment tool and definition of EA used, due to the absence of standardized clinical research practice guidelines. Total intravenous anesthesia, propofol, μ-opioid agonists, N-methyl-D-aspartate receptor antagonists, nefopam, α2adrenoreceptor agonists, regional analgesia, multimodal analgesia, parent-present induction, and preoperative education for surgery may contribute to prevention of EA. However, it is difficult to identify patients at high risk for EA and to properly apply EA prevention methods in various clinical situations, because both risk factors and preventive strategies often show inconsistent results depending on the methodology of the study and the patients assessed. This review discusses the most important research topics related to EA and directions for future research.

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Section: Magnesium Sulfatementioning

confidence: 95%

Section: Magnesium Sulfatementioning

confidence: 99%

Emergence agitation: current knowledge and unresolved questions

Lee

Sung

2020

Korean J Anesthesiol

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“…It should, however, be noted that magnesium sulfate proved inadequate for procedural sedation when combined with ketamine in a recent randomized clinical trial (Azizkhani et al, 2018). Magnesium salts have been used as an adjunct to clinical anesthesia (Elsersy et al, 2017; Elsonbaty and Isonbaty, 2017), and may attenuate vincristine-induced neuropathic pain (Bujalska et al, 2009) and chronic diabetic neuropathic pain (Rondon et al, 2010) in rat models, where they have also been found to reduce inflammatory pain (Srebro et al, 2018), probably due to the blocking action of Mg 2+ on NMDA receptors. Such receptors are well known both in cephalopods (Di Cosmo et al, 2004, 2006) and gastropods (Moccia et al, 2009).…”

Section: Actions Of Anesthetics On Cephalopod Molluscsmentioning

confidence: 99%

Sense and Insensibility – An Appraisal of the Effects of Clinical Anesthetics on Gastropod and Cephalopod Molluscs as a Step to Improved Welfare of Cephalopods

et al. 2018

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Recent progress in animal welfare legislation stresses the need to treat cephalopod molluscs, such as Octopus vulgaris, humanely, to have regard for their wellbeing and to reduce their pain and suffering resulting from experimental procedures. Thus, appropriate measures for their sedation and analgesia are being introduced. Clinical anesthetics are renowned for their ability to produce unconsciousness in vertebrate species, but their exact mechanisms of action still elude investigators. In vertebrates it can prove difficult to specify the differences of response of particular neuron types given the multiplicity of neurons in the CNS. However, gastropod molluscs such as Aplysia, Lymnaea, or Helix, with their large uniquely identifiable nerve cells, make studies on the cellular, subcellular, network and behavioral actions of anesthetics much more feasible, particularly as identified cells may also be studied in culture, isolated from the rest of the nervous system. To date, the sorts of study outlined above have never been performed on cephalopods in the same way as on gastropods. However, criteria previously applied to gastropods and vertebrates have proved successful in developing a method for humanely anesthetizing Octopus with clinical doses of isoflurane, i.e., changes in respiratory rate, color pattern and withdrawal responses. However, in the long term, further refinements will be needed, including recordings from the CNS of intact animals in the presence of a variety of different anesthetic agents and their adjuvants. Clues as to their likely responsiveness to other appropriate anesthetic agents and muscle relaxants can be gained from background studies on gastropods such as Lymnaea, given their evolutionary history.

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“…In our previous report on postoperative agitation in adults, we have investigated the role of magnesium sulfate as a potential treatment for postoperative agitations following functional endoscopic sinus surgery [1]. However, the high incidence of postoperative agitation in our protocol begs the search for the possible contributing factors to this phenomenon.…”

Section: Introductionmentioning

confidence: 98%

Factors Affecting Postoperative Agitation in Adults Following Functional Endoscopic Sinus Surgery: A Randomized, Double - Blinded Controlled Trial

Elsersy¹

2017

ACCMJ

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Background: We have noticed a high incidence of postoperative agitation (POA) following functional endoscopic sinus surgery (FESS), we reviewed our anesthesia protocol and designed this study. The present study investigated the possible contributing factors in the development of POA in adults, by avoiding these factors postoperative agitation can be minimized. Methods: 140 ASA 1 and 2 patients were randomly allocated to either premedication group that received Phenergan 25 mg IM and atropine 0.5mg IM or none premedication group that received an equal volume of water for injection intramuscular injection. Hypotensive anesthesia was induced by nitroglycerin 5 to 20 mcg/kg/minute. In postoperative care unit (PACU), patients were assessed for both agitation and pain using Richmond agitation sedation scale and numerical rating scale respectively. Data were analyzed and compared between groups, P<0.05 was considered significant. Results: Agitation was more frequent in the premedication group; premedicated patients showed a higher incidence of agitation versus the control group 82% versus 35% respectively P<0.0001.Postoperative agitation was more frequent in young ages, males, smokers and was correlated with pain. No correlation was found with BIS value or postoperative O2. Conclusion: premedication with atropine and Phenergan, Pain, smoking, young age, male gender was identified as risk factors for the development of postoperative agitation in adults following FESS.

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Intraoperative magnesium sulphate decreases agitation and pain in patients undergoing functional endoscopic surgery

Abstract: The current study was registered according to WHO and ICMJE standards on 7 January 2014, under registration number PACTR 201402000737691.

Cited by 33 publications

References 31 publications

Emergence agitation: current knowledge and unresolved questions

Emergence agitation: current knowledge and unresolved questions

Sense and Insensibility – An Appraisal of the Effects of Clinical Anesthetics on Gastropod and Cephalopod Molluscs as a Step to Improved Welfare of Cephalopods

Factors Affecting Postoperative Agitation in Adults Following Functional Endoscopic Sinus Surgery: A Randomized, Double - Blinded Controlled Trial

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