Magnesium Sulfate as an Adjuvant to Anesthesia in Patients With Arterial Hypertension

Abstract

SUMMARY -Th ere is limited evidence showing that elevated arterial blood pressure in surgical patients may be associated with increased perioperative risk; however, cardiovascular instability frequently occurs during anesthesia. Th e most commonly used anesthetic agents, both intravenous and inhalation ones, produce a decrease in arterial blood pressure. Magnesium, acting as a natural calciumchannel blocker, induces direct and indirect vasodilatation, thus playing a role in the treatment of arterial hypertension. In this research, we assessed the eff ects of magnesium sulfate on cardiovascular stability in patients undergoing diverse planned surgical procedures (abdominal, orthopedic, urology) under general balanced anesthesia, who were diagnosed with arterial hypertension grade 1 and 2. Th e research encompassed 100 patients of both sexes, aged from 20 to 65. Immediately before induction of anesthesia with propofol, the patients in the experimental group (50 study subjects) received 30 mg/ kg bolus dose and magnesium sulfate infusion at 10 mg/kg/h, whereas the subjects in the control group (50 patients) were administered normal saline. Anesthesia was achieved and maintained with sevofl urane, fentanyl and rocuronium. Th e hemodynamic variables of mean arterial pressure and heart rate were measured every fi ve minutes, starting immediately before magnesium infusion. Statistical analysis of the categorized values of mean arterial pressure and heart rate revealed a statistically signifi cant between-group diff erence at 60 th and 90 th minute of anesthesia. In conclusion, magnesium sulfate as an adjuvant to anesthesia in patients with arterial hypertension reduces hemodynamic changes during anesthesia.

Establishing low‐density lipoprotein apheresis tolerability in patients with prior anaphylactoid reactions to lipoprotein apheresis using magnesium sulfate

“…Immediately before induction of anesthesia with propofol, the treatment group received 30 mg/kg bolus dose and magnesium sulfate infusion at 10 mg/kg/h, while the control group received saline. A statistically significant difference was observed at 60 and 90 minutes of anesthesia for mean arterial pressure and heart rate, demonstrating magnesium sulfate as an effective adjuvant to anesthesia in patients with arterial hypertension 24 …”

Magnesium for Pain Treatment in 2021? State of the Art

“…In post-operative pain, 49 RCTs studied the effectiveness of Mg in reducing pain (VAS) and/or on analgesics consumption (40 RCTs explored both parameters, 4 explored pain evolution only and 5 analgesics use only) [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 ]; 44/49 RCTs explored the efficacy of Mg on the evolution of post-operative pain [ 33 , …”

“…A number of RCTs (16) did not show however any efficacy of Mg on pain [ 36 , 38 , 42 , 44 , 50 , 56 , 57 , 61 , 62 , 66 , 70 , 72 , 73 , 75 , 77 , 81 ]. Six intravenous Mg sulphate regimens ranging from non-bolus infusion to 50 mg/kg bolus followed by infusion showed no efficacy on pain.…”

“…Concerning bolus administration of 50 mg/kg, five RCTs showed no efficacy on reduction of post-operative pain: two RCTs with an infusion of 8 mg/kg/h in 46 [ 62 ] and 60 subjects [ 61 ], one RCT with an infusion of 10 mg/kg/h for 24 h in 40 subjects [ 57 ] and two RCTs with an infusion of 15 mg/kg/h in 58 subjects [ 50 ] and 62 subjects [ 56 ] over 24 and 72 h. With a 40 mg/kg bolus followed by a 10 mg/kg/h infusion, no pain improvement was observed over 24 h in 40 subjects [ 66 ]. Furthermore, four RCTs did not show any difference in the progression of pain: for a bolus administration of 30 mg/kg of Mg sulphate followed by an infusion of 6 mg/kg/h over 120 min in 42 subjects [ 75 ], or by an infusion of 10 mg/kg/h in 84, 96 or 100 subjects [ 70 , 72 , 73 ]. Another RCT did not show efficacy in reducing pain over 5 days of 20 mg/kg Mg sulphate bolus followed by an infusion of 10 mg/kg/30 min during surgery in 24 subjects [ 77 ].…”

“…In post-operative pain, 49 RCTs studied the effectiveness of Mg in reducing pain (VAS) and/or on analgesics consumption (40 RCTs explored both parameters, 4 explored pain evolution only and 5 analgesics use only) ; 44/49 RCTs explored the efficacy of Mg on the evolution of post-operative pain [33][34][35][36][37][38][41][42][43][44][45][46][47][49][50][51][52][53][54][55][56][57][58][59][61][62][63][64][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81] (n = 2988). Twenty-nine studies observed a significant decrease of VAS post-operative pain following intravenous administration of Mg sulphate (ranging from -2/10 [36] to −4/10 [58] at 12 h) compared to placebo or conventional treatment group [33]…”