The effect of magnesium sulphate infusion on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia

Abstract

SummaryThis randomised, controlled, double-blind study investigated the effects of intra-operative magnesium sulphate administration on the incidence of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia. Seventy children were randomly allocated to receive a 30 mg.kg À1 bolus of intravenous magnesium sulphate after induction of anaesthesia followed by a continuous infusion of 10 mg.kg À1 .h À1 or an equal volume of saline 0.9%. All children received titrated sevoflurane anaesthesia adjusted to maintain haemodynamic stability. The Pediatric Anesthesia Emergence Delirium scale and the Children's Hospital of Eastern Ontario Score were used for the assessment of postoperative emergence agitation and pain, respectively. Emergence agitation was more common in the control group than in the magnesium group (23 (72%) and 12 (36%), respectively (p = 0.004)), with a relative risk of 0.51 (95% CI 0.31-0.84), an absolute risk reduction of 0.35 (95% CI 0.10-0.54), and number needed to treat of 3 (95% CI 2-9). Postoperative pain scores were comparable in the two groups. Magnesium sulphate reduces the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane anaesthesia and is not associated with increased postoperative side-effects or delayed recovery.

Magnesium sulfate for postoperative complications in children undergoing tonsillectomies: a systematic review and meta‐analysis

“…Adverse effects observed are listed in Table . For the PONV, meta‐analysis of six studies involving 385 patients reported PONV showed no significant difference between two groups (OR = 1.23, 95% CI = 0.70 to 2.18, P = 0.47) (Fig ). Laryngospasm was founded significantly lower in MgSO 4 group than controlled group by meta‐analysis of seven studies involving 500 patients (OR = 0.36, 95% CI = 0.13 to 0.96, P = 0.04).…”

“…A total of 334 studies were retrieved through database search. After screening, 10 RCTs with 665 participates published between 2003 and 2015 were included. Of which, four studies administrated magnesium locally and six administrated systemically.…”

The Effect of Systemic Magnesium on Postsurgical Pain in Children Undergoing Tonsillectomies

“…Abdulatif et al, using a similar dosing regimen of magnesium (30 mg/kg bolus followed by a continuous infusion of 10 mg/kg/hr) found a reduced incidence and severity of emergence agitation in pediatric patients undergoing tonsillectomies. 24 …”

Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: A metaanalysis

“…It has been suggested that the altered cognitive perception typical of EA might be related to rapid recovery from sevoflurane and desflurane anesthesia . Agitation during recovery is associated with many risks, including self‐inflicted injury to the pediatric patient or the surgical site . Agitation events prolong recovery, extend discharge time, and contribute to unexpected readmission and increased costs, which are major problems that continue to be undertreated in pediatric patients .…”