The effects of magnesium sulphate on desflurane requirement, early recovery and postoperative analgesia in laparascopic cholecystectomy

Abstract

Purpose: we evaluated the effects of magnesium sulphate infusion on anesthetic requirement, early recovery and postoperative analgesia in desflurane-remifentanil-based, balanced anaesthesia. Methods: 60, ASA (American Society of Anesthesiologists) group 1-2 patients who were scheduled for laparoscopic cholecystectomy were randomly divided into two groups. Before anesthesia, the magnesium-treated group (n = 30) received a 15 min infusion of 40 mg/kg of magnesium sulphate followed by 10 mg/kg/h by continuous i.v. infusion during the operation. The same volume of isotonic saline was administered to the control group (n = 30). Anesthesia was induced with propofol, remifentanil and vecuronium, and maintained with desflurane 3-6%, O 2 /air and remifentanil infusion. Desflurane was titrated to maintain BIS (bispectral index) values of 40-60. The times from cessation of anesthesia to spontaneous breathing, eye opening, extubation, reaching BIS 70, and Aldrete scores were recorded. After surgery, patients received a patient-controlled, morphine analgesia device. Results: demographic variables were similar. During the 15 min infusion of magnesium sulphate, the BIS value was significantly lower in the magnesium sulphate-treated group. The amounts of propofol and desflurane used were less in the magnesium sulphate-treated group, by 18% and 22% respectively (p<0.05). The groups did not differ with respect to the time taken to reach BIS 70, spontaneous breathing, eye opening and extubation. Alderete and VAS (visual analogue scale) pain scores, and total morphine consumption were significantly lower in the magnesium sulphate-treated group. There were no differences in side effects, but the rate of re-intubation was higher in the group receiving magnesium sulphate (p = 0.03). Conclusion: perioperative use of magnesium sulphate reduced propofol and desflurane consumption, and the postoperative morphine requirement, while causing a delay in recovery by decreasing the Aldrete score.

The efficacy of N-methyl-d-aspartate receptor antagonists on improving the postoperative pain intensity and satisfaction after remifentanil-based anesthesia in adults: a meta-analysis

“…In 8 trials, a perioperative use of ketamine was administered [11,[22][23][24][25][26][27][28]. In 5 trials, a preoperative bolus of magnesium sulfate was followed by a continuous infusion throughout surgery [29][30][31][32][33]. In 1 trial, a preoperative amantadine was administrated [34].…”

Effects of magnesium sulfate and propofol on the minimum alveolar concentration preventing motor movement in sevoflurane-anesthetized dogs

“…17 Infusion of MgSO 4 at a rate of 10 mg/kg/h to humans undergoing cholecystectomy resulted in a 2-fold increase in serum Mg concentrations and was associated with a decrease in desflurane MAC of 20%. 6 In another study, 8 MgSO 4 infusion at a rate of 8 mg/kg/h decreased propofol dose requirements by 50% and resulted in a 35% increase in baseline serum Mg concentrations. In dogs undergoing elective surgery, infusion of MgSO 4 at a rate of 12 mg/kg/h increased serum Mg concentrations and resulted in a decreased requirement for halothane.…”

“…For instance, MgSO 4 infusion (12 mg/kg/h) significantly reduced the requirement for halothane in dogs undergoing elective ovariohysterectomy in 1 study, 17 but a higher administration rate (15 mg/kg/h) failed to reduce the isoflurane requirement in dogs undergoing a similar surgical procedure 29 and did not change the MAC of isoflurane in goats. 30 Other studies in humans have reported that MgSO 4 infusion decreased desflurane requirements, 6,7 whereas it increased requirements for sevoflurane. 32 The study reported here had some potentially limiting factors that may have influenced the results.…”

“…The selected infusion rates of MgSO 4 in the present study were based on evaluation of the propofolsparing effects of Mg 27 and volatile anesthetic-sparing effects of Mg in humans 6 and dogs. 17 Infusion of MgSO 4 at a rate of 10 mg/kg/h to humans undergoing cholecystectomy resulted in a 2-fold increase in serum Mg concentrations and was associated with a decrease in desflurane MAC of 20%.…”

“…[3][4][5] A volatile anesthetic-sparing effect of MgSO 4 has been found for human patients anesthetized with desflurane. 6,7 Injectable anesthetic-and analgesic-sparing effects of MgSO 4 have been reported for several agents, including propofol, fentanyl, remifentanil, and midazolam. [8][9][10] Postoperative administration of MgSO 4 decreases opioid consumption and pain scores in a variety of human surgical patients.…”