Use Profile of Magnesium Sulfate in Anesthesia in Brazil

Cavalcanti, Ismar Lima; Lima, Fernando Vítor; Silva, Mário Jorge Sobreira da; Filho, Rubens Antunes da Cruz; Braga, Estêvão Luiz Carvalho; Verçosa, Núbia

doi:10.3389/fphar.2019.00429

Cited by 17 publications

(8 citation statements)

References 76 publications

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“…A milestone that could help reducing even further perioperative opioid consumption for cardiac surgery patients might be the integration of opioid-free anesthesia (OFA) protocol. In OFA for non-cardiac surgery, sympathetic nervous system control is obtained administrating a combination of several drugs studied the last 30 years such as intravenous lidocaine [8], ketamine [9], dexmedetomidine which is a highly selective alpha-2 agonist [10] and magnesium sulfate [11]. This multimodal analgesic approach has an important opioid sparing effect that has been shown to limit opioidrelated side effects such as respiratory depression and, thus prolonged duration of mechanical ventilation, delirium, urinary retention, nausea, ileus and vomiting [12].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

Aguerreche¹,

Cadier²,

Beurton

et al. 2021

BMC Anesthesiol

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Background No previous study investigated the dexmedetomidine-based opioid-free anesthesia (OFA) protocol in cardiac surgery. The main objective of this study was to evaluate the feasibility and the postoperative opioid-sparing effect of dexmedetomidine-based OFA in adult cardiac surgery patients. Methods We conducted a single-centre and retrospective study including 80 patients above 18 years old who underwent on-pump cardiac surgery between November 2018 and February 2020. Patients were divided into two groups: OFA (lidocaine, ketamine, dexmedetomidine, MgSO4) or opioid-based anaesthesia (remifentanil and anti-hyperalgesic medications such as ketamine and/or MgSO4 and/or lidocaine at the discretion of the anesthesiologist). The primary endpoint was the total amount of opioid consumed in its equivalent of intravenous morphine during the first 48 postoperative hours. Secondary outcomes included perioperative hemodynamics, post-operative maximal pain at rest and during coughing and adverse outcomes. Data are expressed as median [interquartile range]. Results Patients in the OFA-group had a higher EuroSCORE II, with more diabetes, more dyslipidemia and more non-elective surgery but fewer smoking history. In the OFA group, the median loading dose of dexmedetomidine was 0.6 [0.4–0.6] μg.kg− 1 while the median maintenance dose was 0.11 μg.kg− 1.h− 1 [0.05–0.20]. In 10 (25%) patients, dexmedetomidine was discontinued for a drop of mean arterial pressure below 55 mmHg. The median total amount of opioid consumed in its equivalent of intravenous morphine during the first 48 postoperative hours was lower in the OFA group (15.0 mg [8.5–23.5] versus 30.0 mg [17.3–44.3], p < 0.001). While no differences were seen with rest pain (2.0 [0.0–3.0] versus 0.5 [0.0–5.0], p = 0.60), the maximal pain score during coughing was lower in OFA group (3.5 [2.0–5.0] versus 5.5 [3.0–7.0], p = 0.04). In OFA group the incidence of atrial fibrillation (18% versus 40%, p = 0.03) and non-invasive ventilation use (25% versus 48%, p = 0.04) were lower. The incidence of bradycardia and the intraoperative use of norepinephrine were similar between both groups. Conclusion Dexmedetomidine-based OFA in cardiac surgery patients is feasible and could be associated with a lower postoperative morphine consumption and better postoperative outcomes. Further randomized studies are required to confirm these promising results and determine the optimal associations, dosages, and infusion protocols during cardiac surgery. Graphical abstract

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Section: Introductionmentioning

confidence: 99%

Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

Aguerreche¹,

Cadier²,

Beurton

et al. 2021

BMC Anesthesiol

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“…Neophodan je za skladištenje, metabolizam i korišćenje energije, sintezu proteina, stabilnost nukleinskih kiselina, funkcionisanje nervnog i mišićnog tkiva, održavanje stabilnosti ćelijske membrane i drugo (8). Nalazi se u sastavu adenozin 5trifosfataze (ATP-aze) i endogeni je regulator transmembranskog prolaska nekoliko elektrolita (9). Magnezijum funkcioniše kao prirodni antagonist kalcijuma.…”

Section: Fiziologija Magnezijumaunclassified

“…Nedavno je jedna prospektivna deskriptivna studija preseka pokazala da je u Brazilu magnezijum-sulfat jedan od 5 najčešće korišćenih pomoćnih lekova u anesteziji, pored klonidina, ketamina, lidokaina i deksmedetomidina (9). Primenjen perioperativno, magnezijum-sulfat može da smanji potrebe za opštim anestetikom (37, 38, 39 26, 27, 28), poboljša postoperativnu analgeziju (40,41), smanji potrebu za opioidnim analgetikom (41), ublaži kardiovaskularne efekte kod laringoskopije, intubacije, kao i kod stvaranja pneumoperitoneuma pre videolaparaskopije (42,43), obezbedi bolju hemodinamsku kontrolu pri resekciji feohromocitoma (44), spreči pojavu vazospazma (45), produži dejstvo miorelaksansa i smanji potrebu za miorelaksansom (9,46), kao i smanji postoperativnu drhtavicu (47,48,49). Pri svemu tome, magnezijum-sulfat ima visok terapijski indeks, malo neželjenih efekata i mogao bi da ima povoljan odnos cene i efikasnosti (17).…”

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Role of magnesium sulfate in the treatment of acute postoperative pain

Vučković¹,

Savić-Vujović²,

Srebro³

et al. 2019

Arhiv za farmaciju

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Ko-analgetici se često kombinuju sa opioidima kako bi se smanjila prevalenca neželjenih dejstava opioida uz isti ili čak poboljšan kvalitet analgezije. Magnezijum je esencijalni mineral koji moduliše nocicepciju dejstvom na N-metil-D-aspartatne receptore, kalcijumske, kalijumske, natrijumske i kanale za prolazne receptorske potencijale, sintazu azotnog oksida (NO) i ima druge mehanizme dejstva. Postoje dokazi da magnezijum pojačava efekte opioida, opštih i lokalnih anestetika. Kod ljudi, perioperativno intravenski primenjen magnezijum-sulfat (MS) pokazao se efikasnim u smanjenju postoperativnog bola i postoperativne potrošnje analgetika. Primenjen kao dodatak lokalnim anesteticima u neuraksijalnoj anesteziji može biti još efikasniji nego nakon sistemske primene. Takođe, u kombinaciji sa lokalnim anesteticima, može da produži nervni blok, regionalnu intravensku i infiltracionu anesteziju. MS kad se primeni lokalno, kao monoterapija, značajno smanjuje postoperativnu gušobolju. Međutim, nisu sve studije pokazale postoperativnu analgetičku efikasnost sistemski ili lokalno primenjenog MS. Primenu MS-a prati malo neželjenih efekata. Međutim, rizik od neuroloških komplikacija kod neuraksijalne primene MS još uvek nije detaljno istražen. Za sada, mali broj ispitanika i heterogenost metodologije u ispitivanjima (različite doze, način i dužina primene, različiti parametri efikasnosti) ograničavaju mogućnost donošenja konačnih zaključaka o ulozi perioperativne primene MS u lečenju postoperativnog bola.

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“…(9)(10)(11)(12)(13) Since 1990, the effect of magnesium sulfate has been studied on postoperative analgesia and decreased postoperative opioid consumption. (6,(14)(15)(16) Several studies have reported contradictory results of the effect of magnesium sulfate on postoperative pain relief. Some of these studies suggest that pre-operative magnesium sulfate significantly reduced postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

Preemptive analgesic effect of magnesium sulfate on postoperative pain in patients undergoing lumbar fusion surgery

et al. 2019

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Background Reducing postoperative pain can improve patient satisfaction and hospital cost. Intravenous magnesium sulfate is one of the proposed drugs for preemptive analgesia. The study aimed to evaluate the effect of magnesium sulfate on postoperative pain in patients undergoing lumbar fusion surgery. Methods A double-blind randomized clinical trial was conducted on candidates for vertebral fusion surgery with American Society of Anesthesiologists (ASA) class I-II. One hundred and two patients were randomized into the magnesium sulfate group and control group. The magnesium sulfate group received magnesium sulfate at a dose of 50mg/kg in 20 mL volume and infused during 15-30 minutes pre-operation, while the control group received 20 mL normal saline. The severity of the pain was assessed by the Visual Analogue Scale (VAS) at 2, 4, 6, 12 and 24 hours after patients entering the post-anesthetic care unit. After the operation, the patients’ relaxation rate was assessed based on Ramsay sedation score (RSS). Results There was no significant difference at 2, 4, 6, 12 and 24 hours post-operation between the two groups in the mean severity of pain (p>0.05). There was no significant difference at 2, 4, 6, 12 and 24 hours post-operation between the two groups in the mean of pethidine consumption. There was no significant difference in the relaxation of the patients according to the RSS criteria in the magnesium sulfate and control groups (p=0.162). Conclusion Pre-operative administration of magnesium sulfate does not affect reduction in postoperative pain and opioid consumption of patients undergoing lumbar fusion surgery.

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Use Profile of Magnesium Sulfate in Anesthesia in Brazil

Cited by 17 publications

References 76 publications

Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

Role of magnesium sulfate in the treatment of acute postoperative pain

Preemptive analgesic effect of magnesium sulfate on postoperative pain in patients undergoing lumbar fusion surgery

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