title: Use of the NMDA antagonist magnesium sulfate during monitored anesthesia care for shockwave lithotripsy.
abstract: OBJECTIVE
  To assess whether intravenous magnesium sulfate infusion affects analgesic requirements during monitored anesthesia care (MAC) for shockwave lithotripsy (SWL).
  
  
  METHODS
  Fifty patients in ASA class I or II undergoing SWL with MAC were randomized into two groups. Induction of MAC was produced by bolus doses of midazolam 0.03 mg/kg(-1) and fentanyl 0.5 microg/kg(-1) followed by intravenous infusion of midazolam 0.015 to 0.06 mg/kg(-1)/hr(-1) with fentanyl supplementation 0.2 microg/kg(-1). In addition, group I patients received magnesium sulfate 30 mg/kg(-1) intravenously as a bolus dose followed by a continuous infusion of 10 mg/kg(-1) /hr(-1) beginning 15 minutes before induction of sedation. The midazolam infusion rate and additional fentanyl doses were adjusted by verbal analog scale (VAS) measurements, observer assessment sedation score (OAA/S), and achieving a target bispectral index (BIS) in a range of 70 to 90. At the end of SWL, the total midazolam and total fentanyl consumptions were recorded, and the serum magnesium concentration was measured.
  
  
  RESULTS
  Magnesium caused significant decreases in the total consumption of midazolam (P = 0.001) and fentanyl (P = 0.001). The VAS values at the 15th, 20th, and 25th minute in group I were significantly lower than in group II. In group I, hemodynamic and arterial oxygen parameters were better than in group II.
  
  
  CONCLUSIONS
  A magnesium bolus and infusion can be utilized to reduce analgesic requirements under MAC during SWL.
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Kirikkale, Kirikkale, Turkey.
authors.forename: Cetin
authors.initials: C
authors.lastname: Kaymak
authors.forename: Erdal
authors.initials: E
authors.lastname: Yilmaz
authors.forename: Hulya
authors.initials: H
authors.lastname: Basar
authors.forename: Sibel
authors.initials: S
authors.lastname: Ozcakir
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Apan
authors.forename: Ertan
authors.initials: E
authors.lastname: Batislam
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000494:pharmacology; D000758:Anesthesia; D001794:Blood Pressure / Q000187:drug effects; D016292:Procedural Sedation; D003710:Demography; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008096:Lithotripsy; D008278:Magnesium Sulfate / Q000494:pharmacology*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology; D010100:Oxygen; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors*
chemical_list: D000700:Analgesics; D016194:Receptors, N-Methyl-D-Aspartate; D008278:Magnesium Sulfate; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl