Effects of different dose regimens of magnesium on pharmacodynamics and anesthetic requirements of balanced general anesthesia.
The present double- blind, randomized, placebo-controlled study was designed to assess the effect of two different dose regimens of magnesium sulphate (MgSO4) administration on intraoperative propofol and vecuronium requirements and postoperative fentanyl consumption in patients undergoing hernioraphy. Sixty patients were allocated to three equal groups; two magnesium groups and control group. Magnesium groups received 50 mg kg(-1) of magnesium preoperatively followed by intravenous infusion of magnesium 8 mg kg(-1) h(-1) (Mg1 G) or 16 mg kg(-1) h(-1) (Mg2 G). Patients in control group received the same volume of isotonic solution. Anesthesia was induced and maintained with propofol, fentanyl, and vecuronium. Magnesium Gs required significantly lower propofol (121.0 +/- 4.5, 117.4 +/- 6.3 microg kg(-1) min. (-1) in Mg1 & Mg2 Gs respectively vs. 153.8 +/- 8.4 microg kg(-1) min. (-1) in control G), and vecuronium requirements (0.097 +/- 0.008, 0.0921 +/- 0.006 mg kg(-1) h(-1) in Mg1 & Mg2 Gs respectively vs. 0.124 +/- 0.01 mg kg(-1) h(-1) in control G). Magnesium significantly shortened the onset time of vecuronium (154.0 +/- 25.9, 162.0 +/- 22.4 sec. in Mg1 & Mg2 Gs respectively vs. 227.4 +/- 10.9 sec. in control), prolonged its clinical duration (44.7 +/- 3.2, 46.4 +/- 5.1 min. in Mg1 & Mg2 Gs respectively vs. 26.0 +/- 3.9 min. in control) and prolonged its recovery index which was significantly longest in Mg2 G (25.4 +/- 1.9 min.) compared to Mg1 G (20.1 +/- 2.1 min.) and control (15.3 +/- 1.4 min.). Fentanyl consumption on the first postoperative day was significantly higher in control (1.52 +/- 0.08 microg kg(-1)) than in magnesium Gs (0.96 +/- 0.07, 0.91 +/- 0.08 microg kg(-1) in Mg1 & Mg2 Gs respectively). Postoperative sedation score showed significantly the highest value in Mg2 G compared to Mg1 and control Gs. Mean arterial blood pressure and heart rate were lower in magnesium groups with lowest value in Mg2 G. It is concluded that magnesium 50 mg kg(-1) bolus followed by 8 mg kg(-1) h(-1) leads to significant reductions in intraoperative propofol and vecuronium and postoperative fentanyl consumption. Doubling magnesium infusion rate added minimal benefits on the expense of haemodynamic consequences and delayed recovery.
Khafagy
Hanan F
HF
Department of Anesthesia, Theodor Bilharz Research Institute, Imbaba P.O. Box 30, Giza, Egypt.
Osman
Emad S
ES
Naguib
Amr F
AF
D000328:Adult; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods*; D000777:Anesthetics / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000493:pharmacokinetics*; D006801:Humans; D007262:Infusions, Intravenous; D008278:Magnesium Sulfate / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D015742:Propofol / Q000493:pharmacokinetics*; D014673:Vecuronium Bromide / Q000493:pharmacokinetics*
D000777:Anesthetics; D018686:Anesthetics, Intravenous; D008278:Magnesium Sulfate; D014673:Vecuronium Bromide; D005283:Fentanyl; D015742:Propofol