title: Comparison of the Effects of Magnesium Sulfate and Remifentanil on Hemodynamic Responses During Tracheal Extubation After Laparotomy: A Randomized Double-blinded Trial.
abstract: BACKGROUND
  Because blood pressure and heart rate (HR) elevations during tracheal extubation are common, different medications have been studied to prevent such complications.
  
  
  OBJECTIVE
  To compare magnesium sulfate, remifentanil, and placebo regarding mean arterial pressure (MAP) and HR changes during/after tracheal extubation, in patients who underwent laparotomy.
  
  
  METHODS
  In this randomized double-blinded trial, 120 patients undergoing laparotomy were evenly divided into three groups, including remifentanil (1 mcg/kg), magnesium sulfate (50 mg/kg), or normal saline, as placebo. Hemodynamic responses (MAP and HR) were documented at different times (before operation, during medication administration, immediately before extubation, immediately after extubation, and also 3, 5, and 10 minutes after extubation). The double burst time (DBT) was determined using neuromuscular monitoring, as time interval, between administration of reverse medication and DBT of 100%.
  
  
  RESULTS
  The HR was significantly lower, immediately after extubation and 3, 5, and 10 minutes after extubation, in both magnesium and remifentanil groups, compared to normal saline (P < 0.001). The MAP was also lower in magnesium and remifentanil groups, immediately after extubation and 3 minutes after extubation, in comparison to the normal saline group (P < 0.001). Mean (± SD) DBT 100% was significantly higher in magnesium group (30.2 ± 15.3) vs. remifenatnil (13.6 ± 6.8) and normal saline (13.5 ± 8.2) groups (P < 0.001).
  
  
  CONCLUSIONS
  Both remifentanil and magnesium had favorable outcomes in preventing HR and MAP elevation after tracheal extubation. However, remifentanil was associated with more rapid regaining of consciousness and reversal of muscular relaxation.
authors.affiliation: Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Mojtaba
authors.initials: SM
authors.lastname: Marashi
authors.affiliation: Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Hassan Nikkhouei
authors.affiliation: Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Movafegh
authors.affiliation: Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Gita
authors.initials: G
authors.lastname: Shoeibi
authors.affiliation: Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shaqayeq
authors.initials: S
authors.lastname: Marashi
keywords: Blood Pressure; Heart; Magnesium; Remifentanil