Magnesium sulphate

An adjuvant to tracheal intubation without muscle relaxation-a randomised studyMagnesium sulphateContextTracheal intubation without administration of neuromuscular blocking drug is used frequently in anaesthesia. Several techniques and adjuvant have been tried to improve intubation condition. Magnesium sulphate is an agent with analgesic, anaesthetic and muscle relaxant effects.ObjectiveTo assesss the effect of magnesium sulphate on intubating conditions after induction of anaesthesia without neuromuscular blocking drug.Main outcome measuresIntubating condition were evaluated by a blinded anaethesiologist using criteria of the copenhagen consensus conference: ease of laryngoscopy, vocal cord position and/or movement and response to intubation or cuff inflation (cough or diaphragmatic movement). Intubating condition were considered as acceptable (excellent or good) or unacceptable (poor). Mean arterial pressure and heart rate were also recorded during the study period. ResultThe two group were comparable in their demographic profiles. Clinically acceptable intubating conditions were observed more frequently in the magnesium group than in the control group: 25 (83%) vs 18 patients (60%) (P= 0,042). There was no failed intubation. There were no differences between the groups with regard to haemodynamic variables.ConclusionAddition of magnesium sulphate to propofol and fentanyl at induction of anaesthesia significantly improved intubating condition without administration of a neuromuscular blocking drug.Transmisi Neuromuskular7/26/2015

7/26/2015

Muscle relaxantInappropriate use may be associated with side effects such as anaphylaxis, intraoperative awareness, and complications of residual neuromuscular blockade.ContraindicationMyopathy, allergy, Neuromuscular disease

MagnesiumMagnesium plays a fundamental role in many physiological processesNeuronal activityMuscular contraction Muscle relaxing effects, mostly by reducing acetylcholine release1.3-2.1 mEq/liter54% is part of bone matrix as magnesium salt46% occurs as magnesium ion (Mg2+) intracellular fluid (45%) and extracellular fluid (1%)MethodsEthics Committee of Hospital Militaire Avicenne MarrakechApproval and informed consent60 patients, aged 18 to 60 yearsAirway Mallampati test (I and II)Exclusion criteriaHistory of reactive airway diseaseIncrease risk of regurgitationAnticipated difficult intubationObese patients (BMI>30)Hepatic, renal, cardiovascular or respiratory diseaseTreatment with CCB and pregnancyMethods contThe patients were allocated randomly to one of two groupMagnesium group 10-min infusion of magnesium sulphate 45 mg/kg in 100 ml of 0,9% salineControl group 10-min infusion of 100 ml of 0,9% salineDouble blind study

Result

Duration intubation shorter in the Magnesium sulphate group than the control group but the difference is not significant: 158 vs 20 10 (p=0,092)

DiscussionAddition magnesium sulphate 45 mg/kg to fentanyl 3ug/kg and propofol 2.5mg/kg improved intubating condition during induction of general anesthesia without adverse haemodynamic effect.Magnesium is an agent with analgesic, anaesthetic and muscle relaxant effects.Discussion contAnaesthetic effect Magnesium sulphate has a depressant effect on the CNS Analgesic effect interference with calsium channel and NMDA.Muscle relaxant effect reduction in release of acetylcholine at motor nerve terminal.ConclusionMagnesium sulphate is an effective adjuvant to tracheal intubation without neuromuscular bloking drugCombination with propofol and fentanyl significantly improved intubating conditions which were acceptable in 84% of the patients in magnesium groupDose in this study (45mg/kg) did not induce any clinically important adverse haemodyamic effects.