Magnesium sulfate and lidocaine have good efficacy and safety for hemodynamic management in laryngoscopy and intubation.

No abstract

Inadvertent perioperative hypothermia, defined as a body temperature <36.0°C, is a common outcome of anesthesia that can cause serious consequences to patients. The aim of this study is to determine the prevalence of inadvertent hypothermia among surgical procedures from two referral centers in Brazil and to identify sociodemographic, clinical, or surgery-related predictors of hypothermia. This is a cross-sectional study, conducted at two public hospitals in Brasília, Brazil. After the exclusion of 109 patients, 312 subjects (American Society of Anesthesiologists [ASA] physical status I-III) were enrolled from July 2016 through July 2018. The main outcome measures were the prevalence of hypothermia and its predictors. The mean age of the 312 patients was 43.2 (18.2) years (range 18-85 years), and 186 (59.6%) were female. The prevalence of inadvertent hypothermia was 56.7%. Predictors of hypothermia were perioperative chills ( p = 0.026), patient's body temperature on arrival in the operating room ( p < 0.001), diabetes ( p < 0.001), ASA status III ( p < 0.001), systolic blood pressure ( p < 0.001), general anesthesia ( p < 0.001), medical specialty ( p < 0.001), fentanyl-based anesthesia ( p = 0.002), and surgery time ( p < 0.001). The multivariable model prediction model for hypothermia showed fairly good discrimination (area under the receiver operating characteristic: 79.0%, 95% confidence interval 68.0 to 80.1). Approximately 6 in 10 patients undergoing surgery developed inadvertent perioperative hypothermia. The risk of hypothermia is influenced by a myriad of factors that can be used in simple and low-cost predictive models with adequate discriminatory power.

BACKGROUND Recently, the use of venous adjuvants, such as lidocaine and magnesium sulfate, has been gaining ground in multimodal analgesia. However, no study has evaluated the impact a combination of the two drugs. OBJECTIVES To evaluate the efficacy of venous adjuvants in reducing opioid consumption and pain scores after mastectomy. DESIGN Randomised, double-blind, parallel-group, noninferiority clinical trial with a 1 : 1 : 1 : 1 allocation ratio. SETTING Hospital de Base do Distrito Federal, Brasilia, Federal District, Brazil from November 2014 to December 2017. PATIENTS One-hundred and ninety-eight patients were electively scheduled for mastectomy. Seventy-eight were excluded. INTERVENTIONS Intra-operative infusions of remifentanil (0.1 μg kg−1 min−1), lidocaine (3 mg kg−1 h−1), magnesium sulfate (50 mg kg−1 + 15 mg kg−1 h−1) or lidocaine with magnesium sulfate were used. All patients received standard general anaesthesia. MAIN OUTCOME MEASURES Peri-operative opioid consumption and pain scores. RESULTS The patients who received both lidocaine and magnesium sulfate group (n=30) consumed less alfentanil during surgery (P < 0.001) and less dipyrone (P < 0.001) and morphine (P < 0.001) in the postoperative period. Only two patients (6.7%) in the lidocaine and magnesium sulfate group needed morphine (P < 0.001). These requirements were significantly lower when compared with patients who received remifentanil (n=30; 76.6%) and magnesium sulfate (n=30; 70%; odds ratio 46.0, 95% confidence interval 8.69 to 243.25, P < 0.001, and odds ratio 32.66, 95% confidence interval 6.37 to 167.27, P < 0.001, respectively). The patients of the lidocaine and magnesium sulfate group had lower pain scores in the first 24 h postoperatively using the numerical rating scale and verbal rating scale at discharge from the postanaesthesia care unit (P < 0.001), after 12 h (P < 0.001) and after 24 h (P < 0.001) when compared with the other three groups. CONCLUSION Our findings suggest a synergistic effect of the use of both lidocaine and magnesium in peri-operative pain. This may be another potential strategy in the multimodal analgesia regimen. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02309879.