Effect of magnesium sulphate on bi-spectral index (BIS) values during general anesthesia in children

Abstract

BackgroundMagnesium was reported to reduce both the anesthetic requirements and the period needed to reach a bi-spectral index value of 60 when used intra-operatively (Br J Anaesth 83:302-20, 1999; Anesth Analg 20:1273-5, 1988; Br J Anaesth 89:594-8, 2002; Anesth Analg 87:206-10, 1998; Br J Anaesth 89:594-8, 2002; Br J Anaesth 94:438-41, 2005) and to minimize the emergence agitation (Anaesthesia 61:1058-63, 2006). Previous studies examined the influence of magnesium on the anesthetic requirements while the bi-spectral Index values were kept within a constant range. We evaluated the effect of intraoperative magnesium on the bi-spectral index values during pediatric anesthesia while we kept other anesthetic variables unchanged.MethodsEighty pediatric patients with ASA physical status I, age 2–8 years and scheduled for minor infra-umbilical elective procedures included in a prospective randomized controlled study. We randomly divided patients into two groups. Group I (40 patients); received a bolus dose 50 mg/kg of magnesium sulphate followed by an infusion at rate of 15 mg/kg/h throughout the procedure. Group II (40 patients); received the same amount in the form of ringer acetate for blinding. We compared between the groups regarding: 1) BIS values. 2) Hemodynamic parameters. 3) Arterial oxygen saturation 4) End-tidal CO2 5) Respiratory rate and 6) Tidal volume.ResultsMagnesium group (Group I) showed significantly lower BIS values and shorter time to achieve BIS values below 60. Respiratory parameters (tidal volume and respiratory rate) were significantly lower in the magnesium group. Otherwise, no significant differences between the study group and the control group were detected.DiscussionOur study has the advantage of evaluating the direct effect of magnesium sulphate on the Bi-spectral index scale with keeping other intraoperative factors almost constant (as the type of operations, induction and maintenance techniques, end-tidal anesthetic concentration, analgesia and mode of ventilation) for accurate assessment.ConclusionMagnesium produced significantly lower BIS values, less time to reach BIS values below 60, lower tidal volume and lower respiratory rate during pediatric general anesthesia.Trial registrationPan African Clinical Trial Registry, www.pactr.org, PACTR201312000666231. Registered at 6 October 2013.

Novel Treatment of Radicular Pain With a Multi-Mechanistic Combination Topical Agent: A Case Series and Literature Review

“…With regard to neuropathic pain, a recent randomized, placebo controlled, double blind, crossover trial evaluated the use of 1.5% topical diclofenac for neuropathic pain from PHN and complex regional pain syndrome. The authors found that after 2 weeks of topical application, subjects who received diclofenac had less pain compared to placebo on the visual analogue scale (VAS) ( 38 ).…”

Magnesium sulfate in pediatric anesthesia: the Super Adjuvant

“…MgSO 4 (20–50 mg·kg −1 ± 5–20 mg·kg −1 ·h −1 ) reduces the need for sedative‐hypnotic drugs during general anesthesia: it can decrease the sevoflurane minimum alveolar concentration by 50% and the induction dose of propofol; it shortens the latency time until a bispectral index value <60 is reached; and it reduces ventilation requirements (tidal volume and respiratory rate) as metabolism decreases (O 2 consumption and CO 2 production) .…”

“…Tracheal intubation (IV) (31) 30 mgÁkg À1 Laryngospasm (IV) (23,33,34) 15 mgÁkg À1 Bronchospasm (IV) (36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) 50-100 mgÁkg À1 + 40-50 mgÁkg À1 Áh À1 Bronchospasm (nebulized) (47)(48)(49)(50)(51)(52)(53)(54)(55) 40 mgÁkg À1 or 150 mg (total dose) Antiadrenergic response Cardiopulmonary bypass (IV) (57-60) 25-50 mgÁkg À1 Long QT syndrome (IV) (61) 30-50 mgÁkg À1 + 5-20 mgÁkg À1 Áh À1 Neonatal pulmonary hypertension (IV) (63) 200 mgÁkg À1 + 20-150 mgÁkg À1 Áh À1 Pheocromocytoma (IV) (64) 30-50 mgÁkg À1 + 5-20 mgÁkg À1 Áh À1 Organ protection Neuroprotection (IV) (68-72) 250 mgÁkg À1 Áday À1 Myocardial protection (cardioplegia) (73,74) 40-80 mgÁkg À1 Hypomagnesemia Perioperative hypomagnesemia (IV) (58,59) 25-50 mgÁkg À1 AE 5-20 mgÁkg À1 Áh À1 alveolar concentration by 50% and the induction dose of propofol; it shortens the latency time until a bispectral index value <60 is reached; and it reduces ventilation requirements (tidal volume and respiratory rate) as metabolism decreases (O 2 consumption and CO 2 production) (2,6). Sevoflurane has certain excitatory effects on the central nervous system, which may be associated with increased seizure activity in children.…”

Effect of magnesium sulfate on anesthesia depth, awareness incidence, and postoperative pain scores in obstetric patients

“… 2 , 3 Additionally, the element has potential analgesic and sedative properties; therefore, it is useful as an adjuvant during general anesthesia. 4 Previous study 5 have examined the effects of magnesium on anesthetic agent doses needed to keep bispectral index (BIS) values within fixed ranges. However, only a single pediatric study 5 has evaluated the effect of intraoperative magnesium on BIS values while operation type and end-tidal anesthetic concentration were kept constant.…”

“… 4 Previous study 5 have examined the effects of magnesium on anesthetic agent doses needed to keep bispectral index (BIS) values within fixed ranges. However, only a single pediatric study 5 has evaluated the effect of intraoperative magnesium on BIS values while operation type and end-tidal anesthetic concentration were kept constant. This recent study had evaluated the depth of anesthesia only by intraoperative BIS values.…”