Magnesium Sulfate and Clonidine; Effects on Hemodynamic Factors and Depth of General Anesthesia in Cesarean Section

Abstract

Background: Making stable hemodynamic and also durable unawareness is a daily challenge in the setting of general anesthesia in women who undergo surgical delivery of neonate and have limitations to receive opioids derivatives. Objectives: We aimed to evaluate the effects of magnesium sulfate and clonidine on hemodynamic changes and depth of anesthesia and in mentioned mothers and also in neonatal APGAR index. Methods: Current randomized, double-blind controlled trial study was conducted among a total of 360 pregnant females (38 - 41 weeks of gestation) who underwent elective cesarean section. Participants were randomly divided into three drug-receiving groups (equal 120 members): magnesium sulfate (30 mg/kg), clonidine (3 µg/kg), and placebo (0.9% NaCl). Patients’ blood pressure, heart rate, cerebral state index (CSI) in specific time zones, and also late 24-hour recall were recorded. The CSI is an electroencephalographic monitoring method helping to assess the depth of anesthesia. Neonatal parameters, including APGAR score and umbilical venous blood sampling, were measured. Results: Mean patients’ age was 28 ± 4.5. A significant decreasing and stabilizing effect of magnesium sulfate and clonidine on hemodynamic parameters (blood pressure and heart rate) was revealed (P < 0.001). Evidence implied on deeper anesthesia (lower CSI) among drug receivers comparing to placebo (P < 0.001). None of the participants experienced a late 24-hour recall postoperatively. All neonates were healthy, and no decrease was reported in APGAR score at minutes 1 and 5. Umbilical blood gas analysis showed no signs of acidosis and/or hypoxemia. Conclusions: Adjuvant administration of either magnesium sulfate or clonidine is associated with hemodynamic stability and favorable unawareness in the setting of elective surgical delivery.

Evaluation of the Effects of Oral Magnesium Sachet on the Prevention of Spinal Anesthesia-Induced Headache After Cesarean Section: A Randomized Clinical Trial

“…Magnesium is the second important intracellular cation that plays a crucial role in enzymatic activity and neurochemical transmission at the synaptic junction of muscles. Besides preventing eclamptic seizures and having cardiovascular effects, a new role for this drug in anesthesia has been defined in recent years (28)(29)(30). The antinociceptive effects of magnesium in managing acute and chronic pain have been established in numerous studies (31)(32)(33).…”

Anesthetic Conversion of Preexisting Labor Epidural Analgesia for Emergency Cesarean Section and Efficacy of Levobupivacaine with or Without Magnesium Sulphate: A Prospective Randomized Study

“…Similar results were obtained by Bajwa et al (38), as they found that epidural clonidine in CS resulted in shorter onset of analgesia with a longer duration, but with more bradycardia and hypotension occurrence, which may be detrimental for parturients. Rajabi et al (39) reported that when intravenous infusion of magnesium or clonidine were used in combination with GA in CS, once at the time of the induction, they had favorable hemodynamic and anesthetic profile with no risk to the neonate. This study had some limitations.…”

Magnesium Sulfate and Its Versatility in Anesthesia: A Comprehensive Review

“…During pregnancy, general anesthesia is a complicated process. MgSO4 or clonidine infused intravenously would maintain hemodynamic parameters and deepen general anesthesia in the context of surgical delivery, posing no additional acute danger to newborns [ 18 , 47 ].…”