The Effect of Intraoperative Magnesium Sulphate Infusion on Emergence Agitation after Ambulatory Ophthalmic Surgery in Children

Abstract

This study investigated whether intraoperative infusion of magnesium sulphate reduces the incidence of emergence agitation (EA) in paediatric patients who undergo ambulatory ophthalmic surgery using the Paediatric Anaesthesia Emergence Delirium (PAED) scale. Ninety-two paediatric patients who were scheduled for elective ophthalmic surgery were randomly allocated to two groups: control or magnesium. In the magnesium group, patients received an initial intravenous loading dose of 30 mg/kg of 10% solution of magnesium sulphate over 10 min and then a continuous infusion of 10 mg/kg×h during the surgery. In the control group, an equal volume of 0.9% isotonic saline was administered in the same way as in the magnesium group. The PAED scale was assessed at 15-min intervals until the PAED score reached below 10 at the postanaesthetic care unit. EA was defined as a PAED score of 10 or higher. Of the 86 patients recruited, 44 and 42 were allocated to the control and magnesium groups, respectively. The incidence of EA was 77.3% in the control group and 57.1% in the magnesium group (odds ratio, 0.392; 95% confidence interval, 0.154 to 0.997; p = 0.046). The intraoperative infusion of magnesium sulphate significantly reduced the incidence of EA.

The effects of intraoperative magnesium sulfate administration on emergence agitation and delirium in pediatric patients: A systematic review and meta‐analysis of randomized controlled trials

“…Most patients received sevoflurane anesthesia, except for those in one study that received halothane 23 . In 5 studies, 30 mg/kg of magnesium sulfate was administered as a loading dose, followed by 10 mg/kg/h continuous infusion 14,21,22,24,25 . In 2 studies, 30 mg/kg of magnesium sulfate was administered without continuous infusion, 12,13 while in 1 study, 20 mg/kg was administered as a loading dose 23 .…”

“…The incidence of EA/ED was reported in 8 RCTs, totaling 542 patients 13,15,21–26 . In the study by Elsonbaty et al, 22 the Watcha scale was used to identify ED.…”

“…EA/ED scores from the recovery period were reported in 9 RCTs, totaling 670 pediatric patients 12–14,21–26 . The scores were evaluated upon admission to the PACU in 6 RCTs, 12,13,21,24–26 whereas 2 RCTs recorded scores 5 min after PACU admission, 14,22 and 1 RCT did not predefine a specific time‐point 23 .…”

“…Although exact mechanism of magnesium preventing EA/ED remains unclear, there are several possible explanations for this finding. First, it may be attributed to antagonistic action to NMDA receptors 25 . EA/ED may be induced by activation of NMDA receptors and alteration of excitatory properties of neurons 11 .…”

“…Therefore, 10 RCTs were included in the final analysis (Figure 1). [12][13][14][15][21][22][23][24][25][26]…”