Original Article

Effect of Magnesium Sulfate on Hemodynamic Changes During Sternotomy and Laryngoscopy in Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial

Abstract

Background: This study was designed to evaluate the effectiveness of low and high dose magnesium sulfate in reducing pressure responses to laryngoscopy and sternotomy.
Methods: A total of 90 patients were assigned into three groups. The patients in Group L received a 20 mg/kg bolus dose of magnesium sulfate 3 minutes before intubation followed by an infusion of magnesium sulfate (10 mg/kg/h) in contrast to 40 mg/kg of magnesium sulfate followed by an infusion of 20 mg/kg/h magnesium sulfate administered to Group H. Patients in Group P received saline as placebo. Heart rate and mean arterial pressure (MAP) recorded at the baseline were noted down again before intubation and 30 seconds, 2 and 4 minutes after intubation and 1 minute before, and 30 seconds, 2 and 4 minutes after sternotomy.
Results: MAP in Groups L and H compared to Group P was significantly lower, after intubation (P = 0.0040). The difference between MAP in Groups L and H was only statistically significant 30 seconds after intubation. MAP 30 seconds and 2 minutes after sternotomy was statistically different between Groups L and H compared to Group P. The difference between Groups H and P was only statistically significant before sternotomy and 4 minutes after sternotomy (P = 0.0001).
Conclusions: A low dose magnesium sulfate attenuates the hemodynamic response to laryngoscopy and sternotomy in coronary artery bypass graft surgery.

1. Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth.1996; 8(1): 63-79.
2. Puri GD, Batra YK. Effect of nifedipine on cardiovascular responses to laryngoscopy and intubation.Br J Anaesth. 1988; 60(5): 579-81.
3. Puri GD, Marudhachalam KS, Chari P, Suri RK. The effect of magnesium sulphate on hemodynamics and its efficacy in attenuating the response to endotracheal intubation in patients with coronary artery disease.Anesth Analg. 1998; 87(4): 808-11.
4. James MF, Beer RE, Esser JD. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation. Anesth Analg. 1989; 68(6): 772-6.
5. Trivedi V, Patel RA. Comparative study of efficacy of IV magnesium sulphate v/s buprenorphine for attenuating the pressor response to laryngoscopy and intubation. JAnaesthesiol Clin Pharmacol. 2009; 25(4): 459-62.
6. Peck CH, Meltzer SJ. Anesthesia in human beings byintravenous injection of magnesium sulphate. JAMA.2016; 67(16): 1131-3.
7. Somjen G, Hilmy M, Stephen CR. Failure to anesthetize human subjects by intravenous administration of magnesium sulfate. J Pharmacol Exp Ther. 1966; 154(3): 652-9.
8. Fuchs-Buder T, Wilder-Smith OH, Borgeat A, Tassony I E. Interaction of magnesium sulphate with vecuroniuminduced neuromuscular block. Br J Anaesth. 1995; 74(4):405-9.
9. Hennekens CH, Albert CM, Godfried SL, Gaziano JM,Buring JE. Adjunctive drug therapy of acute myocardial infarction--evidence from clinical trials. N Engl J Med.1996; 335(22): 1660-7.
10. Dube L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth. 2003; 50(7): 732-46.
11. Turlapaty PD, Altura BM. Magnesium deficiency produces spasms of coronary arteries: relationship to etiology of sudden death ischemic heart disease. Science.1980; 208(4440): 198-200.
12. Christensen CW, Rieder MA, Silverstein EL, Gencheff NE. Magnesium sulfate reduces myocardial infarct size when administered before but not after coronary reperfusion in a canine model. Circulation. 1995; 92(9):2617-21.
13. Gambling DR, Birmingham CL, Jenkins LC. Magnesium and the anaesthetist. Can J Anaesth. 1988; 35(6): 644-54.
14. Hunter LA, Gibbins KJ. Magnesium sulfate: past,present, and future. J Midwifery Womens Health. 2011;56(6): 566-74.
15. Anthony J, Johanson RB, Duley L. Role of magnesium sulfate in seizure prevention in patients with eclampsia and pre-eclampsia. Drug Saf. 1996; 15(3): 188-99
Files
IssueVol 3 No 1-2 (2016) QRcode
SectionOriginal Article(s)
Keywords
Magnesium sulfate Laryngoscopy Sternotomy Hemodynamic response Coronary artery bypass graft
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Marashi SM, Azimaraghi O, Saliminia A, Atef-Yekta R, Hejazian-Yazdi A, Movafegh A. Effect of Magnesium Sulfate on Hemodynamic Changes During Sternotomy and Laryngoscopy in Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial. AJS. 2016;3(1-2):19-23.