EVALUATION OF PRE AND

INTRAOPERATIVE MgSO4
INFUSION ON PROLONGATION OF
MUSCLE RELAXATION AND
HEMODYNAMIC STABILITY

AUTHORS:
DR MANISH GOYAL S P MEDICAL COLLEGE
DR MOHD YUNUS KHILJI AND ASSO. HOSPITALS
DR O P SHRIVASTAV(PROF. AND HEAD) BIKANER(RAJ)
DR NEKISHANKER(A.P.)
DR SANGEETA SINGH(M.O.)
DR MANISH GOYAL
DR MOHD YUNUS KHILJI

PRESENTED BY:
DR MOHD YUNUS
KHILJI
 INTRODUCTION
 Magnesium is the fourth most abundant and second most abundant
intracellular cation.

 Magnesium activates enzymes, production of ATP, oxidative

phosphorylation, DNA & RNA synthesis, regulation of calc-ium access
into the cell.

 Magnesium reduces release of catecholamines by adrenal medulla, act

as vasodialator and antiarrhythmic, treatment and and prevention of
pain have been advanced as a rationale for the use of magnesium
infusion in the anaesthetic management of patients .

 Magnesium has shown to produce a dose related lengthening of

neuromuscular blockade by decreasing depolarizing action of
acetylcholine at end plate;
 AIM
 Evaluation of effects of preoperative use of
magnesium sulphate in reduction of heart rate and
B.P. increased due to laryngoscopy and
endotracheal intubation.
 Evaluation of effects of preoperative &
intraoperative use of magnesium sulphate in
prolongation of muscle relaxation and reduction
in doses of vecuronium, atracurium, rocuronium.
 Any complications or side effects due to use of
magnesium sulphate during perioperative and
postoperative period.
 METHOD
 Total 120 patients of either sex between 20–60
years of ASA Grade I and II were selected.

 Pregnancy, hypertension , congestive heart

failure, bronchial asthma, severe renal and hepatic
dysfunction, central nervous system disease,
bleeding disorder were excluded from study.

 Patients were randomly allocated into six groups.

Groups I II III No. of
Patien-
ts
Control Vecuronium(0.05g/ Atracuronium(0.3 Rocuronium(0.3m 30
Group kg and 0.01 mg/kg) mg/kg and 0.1 g/kg and 0.15
(A) with normal saline mg/kg) with mg/kg) with
normal saline normal saline

Study Vecuronium(0.05g/ Atracuronium(0.3 Rocuronium(0.3m 30

Group (B) kg and 0.01 mg/kg) mg/kg and 0.1 g/kg and 0.15
with magnesium mg/kg) with mg/kg) with
sulphate (in normal magnesium magnesium
saline) sulphate (in sulphate (in normal
normal saline) saline)

Magnesium sulphate given in 100ml normal saline as-30mg/kg iv

infusion before induction & 10mg/kg/hr as slow infusion during
maintenance in study group. Control group received same amount
of normal saline.
 All patients were premedicated with inj. glycopyrrolate (4-8µg/kg), inj
midazolam(0.05 mg/kg) and inj.Tramadol (1mg/kg).

 Induction was done by inj. Thiopentone (3-5mg/kg) and inj.

Succinycholine (0.5-1.5mg/kg) to facilitate laryngoscopy and intubation.
Maintenance of anaesthesia with intermediate acting muscle relaxants
along with 60% nitrous oxide, 40% oxygen and halothane.

 Pulse rate, ECG, systolic and diastolic B.P. were recorded in each group
during laryngoscopy, intubation and perioperatively at every 15 minutes.

 Muscle relaxation was accessed using peripheral nerve stimulator .

 SHOWING DISTRIBUTION OF PATIENTS ACCORDING
TO NATURE OF OPERATION
:
NATURE OF GROUP - A GROUP - B TOTAL
OPERATION (CONTROL GROUP) (STUDY GROUP)
No. of % in Groups No. of Patients % in Groups No. of Patients % in Groups
Patients
Breast Surgery 3 10 4 13.33 7 11.66
Hyterectomy 2 6.66 7 23.33 9 15
Ortho Surgery 1 3.33 4 13.33 5 8.33
Laparotomy 4 13.33 6 20 10 16.66
Excisional biopsy 1 3.33 2 6.66 3 5
Gastrojejunostomy 4 13.33 2 6.66 6 10
Cholecystectomy 12 40 1 3.33 13 21.66
Hernioplasty 1 3.33 1 3.33 2 3.33
Varicose vein ligation 1 3.33 -- -- 1 1.66
Appendisectomy 1 3.33 -- -- 1 1.66
APR -- -- 1 3.33 1 1.66
Hemithyroidectomy -- -- 1 3.33 1 1.66
Ileostomy closure -- -- 1 3.33 1 1.66
TOTAL 30 30 60
SHOWING DISTRIBUTION OF PATIENTS ACCORDING
TO AGE

GROUP - A GROUP- B Total

AGE (yr) (CONTROL GROUP) (STUDY GROUP)

No. of % in Groups No. of % in Groups No. of % in Groups

Patients Patients Patients

21-30 6 20 5 16.66 11 18.33

31-40 8 26.66 8 26.66 16 26.66

41-50 8 26.66 13 43.33 21 35

51-60 8 26.66 4 13.33 12 20

TOTAL 30 30 60
 SHOWING COMPARISON BETWEEN MEAN VALUE OF HEART
RATE (bpm) WITH STATISTICAL EVALUATION (BEFORE
GIVING NDMR)

Parameters Preoperative Before induction After induction 2 min. after 5 min. after
(a) (b) (c) Intubation (d) Intubation (e)

A B A B A B A B A B

Mean 82.7 82.03 83.3 84.66 92.57 90.73 111.37 102.37 102.57 94.2

Std. Deviation 4.3 5.623 4.587 4.559 4.56 4.36 7.85 4.612 6.73 5.391

Std. Error 0.785 1.027 0.8376 0.8323 0.8328 0.7964 1.43 0.842 1.22 0.9842

t 0.4955 1.005 1.607 5.111 4.833

P 0.6240 0.3232 0.1189 <0.0001 <0.0001

 SHOWING COMPARISON BETWEEN MEAN VALUE OF
SYSTOLIC BLOOD PRESSURE (mmHg)
WITH STATISTICAL EVALUATION (BEFORE GIVING NDMR)

Parameters Preoperative Before induction After induction 2 min. after 5 min. after
(a) (b) (c) Intubation Intubation
(d) (e)

A B A B A B A B A B

Mean 122.53 121.8 120.80 120.4 119.33 116.73 165.5 152.66 150.7 142.73

Std. Deviation 5.501 6.609 5.67 7.564 6.609 8.39 7.785 8.308 7.98 7.027

Std. Error 1.004 1.207 1.04 1.381 1.207 1.53 1.42 1.517 1.458 1.281

t 0.6780 0.3346 1.783 6.699 5.025

p 0.5032 0.7403 0.085 <0.0001 <0.0001

SHOWING COMPARISON BETWEEN DURATION OF
ACTION OF VECURONIUM (CONTROL GROUP AND
STUDY GROUP)

Duration of Action (min) p value Remark

Mean ± S.D.

Group AI Group BI

INITIAL DOSE 14.3±2.163 24.1±2.923 <0.0001 SIGNIFICANT

MAINTENANCE 12.687±1.991 21.97±5.210 <0.0001 SIGNIFICANT

DOSES
 SHOWING COMPARISON BETWEEN DURATION OF ACTION
OF ATRACURIUM
(CONTROL GROUP AND STUDY GROUP)

Duration of Action (min) p value Remark

Mean ± S.D

Group AII Group BII

INITIAL DOSE 14.1±1.524 23.10±2.079 <0.0001 SIGNIFICANT

MAINTENANCE 11.04±1.134 17.86±2.309 <0.0001 SIGNIFICANT

DOSES
 COMPARISON BETWEEN DURATION OF ACTION OF
ROCURONIUM
(CONTROL GROUP AND STUDY GROUP)

Duration of Action (min) p value Remark

Mean ± S.D

Group AIII Group BIII

INITIAL DOSE 14.6±1.506 23.6±1.578 <0.0001 SIGNIFICANT

MAINTENANC 13.13±1.608 22.23±5.919 <0.0001 SIGNIFICANT

E DOSES
 GROUP A GROUP B
AI AII AIII BI BII BIII
--- --- --- --- --- ---
NAUSEA 1 --- --- --- 1 ---
VOMITING --- --- --- --- --- ---
BRADYCARDIA --- --- --- 1 --- ---
HYPOTENSION --- --- --- --- --- ---
ARRYTHMIA --- --- --- --- --- ---
DELAYED --- --- --- 1 --- 1
RECOVERY OF
MOTOR POWER
SEDATION --- --- --- --- --- ---
RESPIRATORY --- --- --- --- --- ---
DEPRESSION

CARDIAC ARREST --- --- --- --- --- ---

RESULTS
 Magnesium sulphate :
 Provides better hemodynamic stability .
 Prolonged the duration of neuromuscular block .
 Reduces the requirement of subsequent doses of muscle relaxants.
 The duration of blockade after initial dose 24.1±2.923 > 14.3±2.163
and maintenence doses 21.97±5.210 > 12.687±1.991 are prolonged in
study group compared to control group with vecuronium.
 The duration of blockade after initial dose 23.10±2.079 > 14.1±1.524
and maintenence doses 17.86±2.309 > 11.04±1.134 are prolonged in
study group compared to control group with atracurium.
 The duration of blockade after intial dose 23.6±1.578 > 14.6±1.506
and maintenence doses 22.23±5.919 > 13.13±1.608 are prolonged in
study group compared to control group with rocuronium.
 CONCLUSIONS:
 Magnesium sulphate infusion attenuates the
hemodynamic changes during laryngoscopy &
intubation.
 It reduces the dose requirement of muscle relaxants
and increases their duration of action .
THANK YOU

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