Главная страница | Контакты | Случайная страница Автомобили Астрономия Биология География Дом и сад Другие языки Другое Информатика История Культура Литература Логика Математика Медицина Металлургия Механика Образование Охрана труда Педагогика Политика Право Психология Религия Риторика Социология Спорт Строительство Технология Туризм Физика Философия Финансы Химия Черчение Экология Экономика Электроника

Introduction

Effect of magnesium sulfate pretreatment on onset and recovery characteristics of cisatracurium

Abstract

Background

To determine how pretreatment with magnesium sulfate (MgSO₄) potentiates neuromuscular blocking agents. We investigated how the onset and recovery characteristics of cisatracurium are changed by pretreatment with MgSO₄.

Methods

After Institutional Review Board approval, a total of 48 ASA I and II patients were devided into 2 groups. Patients in each group received either the MgSO₄ 30 mg/kg (group M) in 0.9% normal saline (total volume 100 ml) or 0.9% normal saline (control group C) alone intravenously for 15 min before induction of anesthesia with propofol, remifentanil and cisatracurium 0.15 mg/kg. Anesthesia was maintained with propofol and remifentanil. Electromyographical responses were measured by train-of-four. Lag time, onset time, total recovery time, clinical duration, recovery index, and recovery time were measured. The mean arterial blood pressure, heart rate, and ionized magnesium were also measured.

Results

The lag time and onset time were significantly shorter in the MgSO₄ group than the control group (P < 0.05). Recovery index, recovery time, clinical duration, and total recovery time showed no significant differences in the MgSO₄ group compared to the control group (P > 0.05). Mean arterial pressure was more significantly increased in the MgSO₄ group than in the control group at the time point immediately after the administration of MgSO₄. Heart rate showed no significant changes in both groups. The concentrations of ionized magnesium were significantly more increased at the all time point (P < 0.05).

Conclusions

MgSO₄ results in about 29% shortening of onset time of cisatracurium (0.15 mg/kg) without prolongation on the recovery of neuromuscular block.

Keywords: Cisatracurium, Magnesium sulfate, Onset, Recovery

Introduction

Magnesium sulffate (MgSO₄) is widely used during the peri-operative period to treat arrhythmia, asthma and acute respiratory failure, to attenuate blood pressure increases, and to prevent seizures in parturient with pre-eclampsia. MgSO₄, which acts as an antagonist at N-methyl-D-aspartate receptors, has an effect on neuromuscular transmission [1]. MgSO₄ diminishes the amount of acetylcholine released from the motor nerve terminal, attenuating the excitability of the muscle fiber and reducing the amplitude of the end plate potential. It therefore potentiates the neuromuscular block produced by nondepolarizing neuromuscular blocking agents (NMBAs) [2].

Relatively few studies have been conducted on the effects of MgSO₄ administration before induction with NMBAs. Some authors have reported that pre-treatment with MgSO₄ increased the speed of onset and prolonged the recovery characteristics of non-depolarizing NMBAs [3,4]. On the other hand, Kussman et al. [5] reported that MgSO₄ significantly prolonged the recovery of the neuromuscular block but curiously had no influence on onset time. Rocuronium and cisatracurium are relatively recently introduced non-depolarizing muscle relaxants. Although they have similar hemodynamic effects, cisatracurium has a relatively long onset time, discouraging rapid-sequence induction [6,7]. Few reports have been presented on the onset and recovery characteristics of cisatracurium [8].

The purpose of this study was to investigate the effects of magnesium sulfate, given before the induction of anesthesia, on the onset time and recovery characteristics of cisatracurium.