Archives of Anesthesiology and Critical Care 2017. 3(1):273-277.

The Effect Comparison of Two Injections Doses of Magnesium Sulfate on Hemodynamic Changes Caused by Laryngoscopy and Endotracheal Intubation in Caesarean Patients with General Anesthesia
Anahita Hirmanpour, Mohammadreza safavi, Reihanak Talakoub, Azim Honarmand, Marjan Ghasri, Navid Chitsaz


Background: The aim of this study was to evaluate the effect of two injections doses of magnesium sulfate for controlling and reducing hemodynamic changes caused by laryngoscopy and endotracheal intubation in pregnant women who were candidates for caesarean section with general anesthesia.

Methods: In this controlled randomized double-blind clinical trial, 165 pregnant women who were candidates for caesarean section were allocated into three groups of receiving 40mg/kg of magnesium sulfate (M1 group), 60 mg/kg of magnesium sulfate (M2 group) and placebo (P group) before induction of anesthesia. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean of arterial pressure (MAP), heart rate (HR) and arterial oxygen saturation (SPO2) were measured and recorded at the baseline (before the induction), right before the intubation and 1, 3, 5 and 10 minutes after laryngoscopy and endotracheal intubation. The Apgar score of the neonates was also measured and recorded 1 and 5 minutes after delivery.

Results: The mean of changes in systolic blood pressure and mean of arterial pressure showed a significant difference between the M1 and M2 groups with the placebo group right before the intubation and 1, 3 and 10 minutes after laryngoscopy. The mean of changes in heart rate was specifically significant 1, 5 and 10 minutes after intubation in the M2 group (p< 0.05). The Apgar score of neonates had no significant difference 1 and 5 minutes after delivery (p> 0.05).

Conclusion: For inducing anesthesia in pregnant women, using 60 mg/kg of magnesium sulfate decreased the hemodynamic changes after laryngoscopy and endotracheal intubation and it had no adverse effect on the Apgar score of the neonates.


caesarean section; general anesthesia; laryngoscopy; magnesium sulfate

Full Text:



Kotwani MB, Kotwani DM, Laheri V. A comparative study of two doses of magnesium sulphate in attenuating haemodynamic responses to laryngoscopy and intubation. International Journal of Research in Medical Sciences, 2016. 4(7):2548-55.

Velickovic I, Yan J, Grass JA. Modifying the neuroendocrine stress response. in Seminars in Anesthesia, Perioperative Medicine and Pain. 2002. WB Saunders.

Fox EJ, Sklar GS, Hill CH, Villanueva R, King BD. Complications related to the pressor response to endotracheal intubation. Anesthesiology. 1977; 47(6): 524-5.

Sugiura S, Seki S, Hidaka K, Masuoka M, Tsuchida H. The hemodynamic effects of landiolol, an ultra-short-acting β1-selective blocker, on endotracheal intubation in patients with and without hypertension. Anesthesia & Analgesia. 2007. 104(1):124-129.

van den Berg AA, Halliday EM, Soomro NA, Rasheed A, Baloch M. Reducing cardiovascular responses to laryngoscopy and tracheal intubation: a comparison of equipotent doses of tramadol, nalbuphine and pethidine, with placebo. Middle East journal of anaesthesiology. 2004; 17(6): 1023-36.

Saroj P, Satyanarayana A, Suhasini PS, Chaitanaya BK, Kranthi J. Comparative study of effect of intravenous magnesium sulphate and intravenous fentanyl in attenuating the haemodynamic responses to laryngoscopy and intubation. J Evid Based Med Healthc. 2016; 3(30):1360-7.

Takita K, Morimoto Y, Kemmotsu O. Tracheal lidocaine attenuates the cardiovascular response to endotracheal intubation. Can J Anaesth. 2001; 48(8):732-6.

van den Berg AA, Savva D, Honjol NM. Attenuation of the haemodynamic responses to noxious stimuli in patients undergoing cataract surgery. A comparison of magnesium sulphate, esmolol, lignocaine, nitroglycerine and placebo given iv with induction of anaesthesia. Eur J Anaesthesiol. 1997; 14(2):134-47.

Freye E, Levy JV. Reflex activity caused by laryngoscopy and intubation is obtunded differently by meptazinol, nalbuphine and fentanyl. Eur J Anaesthesiol. 2007; 24(1):53-8.

Hasegawa J, Mitsuhata H, Matsumoto S, Enzan K. [Attenuation of cardiovascular response to laryngoscopy and tracheal intubation with bolus injection of diltiazem]. Masui. [Article in Japanese]. 1992; 41(3): 356-62.

Kord Valeshabad A, Nabavian O, Nourijelyani K, Kord H, Vafainejad H, Kord Valeshabad R. Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: Propacetamol versus Lidocaine—A Randomized Clinical Trial. Anesthesiol Res Pract. 2014;2014:170247.

Padmawar S, Patil M. A Comparative Study of 2% Lignocaine vs 50% Magnesium Sulphate for Attenuation of Stress Responses to Laryngoscopy and Endotracheal Intubation. International Journal of Contemporary Medical Research. 2016; 3(8): 2317-21.

Honarmand A, Safavi M, Badiei S, Daftari-Fard N. Different doses of intravenous Magnesium sulfate on cardiovascular changes following the laryngoscopy and tracheal intubation: A double-blind randomized controlled trial. J Res Pharm Pract. 2015; 4(2): 79–84.

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.

Sakuraba S, Serita R, Kosugi S, Eriksson LI, Lindahl SG, Takeda J. Pretreatment with magnesium sulphate is associated with less succinylcholine-induced fasciculation and subsequent tracheal intubation-induced hemodynamic changes than precurarization with vecuronium during rapid sequence induction. Acta Anaesthesiol Belg. 2006; 57(3):253-7.

Allen RW, James MF, Uys PC. Attenuation of the pressor response to tracheal intubation in hypertensive proteinuric pregnant patients by lignocaine, alfentanil and magnesium sulphate. Br J Anaesth. 1991; 66(2):216-23.

Panda NB, Bharti N, Prasad S. Minimal effective dose of magnesium sulfate for attenuation of intubation response in hypertensive patients. J Clin Anesth. 2013; 25(2):92-7.

Kadam R, Ursekar R, Aphale SS. Effect of Magnesium Sulphate on Haemodynamic Response to Laryngoscopy and Intubation. International Journal of Scientific Research, 2016. 5(4):197-9.

Kumar S, Mishra MN, Mishra LS, Bathla S. Comparative study of the efficacy of iv esmolol, diltiazem and magnesium sulphate in attenuating haemodynamic response to laryngoscopy and tracheal intubation. Indian J Anaesth. 2003; 47(1):41-4.


Lee DH, Kwon IC. Magnesium sulphate has beneficial effects as an adjuvant during general anaesthesia for Caesarean section. Br J Anaesth. 2009; 103(6):861-6.

Hoefnagel A, Yu A, Kaminski A. Anesthetic Complications in Pregnancy. Crit Care Clin. 2016; 32(1):1-28.

Shukla D, Dhabarde M, Tracheal Intubation in Patients with Pregnancy Induced Hypertension: Comparative Study between Esmolol, Diltiazem & Magnesium Sulphate. International Journal of Scientific Research. 2016. 5(5): 563-6.

Ashton WB, James MF, Janicki P, Uys PC. Attenuation of the pressor response to tracheal intubation by magnesium sulphate with and without alfentanil in hypertensive proteinuric patients undergoing caesarean section. Br J Anaesth. 1991; 67(6):741-7.

von Euler US, Lishajko F. Effects of Mg2+ and Ca2+ on noradrenaline release and uptake in adrenergic nerve granules in different media. Acta Physiol Scand. 1973; 89(3):415-22.

James MF, Manson ED. The use of magnesium sulphate infusions in the management of very severe tetanus. Intensive Care Med. 1985; 11(1):5-12.

James MF. The use of magnesium sulfate in the anesthetic management of pheochromocytoma. Anesthesiology. 1985; 62(2):188-90.

Wang L, Liu ZQ, Huo YQ, Yao LJ, Wei XG, Wang YF. Change of hs–CRP, sVCAM–1, NT–proBNP levels in patients with pregnancy-induced hypertension after therapy with magnesium sulfate and nifudipine. Asian Pac J Trop Med. 2013; 6(11):897-901.

James MF, Beer RE, Esser JD. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation. Anesth Analg. 1989; 68(6):772-6.

Abbassi-Ghanavati M, Alexander JM, McIntire DD, Savani RC, Leveno KJ. Neonatal effects of magnesium sulfate given to the mother. Am J Perinatol. 2012; 29(10):795-9.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.