The Effects of Magnesium Sulfate Loading on Hemodynamic Parameters During Laparoscopic Cholecystectomy: Randomized Controlled Trial

  • Mohammad Reza Ghodraty Tehran University of Medical Sciences
  • Mohammad Mahdi Zamani Tehran University of Medical Sciences
  • Shahin Jamili Tehran University of Medical Sciences
  • Alireza Pournajafian Tehran University of Medical Sciences
  • Parisa Salemi Tehran University of Medical Sciences
  • Behshid Ghadrdoost Tehran University of Medical Sciences
  • Seyyedeh Fatemeh Parsa Tehran University of Medical Sciences
  • Alireza Kholdebarin Tehran University of Medical Sciences
  • Mohammad Tashayoei Tehran University of Medical Sciences
  • Ali Mougouee Tehran University of Medical Sciences
Keywords: carbon dioxide, hemodynamics, laparoscopy, magnesium sulfate


Background: This study was designed to investigate the effect of intravenous magnesium sulfate on hemodynamic changes induced by pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.Methods: A randomized, placebo controlled study was performed on 52 ASA class I or II aged 20-70 years patients undergoing laparoscopic cholecystectomy with pneumoperitoneum with carbon dioxide. Before induction, Magnesium group received 50 magnesium sulfate, within 10 minutes, in 100 ml of normal saline and control group received 100 ml normal saline. Hemodynamic variables were recorded before induction, before the infusion of magnesium sulfate, during intubation, during pneumoperitoneum and finally during extubation, every 10 minutes. Postoperative pain and other complications were recorded in post anesthesia care unit (PACU) also.Results: Variations in heart rate and mean arterial pressure between the two groups during pneumoperitoneum were not significantly different (P>0.05). Propofol consumption in the magnesium group compared with the control group was significantly decreased (P<0.05). The prescribed dose of TNG and total amount of administrated TNG (SUM), both were significantly higher in control group than in the magnesium group (respectively P=0.02 and P=0.042). In PACU, patients in the magnesium presented lower shivering, nausea vomiting and post operative pain than the control group (P <0.05).Conclusion: Magnesium sulfate reduces the amount of anesthetic drug (propofol), TNG and intraoperative blood pressure, during pneumoperitoneum induced by laparoscopy. The postoperative pain of laparoscopy and anesthesia side effects such as nausea, vomiting and shivering were blunted, with bolus administration of magnesium sulfate before induction of anesthesia.


Wahba RW, Béïque F, Kleiman SJ. Cardiopulmonary function and laparoscopic cholecystectomy. Can J Anaesth. 1995; 42(1):51-63.

Sharma KC, Brandstetter RD, Brensilver JM, Jung LD. Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery. Chest. 1996; 110(3):810-5.

Mann C, Boccara G, Pouzeratte Y, Eliet J, Serradeil-Le Gal C, Vergnes C, et al. The relationship among carbon dioxide pneumoperitoneum, vasopressin release, and hemodynamic changes. Anesth Analg. 1999; 89(2):278-83.

Junghans T, Modersohn D, Dörner F, Neudecker J, Haase O, Schwenk W. Systematic evaluation of different approaches for minimizing hemodynamic changes during pneumoperitoneum. Surgi Endosc. 2006; 20(5):763-9.

Altura B, Altura B. Magnesium and vascular tone and reactivity. Blood Vessels. 1978; 15(1-3):5-16.

Shariat Moharari R, Motalebi M, Najafi A, Zamani MM, Imani F, Etezadi F, et al. Magnesium Can Decrease Postoperative Physiological Ileus and Postoperative Pain in Major non Laparoscopic Gastrointestinal Surgeries: A Randomized Controlled Trial. Anesth Pain Med. [Research Article]. 2014; 3(3):e12750.

Kiaee MM, Safari S, Movaseghi GR, Dolatabadi MRM, Ghorbanlo M, Etemadi M, et al. The Effect of Intravenous Magnesium Sulfate and Lidocaine in Hemodynamic Responses to Endotracheal Intubation in Elective Coronary Artery Bypass Grafting: A Randomized Controlled Clinical Trial. Anesth Pain Med. 2014; 4(3).

Ryu J-H, Kang M-H, Park K-S, Do S-H. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth. 2008; 100(3):397-403.

Jensen MP CC, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain J Pain. 2003; 4(4):407–14.

Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain. 1991; 44(3):293-9.

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

Pearson M, Paul J, Evora M, Paulo R, Seccombe M, John F, et al. Hypomagnesemia inhibits nitric oxide release from coronary endothelium: protective role of magnesium infusion after cardiac operations. Ann Thorac Surg. 1998; 65(4):967-72.

Elsharnouby N, Elsharnouby M. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anaesth. 2006; 96(6):727-31.

Ray M, Bhattacharjee DP, Hajra B, Pal R, Chatterjee N. Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoperative recovery: A comparative study. Indian J Anaesth. 2010; 54(2):137.

Jee D, Lee D, Yun S, Lee C. Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy. Br J Anaesth. 2009; 103(4):484-9.

James MF. Clinical use of magnesium infusions in anesthesia. Anesth Analg. 1992; 74(1):129-36.

Süzer T, Coskun E, Islekel H, Tahta K. Neuroprotective effect of magnesium on lipid peroxidation and axonal function after experimental spinal cord injury. Spinal Cord. 1999; 37(7).

Koinig H, Wallner T, Marhofer P, Andel H, Horauf K, Mayer N. Magnesium sulfate reduces intra-and postoperative analgesic requirements. Anesth Analg. 1998; 87(1):206-10.

Schulz‐Stübner S, Wettmann G, Reyle‐Hahn S, Rossaint R. Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double‐blind, randomized prospective study in 50 patients. Eur J Anaesthesiol. 2001; 18(11):723-9.

Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis. Anaesthesia. [Meta-Analysis Research Support, Non-U.S. Gov't Review]. 2013; 68(1):79-90.

Telci L, Esen F, Akcora D, Erden T, Canbolat A, Akpir K. Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth. 2002; 89(4):594-8.

Seyhan T, Tugrul M, Sungur M, Kayacan S, Telci L, Pembeci K, et al. Effects of three different dose regimens of magnesium on propofol requirements, haemodynamic variables and postoperative pain relief in gynaecological surgery. Br J Anaesth. 2006; 96(2):247-52.

Joris JL, Chiche J-D, Canivet J-LM, Jacquet NJ, Legros JJY, Lamy ML. Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol. 1998; 32(5):1389-96.

Mikami O, Kawakita S, Fujise K, Shingu K, Takahashi H, Matsuda T. Catecholamine release caused by carbon dioxide insufflation during laparoscopic surgery. J Urol. 1996; 155(4):1368-71.

Braumann C, Guenther N, Doerner F, Schwenk W, Junghans T. Effects of animal positioning on catecholamine and vasopressin levels in pigs undergoing laparoscopy. Eur Surg Res. 2011; 47(2):75-80.

Thwaites C, Yen L, Cordon S, Thwaites G, Loan H, Thuy T, et al. Effect of magnesium sulphate on urinary catecholamine excretion in severe tetanus. Anaesthesia. 2008;63(7):719-25.

How to Cite
Ghodraty MR, Zamani MM, Jamili S, Pournajafian A, Salemi P, Ghadrdoost B, Parsa SF, Kholdebarin A, Tashayoei M, Mougouee A. The Effects of Magnesium Sulfate Loading on Hemodynamic Parameters During Laparoscopic Cholecystectomy: Randomized Controlled Trial. AACC. 3(2):313-8.
Research Article(s)