The Effectiveness of Intravenous Magnesium Sulfate for Deliberate Hypotension in Rhinoplasty
AbstractBackground: Deliberate hypotension is a strategy that reduces intraoperative bleeding and increases the speed of surgery in otolaryngology procedures. Magnesium (Mg) sulfate is a vasodilator agent that reduces intraoperative hypnotic requirements and in combination with analgesic agents, it reduces intraoperative and postoperative pain. In this study we evaluated the use of intravenous Mg sulfate for inducing deliberate hypotension in rhinoplasty.Methods: Sixty ASA I, II patients aged between 18 to 45, scheduled for rhinoplasty were recruited into a randomized clinical trial. Patients were randomly assigned into placebo (group P) and Mg sulfate (group M) groups. For patients in group M, 40m/kg Mg sulfate was administered before induction and continued with 15mg/kg/hr infusion during the operation. Patients of group P received normal saline as placebo. In each group mean arterial pressure (MAP), mean heart rate, amount of bleeding, anesthetic agents, opioid requirement and duration of surgery were recorded. The incidence of nausea, vomiting, shivering and the score of pain were recorded in post-operative period in both groups.Results: Patients in group M had lower MAP (P= 0.0001), less intraoperative bleeding (P=0.0001), lower anesthetic agents (P=0.0001) and opioid consumption (P=0.001), and shorter duration of procedure (P=0.0001). Mean heart rate was lower in group P (P=0.001). Moreover, surgeon`s satisfaction was more in group P (P=0.001).They also had less incidence of post-operative nausea and vomiting (P=0.008), shivering (P=0.001) and lower pain scores postoperatively (P=0.0001).Conclusion: Magnesium sulfate can be a useful drug to induce controlled hypotension in rhinoplasty surgery. By employing this agent patients have better anesthetic condition and recovery profile
Boonmak S, Boonmak P, Laopaiboon M. Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS). Cochrane Database Syst Rev. 2013; 6: CD006623.
Na Young K, Young-Chul Y, Duk-Hee C, HyeMi L, Young-Soo J, Sun-Joon B. The effects of oral atenolol or enalapril premedication on blood loss and hypotensive anesthesia in orthognathic surgery. Yonsei Med J. 2015; 56(4): 1114–1121.
Degoute CS. Controlled hypotension: a guide to drug choice. Drugs. 2007; 67(7):1053-76.
Prasant MC, Kar S, Rastogi S, Hada P, Ali FM, Mudhol A. Comparative study of blood loss, quality of surgical field and duration of surgery in maxillofacial cases with and without hypotensive anesthesia. J Int Oral Health. 2014; 6(6):18-21.
Tagarakis GL, Whitlock RP, Gutsche JT, Diegeler A, Patel PA, Daskalopoulos ME, et al. New frontiers in aortic therapy: focus on deliberate hypotension during thoracic aortic endovascular interventions. J Cardiothoracic Vasc Anesth. 2014; 28(3):843-7.
Spielberg DR, Barrett JS, Hammer GB, Drover DR, Reece T, Cohane CA, et al. Predictors of arterial blood pressure control during deliberate hypotension with sodium nitroprusside in children. Anesth Analg. 2014; 119(4):867-74.
Goldman RD, Mounstephen W, Kirby-Allen M, Friedman JN. Intravenous magnesium sulfate for vaso-occlusive episodes in sickle cell disease. Pediatrics. 2013; 132(6):e1634-41.
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.
Komaki F, Akiyama T, Yamazaki T, Kitagawa H, Nosaka S, Shirai M. Effects of intravenous magnesium infusion on in vivo release of acetylcholine and catecholamine in rat adrenal medulla. Auton Neurosci. 2013; 177(2):123-8.
Kalra NK, Verma A, Agarwal A, Pandey H. Comparative study of intravenously administered clonidine and magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2011; 27(3):344-8.
Laurant P, Touyz RM, Schiffrin EL. Effect of magnesium on vascular tone and reactivity in pressurized mesenteric resistance arteries from spontaneously hypertensive rats. Can J Physiol Pharmacol. 1997; 75(4):293-300.
Telci L, Esen F, Akcora D, Erden T, Canbolat AT, Akpir K. Evaluation of effects of magnesium sulfate in reducing intraoperative anaesthetic requirements. Br J Anaesth. 2002; 89:594-8.
Kroin JS, McCarthy RJ, Von Roenn N, Schwab B, Tuman KJ, Ivankovich AD. Magnesium sulfate potentiates morphine antinociception at the spinal level. AnesthAnalg. 2000; 90(4):913-7.
Choi JC, Yoon KB, Um DJ, Kim C, Kim JS, Lee SG. Intravenous magnesium sulfate administration reduces propofol infusion requirements during maintenance of propofol-N2O anesthesia: part I: comparing propofol requirements according to hemodynamic responses: part II: comparing bispectral index in control and magnesium groups. Anesthesiology. 2002; 97(5):1137-41.
Jang Y, Shin HY, Kim JM, Lee MY, Keum DY. Effects of magnesium sulfate on supraceliac aortic unclamping in experimental dogs. J Korean Med Sci. 2005; 20(4):612-7.
Sanath Kumar SB, Date R, Woodhouse N, El-Shafie O, Nollain K. Successful management of phaeochromocytoma using preoperative oral labetalol and intraoperative magnesium sulfate: report of four cases. Sultan Qaboos Univ Med J. 2014; 14(2):e236-40.
Machata AM, Kabon B, Willschke H, Fässler K, Gustorff B, Marhofer P, et al. A new instrument for pain assessment in the immediate postoperative period. Anaesthesia. 2009; 64(4):392-8.
Hadavi MR, Zarei Y, Tarogh S. Comparison of effects of labetalol and nitroglycerine on intraoperative blood loss and surgical field quality in rhinoplasty surgery. World J Plast Surg. 2015; 4(1):60-5.
Gruber RP, Zeidler KR, Berkowitz RL. Desmopressin as a hemostatic agent to provide a dry intraoperative field in rhinoplasty. Plast Reconstr Surg. 2015; 135(5):1337-40.
Choi WS, Samman N. Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. Int J Oral Maxillofac Surg. 2008; 37(8):687-703.
Paul JE, Ling E, Lalonde C, Thabane L. Deliberate hypotension in orthopedic surgery reduces blood loss and transfusion requirements: a meta-analysis of randomized controlled trials. Can J Anaesth. 2007; 54(10):799-810.
Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H, et al. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Braz J Anesthesiol. 2015; 65(3):191-9.
Öbrink E, Jildenstål P, Oddby E, Jakobsson JG. Post-operative nausea and vomiting: update on predicting the probability and ways to minimize its occurrence, with focus on ambulatory surgery. Int J Surg. 2015; 15:100-6.
Wadhwa A, Sengupta P, Durrani J, Akça O, Lenhardt R, Sessler DI, et al. Magnesium sulfate only slightly reduces the shivering threshold in humans. Br J Anaesth. 2005; 94(6):756-62.
Faiz SH, Rahimzadeh P, Imani F, Bakhtiari A. Intrathecal injection of magnesium sulfate: shivering prevention during cesarean section: a randomized, double-blinded, controlled study. Korean J Anesthesiol. 2013; 65(4):293-8.
Gozdemir M, Usta B, Demircioglu RI, Muslu B, Sert H, Karatas OF. Magnesium sulfate infusion prevents shivering during transurethral prostatectomy with spinal anesthesia: a randomized, double-blinded, controlled study. J Clin Anesth. 2010; 22(3):184-9.
Manouchehrian N, Mohammadian A, Sanie MS, Faridi-Tazeh-kand N, Sanatkar M. A comparison of the therapeutic effect of tramadol and meperidine for treatment of shivering after spinal anesthesia in elective caesarean section. Archives of Anesthesiology and Critical Care. 2015; 1(2): 50-54.
Ryu JH, Sohn IS, Do SH. Controlled hypotension for middle ear surgery: a comparison between remifentanil and magnesium sulfate. Br J Anaesth. 2009; 103(4):490-5.
Rezae M, Naghibi K, Taefnia AM. Effect of pre-emptive magnesium sulfate infusion on the post-operative pain relief after elective cesarean section. Adv Biomed Res. 2014; 3:164.
Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014; 112(6):991-1004.
Chen Y, Yao Y, Wu Y, Dai D, Zhao Q, Qiu L. Transcutaneous electric acupoint stimulation alleviates remifentanil-induced hyperalgesia in patients undergoing thyroidectomy: a randomized controlled trial. Int J ClinExp Med. 2015; 8(4):5781-7.