Magnesium sulphate

An adjuvant to tracheal intubation

without muscle relaxation-a
randomised study

Context
Tracheal intubation without administration

of neuromuscular blocking drug is used

frequently
in
anaesthesia.
Several
techniques and adjuvant have been tried to
improve intubation condition. Magnesium
sulphate is an agent with analgesic,
anaesthetic and muscle relaxant effects.

Objective
To assesss the effect of magnesium

sulphate on intubating conditions after

induction of anaesthesia without
neuromuscular blocking drug.

Main outcome measures

Intubating condition were evaluated by a

blinded anaethesiologist using criteria of

the copenhagen consensus conference:
ease of laryngoscopy, vocal cord position
and/or
movement
and
response
to
intubation or cuff inflation (cough or
diaphragmatic
movement).
Intubating
condition were considered as acceptable
(excellent or good) or unacceptable (poor).
Mean arterial pressure and heart rate were
also recorded during the study period.

Result
The two group were comparable in their

demographic profiles. Clinically acceptable

intubating conditions were observed more
frequently in the magnesium group than in
the control group: 25 (83%) vs 18 patients
(60%) (P= 0,042). There was no failed
intubation. There were no differences
between the groups with regard to
haemodynamic variables.

Conclusion
Addition of magnesium sulphate to propofol

and fentanyl at induction of anaesthesia

significantly improved intubating condition
without administration of a neuromuscular
blocking drug.

Transmisi Neuromuskular

7/26/2015

7/26/2015

Muscle relaxant
Inappropriate use may be associated with

side effects such as anaphylaxis,

intraoperative awareness, and
complications of residual neuromuscular
blockade.
Contraindication
Myopathy, allergy, Neuromuscular disease

Magnesium
Magnesium plays a fundamental role in many

physiological processes
Neuronal activity
Muscular contraction
Muscle relaxing effects, mostly by reducing
acetylcholine release
1.3-2.1 mEq/liter
54% is part of bone matrix as magnesium salt
46% occurs as magnesium ion (Mg 2+)
intracellular fluid (45%) and extracellular fluid
(1%)

Methods
Ethics Committee of Hospital Militaire Avicenne

Marrakech
Approval and informed consent
60 patients, aged 18 to 60 years
Airway Mallampati test (I and II)
Exclusion criteria
History of reactive airway disease
Increase risk of regurgitation
Anticipated difficult intubation
Obese patients (BMI>30)
Hepatic, renal, cardiovascular or respiratory disease
Treatment with CCB and pregnancy

Methods cont
The patients were allocated randomly to

one of two group

Magnesium group 10-min infusion of
magnesium sulphate 45 mg/kg in 100 ml of
0,9% saline
Control group 10-min infusion of 100 ml
of 0,9% saline
Double blind study

Result

Duration intubation shorter in the Magnesium sulphate group than

the control group but the difference is not significant: 158 vs 20
10 (p=0,092)

Discussion
Addition magnesium sulphate 45 mg/kg to

fentanyl 3ug/kg and propofol 2.5mg/kg

improved intubating condition during
induction of general anesthesia without
adverse haemodynamic effect.
Magnesium is an agent with analgesic,
anaesthetic and muscle relaxant effects.

Discussion cont
Anaesthetic effect Magnesium

sulphate has a depressant effect on the

CNS
Analgesic effect interference with
calsium channel and NMDA.
Muscle relaxant effect reduction in
release of acetylcholine at motor nerve
terminal.

Conclusion
Magnesium sulphate is an effective

adjuvant to tracheal intubation without

neuromuscular bloking drug
Combination with propofol and fentanyl
significantly improved intubating conditions
which were acceptable in 84% of the
patients in magnesium group
Dose in this study (45mg/kg) did not induce
any clinically important adverse
haemodyamic effects.