Intravenous Magnesium Sulfate to Deliberate Hypotension and Bleeding after Bimaxillary Orthognathic Surgery; A Randomized Double-blind Controlled Trial

Hamed Modanlou Juibari, Hamid Reza Eftekharian, Hamid Reza Arabion, Hamed Modanlou Juibari, Hamid Reza Eftekharian, Hamid Reza Arabion

Abstract

Statement of the problem: The preoperative or intraoperative administration of intravenous magnesium sulfate has been approved as an accepted medication for stabilizing hemodynamic indices during surgeries.

Purpose: Intraoperative blood loss during orthognathic surgery is frequently abundant and sometimes requires blood transfusion. The present trial addressed the efficacy of intravenous magnesium sulfate on deliberating hypotension and bleeding reduction in patients undergoing bimaxillary orthognathic surgery.

Materials and method: This randomized double-blinded placebo controlled trial was conducted on 52 consecutive patients who underwent orthognathic surgery. The participants were randomly assigned to two groups receiving intravenous magnesium sulfate 30 mg/kg body weight bolus for 15 minutes immediately before anesthesia induction, followed by 10 mg/kg/hr dissolved in saline via pump infusion (n=26) and the second group received placebo as same bolus volume of normal saline in a 15-minute intravenous infusion which was continued until the end of operation (n=26). Both systolic and diastolic blood pressures were measured before anesthesia induction at baseline, during surgery, and at the end of the surgery. Intraoperative blood loss was also determined.

Results: Systolic and diastolic blood pressures did not differ between the two groups at baseline. Although a downward trend of both systolic and diastolic blood pressures was seen during the operation in both groups, the decrease in blood pressures occurred with greater gradient in the group administered magnesium sulfate. Assessing difference in the trend of the changes in systolic and diastolic blood pressures between the two study groups (adjusted for gender, age, mean body mass index, and time of surgery) showed different trends in the changes of blood pressures. No differences were observed in blood loss or blood product requirement between the two groups.

Conclusion: The administration of intravenous magnesium sulfate can attenuate both systolic and diastolic blood pressures during orthognathic surgery with no significant effect on the volume of blood loss or need for blood transfusion.

Keywords: Bimaxillary Orthognathic Surgery; Bleeding; Deliberate; Hypotension; Intravenous Magnesium Sulfate.

Figures

Figure1
Figure1
CONSORT diagram for the study protocol

References

    1. Somani M, Mathur V, Sachdev S, Jethava D, Jethava DD. Role of Intravenous Magnesium Sulphate in Spine Surgery for Hypotensive Anesthesia; A Randomized Control Trial. International. J Contemp Med Res 2015; 2: 818–821.
    1. Carlos E, Monnazzi MS, Castiglia YM, Gabrielli MF, Passeri LA, Guimarães NC. Orthognathic surgery with or without induced hypotension. Int J Oral Maxillofac Surg. 2014; 43: 577–580.
    1. Koinig H, Wallner T, Marhofer P, Andel H, Hörauf K, Mayer N. Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg. 1998; 87: 206–210.
    1. Cunha AR, Umbelino B, Correia ML, Neves MF. Magnesium and vascular changes in hypertension. Int J Hypertens. 2012; 2012: 754250.
    1. Sharma N, Prasad Bhattarai J, Han Hwang P, Kyu Han S, Yang YS. Inhibition of L-type calcium currents by magnesium sulfate on the rat basilar artery smooth muscle cells. Neurology Asia. 2014; 19: 301–307.
    1. Mesbah Kiaee M, Safari S, Movaseghi GR, Mohaghegh Dolatabadi MR, 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: arandomized controlled clinical trial. Anesth Pain Med. 2014;4:e15905.
    1. Massy ZA, Drüeke TB. Magnesium and cardiovascular complications of chronic kidney disease. Nat Rev Nephrol. 2015; 11: 432–342.
    1. Kiziltepe U, Eyileten ZB, Sirlak M, Tasoz R, Aral A, Eren NT, et al. Antiarrhythmic effect of magnesium sulfate after open heart surgery: effect of blood levels. Int J Cardiol. 2003; 89: 153–158.
    1. Dabbagh A, Rajaei S, Shamsolahrar MH. The effect of intravenous magnesium sulfate on acute postoperative bleeding in elective coronary artery bypass surgery. J Perianesth Nurs. 2010; 25: 290–295.
    1. Nooraei N, Dehkordi ME, Radpay B, Teimoorian H, Mohajerani SA. Effects of intravenous magnesium sulfate and lidocaine on hemodynamic variables following direct laryngoscopy and intubation in elective surgery patients. Tanaffos. 2013; 12: 57–63.
    1. Göral N, Ergil J, Alptekin A, Ozkan D, Gürer B, Dolgun H, et al. Effect of magnesium sulphate on bleeding during lumbar discectomy. Anaesthesia. 2011; 66: 1140–1145.
    1. Gröber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients. 2015; 7: 8199–8226.
    1. Lanigan DT, Hey JH, West RA. Major vascular complications of orthognathic surgery: hemorrhage associated with Le Fort I osteotomies. J Oral Maxillofac Surg. 1990; 48: 561–573.
    1. Elsharnouby NM, Elsharnouby MM. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anaesth. 2006; 96: 727–731.
    1. Sanders GM, Sim KM. Is it feasible to use magnesium sulphate as a hypotensive agent in oral and maxillofacial surgery? Ann Acad Med Singapore. 1998; 27: 780-785
    1. Prielipp RC, Zaloga GP, Butterworth JF 4th, Robertie PG, Dudas LM, Black KW, et al. Magnesium inhibits the hypertensive but not the cardiotonic actions of low-dose epinephrine. Anesthesiology. 1991; 74: 973–979.
    1. Nastou H, Sarros G, Nastos A, Sarrou V, Anastassopoulou J. Prophylactic effects of intravenous magnesium on hypertensive emergencies after cataract surgery. A new contribution to the pharmacological use of magnesium in anaesthesiology. Magnes Res 1995; 8: 271–276.
    1. Crozier TA, Radke J, Weyland A, Sydow M, Seyde W, Markakis E, et al. Haemodynamic and endocrine effects of deliberate hypotension with magnesium sulphate for cerebral-aneurysm surgery. Eur J Anaesthesiol. 1991; 8: 115–121.
    1. Min JH, Chai HS, Kim YH, Chae YK, Choi SS, Lee A, et al. Attenuation of hemodynamic responses to laryngoscopy and tracheal intubation during rapid sequence induction: remifentanil vs. lidocaine with esmolol. Minerva Anestesiol 2010; 76: 188–192.
    1. Massy ZA, Drüeke TB. Magnesium and cardiovascular complications of chronic kidney disease. Nat Rev Nephrol. 2015; 11: 432–442.
    1. James MF, Beer RE, Esser JD. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation. Anesth Analg. 1989; 68: 772–776.
    1. Jee D, Lee D, Yun S, Lee C. Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy. Br J Anaesth. 2009; 103: 484–489.
    1. Héman LM, Van Der Linden PJ. Does magnesium sulfate increase the incidence of postpartum hemorrhage? A systematic review. Open Journal of Obstetrics and Gynecology. 2011; 1: 168–173.
    1. Guzin K, Goynumer G, Gokdagli F, Turkgeldi E, Gunduz G, Kayabasoglu F. The effect of magnesium sulfate treatment on blood biochemistry and bleeding time in patients with severe preeclampsia. J Matern Fetal Neonatal Med. 2010; 23: 399–402.
    1. Gries A, Bode C, Gross S, Peter K, Böhrer H, Martin E. The effect of intravenously administered magnesium on platelet function in patients after cardiac surgery. Anesth Analg. 1999; 88: 1213–1219.

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