DOI: http://dx.doi.org/10.18203/2349-3933.ijam20212399

The effects of magnesium sulphate on haemodynamic stress response to pneumoperitonium in laparoscopic cholecystectomy: a double blinded randomised controlled study

Samiran Das, Sraboni Basu, Shibu Sasidharan, Harpreet Singh Dhillon

Abstract


Background: To study the effect of intravenous magnesium sulphate on hemodynamic response to pneumoperitoneum during laparoscopic cholecystectomy and to study the side effects of the drug of any.

Methods: Patients were randomly allocated into two groups of 40 each. Automated NIBP, Heart rate, Nausea, headache was noted. Magnesium ion concentration was measured. Chi square test was used to test the association between different study variables under study. Corrected test was used in case of any one of the cell frequency was found less than 5 in the bivariate frequency distribution. Fisher’s Exact Test was also used in the case where the test could not be applied. Test of proportion (Z-test) was used to test the significant difference between two proportions. t-test was used to test the significant difference between means. P≤0.05 was considered statistically significant.

Results: Patients’ characteristics were comparable in both groups. Most data related to surgery and anaesthesia were comparable in both groups. The MAP of group N (control) was significantly higher than that of group M throughout surgery (P5,P10,P20,P30, and at extubation) except at baseline and at the time of PP (P0). The MAP is better maintained in M group. Usage of GTN in the control group was significantly higher. HR of the control group was significantly higher after 20 min (P20) of pneumoperitoneum and after extubation. There was significantly more incidence of nausea and vomiting in the control group.

Conclusions: Use of magnesium sulphate just before pneumoperitoneum is very useful for attenuating haemodynamic alterations to pneumoperitoneum and the requirement of antihypertensive GTN is significantly much less compared to the control group during laparoscopic surgery without increasing any adverse outcome.  


Keywords


Pneumoperitoneum, MgSO4, Magnesium, Laparoscopic surgery, General anaesthesia

Full Text:

PDF

References


Vecchio R, Macfayden BV, Palazzo F. History of laparoscopic surgery. Panminerva Med. 2000;42:87-90.

Hodgson G, Mc Clelland RM, Newton JR. Some effects of the peritoneal insufflation of carbon dioxide at laparoscopy. Anaesthesia. 1970;25:382-90.

Blobner M, Felber AR, Gögler S, Weigl EM, Jelen ES. Carbon dioxide uptake from the pneumoperitoneum during laparoscopic cholecystectomy. Anesthesiology 1992;77:A37-40.

Richardson JD, Trinkl JK. Haemodynamic and respiratory alterations with increased intra abdominal pressure. J Surg Res. 1976;20:401-4.

Lenz RJ, Thomas TA, Wilkins DG. Cardiovascular changes during laparoscopy. Studies of stroke volume and cardiac output using impedance cardiography. Anaesthesia. 1976;31:4-12.

Myre K, Rostrup M, Buanes T, Stokland O. Plasma catecholamines and hemodynamic changes during pneumoperitoneum. Acta Anaesthesiol Scand. 1998;42:343-7.

Walder AD, Aitkenhead AR. Role of vasopressin in the hemodynamic response to laparoscopic cholecystectomy. Br J Anaesth. 1997;78:264-6.

Wilcox S, Vandar LD. Trendelenburg and his position! A critique of its uses and effectiveness. Anesth Analg. 1988;67:574-8.

McLaughlin JG, Scheeres D, Dean R, Bonnell BW. The adverse hemodynamic effects of laparoscopic cholecystectomy. Surg Endosc. 1995;9:121-4.

Lentschener C, Axler O, Fernandez H, Megarbane B, Billard V, Fouqueray B,et al. Haemodynamic changes and vasopressin release are not consistently associated with carbon dioxide pneumoperitoneum in humans. Acta Anaesthesiol Scand. 2001;45:527-35.

Joris JL, Hamoir EE, Hartstein GM, Meurisse MR, Hubert BM, Charlier CJ,et al. Haemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma. Anesth Analg. 1999;88:16-21.

Koivusalo AM, Scheinin M, Tikkanen I, Yli‑Suomu T, Ristkari S, Laakso J, et al. Effects of esmolol on hemodynamic response to CO2 pneumoperitoneum for laparoscopic surgery. Acta Anaesthesiol Scand. 1998;42:510-7.

Sasidharan, Shibu, Dhillon HS. Prolonged apnea after ECT in organophosphorus poisoning–the need to redefine norms." BMC psychiatry.2021;21(1):1-5.

Lishajko F. Releasing effect of calcium and phosphate on catecholamines, ATP, and protein from chromaffin cell granules. Acta Physiol Scand. 1970;79:575-84.

Altura BM, Altura BT. Magnesium and vascular tone and reactivity. Blood Vessels. 1978;15:5-16.

Sasidharan S, Singh V, Dhillon HS, Babitha M. Patient isolation pods for the evacuation of COVID-19 infected patients–Is this the answer?. Journal of Anaesthesiology, Clinical Pharmacology. 2020;36(1):S152.

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

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

Paul S, Biswas P, Bhattacharjee DP, Sengupta J. Effects of magnesium sulfate on hemodynamic response to carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Anesth Essays Res. 2013;7:228-31.

Kalra NK, Verma A, Agarwal A, Pandey HD. Comparative study of intravenously administered clonidine and magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy. Journal Anesthesiology & Clinical Pharmacology. 2011;27:344-8.

Ray M, Bhattacharjee DP, Hajra B, Pal R, Chatterjee N. Clonidine and magnesium sulphate on anaesthetic consumption, hemodynamic and postoperative recovery: A comparative study.Indian J of Anaesth. 2010;54(2):137-41.

Dhillon HS, Yadav B, Bhat PS, Dhillon GK, Sasidharan S. Association of sociodemographic factors with various domains of alcohol-induced sexual dysfunction–An Indian perspective. Industrial Psychiatry Journal. 2020;29(2):272.

Piplai G, Mukhopadhyay M, Maji A, Barua D, Bhattacharya A, Mukhopadhyay A,et al . International Journal of Pharmacology and Therapeutics 2013;3(3);73-84.

Rajan S, Kavita M, Andrews S. The attenuating effect of magnesium on hemodynamic responses during transnasal transsphenoidal surgery. Amrita Journal of Medicine. 2012;8(2):1-44.

Hossain MPA, Islam MS, Chowdhury MH, Ahmed M, Haque M, Aleem MA,et al. Comparative study between efficacy of magnesium sulphate and lignocaine in attenuating haemodynamic response to laryngoscopy and endotracheal intubation JAFMC Bangladesh. 2012;8(1):15-9.

Dhillon HS, Yadav B, Kumar R, Dhillon GK, Sasidharan S. Association of Severity of Alcohol Dependence with Various Domains of Alcohol-Induced Sexual Dysfunction.

Minami T, Adachi T,and Fukuda K. An Effective Use of magnesium sulfate for intraoperative management of laparoscopic adrenalectomy for pheochromocytoma in a pediatric patient. Anesth Analg. 2002;95:1243-4.