![]() ![]() 207 Finally, a randomized, controlled multicenter trial in the United States found that fetal exposure to magnesium sulfate within 24 hours of preterm delivery (between 24 and 32 completed weeks’ gestational age) did not reduce the combined risk for moderate or severe cerebral palsy or death. 207 A reduction in death and/or motor or cognitive dysfunction (34.9% versus 40.5% OR, 0.68 95% CI, 0.47 to 0.99) was observed in the magnesium-exposed offspring at 2 years of age. In another large trial from France, which included women in preterm labor before 33 weeks’ gestation, a significant reduction in death and/or gross motor dysfunction was again identified in the children whose mothers received magnesium sulfate (25.6% versus 30.8% OR, 0.62 95% CI, 0.41 to 0.99). 6.6% relative risk, 0.51 95% CI, 0.29 to 0.91) and combined death or substantial gross motor dysfunction (17% versus 22.7% RR, 0.75 95% CI, 0.59 to 0.96) in children whose mothers were randomized to receive antenatal magnesium sulfate treatment. 206 reported a lower incidence of substantial gross motor dysfunction (3.4% vs. In a placebo-controlled trial of women who were thought likely to deliver within 24 hours and before 30 weeks’ gestation in New Zealand and Australia, Crowther et al. 206–208 Although none of these studies demonstrated significant improvement in the primary outcome, all showed reduced cognitive morbidity, and none showed any increase in pediatric morbidity or mortality associated with magnesium sulfate use for neuroprotection. ![]() Some controversy remains, but the publication of several large randomized studies of the effect of antenatal maternal magnesium sulfate administration on offspring outcome has dramatically altered practice guidelines and clinical practice. Until recently there was considerable controversy regarding the role of magnesium sulfate in preventing or possibly exacerbating fetal brain injury. Chestnut MD, in Chestnut's Obstetric Anesthesia, 2020 Magnesium Sulfate and Cerebral Palsy 307Įven though succinylcholine mimics acetylcholine at the nerve terminal, the onset and duration of a single intubating dose is not prolonged when administered concurrently with a magnesium sulfate infusion 308 a routine intubating dose of 1 to 1.5 mg/kg should be used during rapid-sequence induction of anesthesia.Īlthough some reports have suggested that co-administration of a calcium entry–blocking agent and magnesium may cause hypotension and/or neuromuscular blockade, 182–184,309 more recent information suggests that these medications can be used safely together. Although these studies did not address the patient with preeclampsia who is receiving magnesium, several case reports of magnesium use in women with severe preeclampsia support the contention that magnesium does not influence reversal with sugammadex. 305,306 No cases of recurarization were observed. Studies in nonpregnant populations showed that peri-induction administration of magnesium sulfate 40 to 60 mg/kg did not delay reversal of neuromuscular blockade with sugammadex. Many practitioners avoid the use of nondepolarizing neuromuscular blocking agents in women with preeclampsia because of concern regarding residual postoperative neuromuscular blockade.Īirway guidelines discuss the use of sugammadex for the reversal of neuromuscular blockade when rocuronium has been used for rapid-sequence induction. Interpretation of responses to peripheral nerve stimulation may be difficult in this setting. 304 Thus, if nondepolarizing muscle relaxants are used, they should be administered in very small doses. 301–303 Several case reports have described a requirement for overnight mechanical ventilation after administration of routine doses of vecuronium in women receiving magnesium sulfate. Magnesium sulfate increases the potency and duration of vecuronium, rocuronium, and mivacurium. Magnesium inhibits the presynaptic release of acetylcholine at the neuromuscular junction, decreases the sensitivity of the postsynaptic receptor to acetylcholine, and depresses the excitability of the muscle fiber membrane. Although magnesium sulfate has been used for tocolysis, it is relatively ineffective, and uterine tone is unlikely to be altered significantly. Magnesium sulfate, when appropriately administered, is generally a safe drug, but systems should be in place to avoid inadvertent infusion of large boluses of the drug. 2 The primary anesthetic considerations for women receiving magnesium sulfate is the interaction with nondepolarizing muscle relaxants. ![]() The magnesium infusion should continue throughout surgery to minimize the risk for eclampsia. Most women with severe preeclampsia will present to the operating room while receiving magnesium sulfate for seizure prophylaxis. Chestnut MD, in Chestnut's Obstetric Anesthesia, 2020 Effects of magnesium sulfate. ![]()
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