Reporte de seis casos de eclampsia en un hospital rural de la selva de Chiapas / Six Cases of Reports of Eclampsia in a Rural Hospital from the Chiapas Jungle

Resumen La eclampsia es un síndrome relativamente raro e impredecible de la enfermedad hipertensiva inducida por el embarazo, caracterizado por un estado convulsivo tónico-clónico que puede o no cursar con hipertensión previa o daño orgánico. Complica aproximadamente 3 de cada 1,000 embarazos, con alta incidencia en pacientes de zonas rurales y bajo nivel socioeconómico, mujeres con preeclampsia, primigestas adolescentes y multíparas mayores de 35 años de edad. Presentamos el reporte de 6 casos de eclampsia que sucedieron en un hospital rural del estado de Chiapas, ubicado en el corazón de la Selva Lacandona. La mayoría fueron primigestas adolescentes en trabajo de parto, quienes rebasaban las 40 semanas de gestación. Todas fueron manejadas con medidas de soporte y neuroprotección con sulfato de magnesio, 5 de ellas fueron referidas a segundo nivel a la unidad de cuidados intensivos para recibir una atención integral, con un tiempo promedio de estancia de 2 días. Ninguna presentó un nuevo cuadro convulsivo. No se registraron resultados perinatales adversos ni muerte materna. El síndrome preeclampsia-eclampsia es un problema de alto impacto en el embarazo y un reto para los 3 niveles de atención, pero sobre todo para la atención en el medio rural y zonas indígenas de todo México, ya que, debido a costumbres arraigadas, las pacientes omiten el control prenatal, además de habitar en lugares con difícil acceso a hospitales o clínicas.

Abstract Eclampsia is a relatively rare and unpredictable syndrome of pregnancy-induced hypertensive disease, characterized by a tonic-clonic seizure state which may or may not present hypertension or end-organ damage. It complicates approximately 3 out of 1000 pregnancies, with a high incidence in patients of low socioeconomic status and rural areas, women with pre-eclampsia, primiparous teen or multiparous women over 35 years old. We present the report of 6 cases of eclampsia that occurred in a first level rural hospital of attention in the state of Chiapas, located in the heart of the Lacandon Jungle. Most of them occurred in primiparous teen patients during labor, which exceeded 40 weeks of gestation. All were promptly managed with support measures and magnesium sulfate neuroprotection, 5 of them referred to the second level of the intensive care unit for more comprehensive care, the average length of stay was 2 days. No one presented a new seizure. No adverse perinatal outcomes or maternal death were recorded. The pre-eclampsia-eclampsia syndrome is a problem with a high impact on pregnancy and a challenge for all three levels of care, but especially for care in rural areas and indigenous areas throughout Mexico, since, due to entrenched customs, patients omit prenatal control, in addition to living in places with difficult access to hospitals or clinics.

Analgesic effect of pregabalin and magnesium sulfate after mastectomy with axillary lymphadenectomy / Efeito analgésico da pregabalina e do sulfato de magnésio no pósoperatório de mastectomia com linfadenectomia axilar

ABSTRACT BACKGROUND AND OBJECTIVES: Mastectomy with lymphadenectomy is a surgery associated with moderate to severe pain in the immediate postoperatory. Several safe adjuvant drugs that provide good analgesia with few adverse effects have been researched. Pregabalin and magnesium sulfate are drugs that promote analgesia with few adverse effects. The objective of the present study was to evaluate the analgesic effect of pregabalin and magnesium sulfate in the postoperatory of mastectomy with axillary lymphadenectomy. METHODS: Double-blinded, randomized study involving 80 patients submitted to mastectomy with axillary lymphadenectomy under general anesthesia. The patients were distributed into 4 groups: Control (CG, did not receive the proposed adjuvant drug); Magnesium+Placebo (MG, received magnesium sulfate during anesthesia); Pregabalin+Magnesium (P+MG, received magnesium added to pregabalin 150 mg before and 12 h after surgery); and Pregabalin+Placebo (PG, received pregabalin). All patients completed the Self-Report Questionnaire 20 (SRQ-20) to screen for possible mental disorders and had their physical status monitored at 1 h, 12 h, and 24 h after surgery, through anamnesis, pain questionnaire, opioid consumption, and presence of complications and/or adverse events such as nausea, vomiting, and sleepiness. Randomization was performed using sealed opaque envelopes without the knowledge of the anesthesiologist (researcher) and the patient. RESULTS: For each group, twenty patients were randomized, which were analyzed at the end of the study. The number of patients presenting absent/mild pain in P+MG was significantly higher than in CG, MG and PG after one hour. After 12 hours, P+MG and PG had more patients with absent/mild pain than CG and MG. At 24 hours postoperatively, all patients in all evaluated groups had no moderate/severe pain. There was no diference in the frequency of patients presenting nausea or vomiting, nor in the scores of the sleep evaluation after surgery in the four groups. CONCLUSION: The combination of magnesium sulfate and pregabalin provided satisfactory analgesia in the first hour after mastectomy with axillary lymphadenectomy. Nevertheless, magnesium sulfate isolated presented no analgesic beneft for the patients, and pregabalin isolated was only slightly effective at the first hour after surgery.

RESUMO JUSTIFICATIVA E OBJETIVOS: Mastectomia com linfadenectomia é uma cirurgia que causa dor moderada ou intensa no pós-operatório imediato. Muitos fármacos adjuvantes, seguros, que promovem boa analgesia e com poucos efeitos adversos têm sido pesquisados. A pregabalina e o sulfato de magnésio são fármacos que promovem analgesia com poucos efeitos adversos. O objetivo deste estudo foi avaliar o efeito analgésico da pregabalina e do sulfato de magnésio no pós-operatório de mastectomia com linfadenectomia axilar. MÉTODOS: Estudo randomizado e duplo-cego envolvendo 80 pacientes submetidas à mastectomia com linfadenectomia axilar sob anestesia geral. As pacientes foram divididas em quatro grupos: Controle (GC, não receberam o fármaco adjuvante proposto); Magnésio+Placebo (GM, receberam sulfato de magnésio durante a anestesia); Pregabalina+Magnésio (GP+M, receberam magnésio adicionado a pregabalina 150 mg antes e 12 h após a cirurgia); e Pregabalina+Placebo (GP, receberam a pregabalina). Todas as pacientes responderam o Self-Report Questionnaire 20 (SRQ-20) para rastrear possível transtorno mental e foram seguidas, monitorando o estado físico 1h, 12h e 24h após a cirurgia, através de anamnese, questionário de dor, consumo de opioides e presença de complicações e/ou eventos adversos como náusea, vômito e sonolência. A randomização foi realizada por meio de envelopes opacos e selados sem o conhecimento do anestesiologista (pesquisador) e do paciente. RESULTADOS: Foram randomizadas 20 pacientes para cada grupo, as quais foram analisadas ao fim do estudo. O número de pacientes apresentando dor ausente/leve no GP+M foi significantemente maior que nos GC, GM e GP após uma hora. Após 12 horas, GP+M e GP apresentaram maior número de pacientes com dor ausente/leve que GC e GM. Em 24 horas do pós-operatório, todos os pacientes de todos os grupos avaliados não apresentaram dor moderada/severa. Não houve diferença na frequência de pacientes apresentando náusea ou vômito, nem nos escores da avaliação do sono após a cirurgia nos quatro grupos. CONCLUSÃO: A associação de sulfato de magnésio e pregabalina causa boa analgesia de mastectomia com linfadenectomia axilar na primeira hora do pós-operatório. No entanto, o uso isolado do sulfato de magnésio não trouxe benefício para analgesia nestas pacientes, assim como a pregabalina sozinha se mostrou pouco efetiva na primeira hora de avaliação.

Sulfato de magnesio como ahorrador de opioides en cirugía mayor abdominal / Magnesium sulfate as an opioid sparer in major abdominal surgery

Introducción: El efecto del sulfato de magnesio como adyuvante de la analgesia en la práctica de diferentes intervenciones quirúrgicas es un tema en debate y estudio constante con el fin de probar su eficacia y seguridad en la mejora de la evolución posoperatoria de los pacientes. Objetivo: Evaluar la efectividad y seguridad del sulfato de magnesio como ahorrador de opioides en la anestesia general de pacientes intervenidos por cirugía mayor abdominal. Métodos: Estudio cuasiexperimental, prospectivo, longitudinal realizado en 44 pacientes del Hospital Universitario "General Calixto García", desde diciembre de 2019 hasta diciembre de 2020. Se crearon dos grupos, un grupo estudio (sulfato de magnesio) y otro control. Se evaluó la analgesia intraoperatoria y posoperatoria, el consumo intraoperatorio de fentanil, la necesidad de analgesia de rescate y las complicaciones perioperatorias. Resultados: En los pacientes que se les administró el sulfato de magnesio la tensión arterial media, la frecuencia cardiaca y el índice de shock tuvieron una tendencia a mantenerse por debajo de la media global. El índice de perfusión aumentó y se mantuvo con esa tendencia y tuvieron un menor consumo de fentanil. Conclusiones: La administración de sulfato de magnesio como adyuvante de la anestesia general en pacientes intervenidos por cirugía abdominal mayor electiva, resultó efectiva y segura, pues brindó mayor analgesia perioperatoria, estabilidad hemodinámica, menor consumo de opioides intraoperatorio y menor rescate analgésico posoperatorio que cuando no se usó. La incidencia de complicaciones fue baja y sin repercusión clínica(AU)

Introduction: The effect of magnesium sulfate as an adjunct to analgesia during different surgical interventions is a subject under constant debate and study, with respect to showing its efficacy and safety in improving the postoperative evolution of patients. Objective: To assess the effectiveness and safety of magnesium sulfate as an opioid sparer in general anesthesia with patients undergoing major abdominal surgery. Methods: Quasiexperimental, prospective and longitudinal study carried out, from December 2019 to December 2020, with 44 patients from General Calixto García University Hospital. Two groups were created: a study group (magnesium sulfate) and a control group. Intraoperative and postoperative analgesia, intraoperative fentanyl consumption, requirement of salvage analgesia, as well as perioperative complications were evaluated. Results: In the patients who were administered magnesium sulfate, mean arterial pressure, heart rate and shock index tended to remain below the global mean. The perfusion index increased and maintained this trend, while they had a lower consumption of fentanyl. Conclusions: The administration of magnesium sulfate as an adjunct to general anesthesia in patients undergoing major elective abdominal surgery was effective and safe, as it provided greater perioperative analgesia, hemodynamic stability, less intraoperative opioid consumption and less postoperative analgesic rescue than in the control group. The incidence of complications was low and without clinical repercussions(AU)

Ventajas del sulfato de magnesio en anestesiología / Advantages of magnesium sulfate in anesthesiology

Objetivos: explicar la utilidad del sulfato de magnesio en el área de anestesiología con la información disponible de libre acceso. Material y métodos: para alcanzar el objetivo se realizó una revisión bibliográfica de ensayos clínicos, meta análisis publicados en importantes plataformas de datos de ciencia médicas. Con palabras de búsqueda como: anestesiología y sulfato de magnesio, analgesia, relajantes musculares, escalofríos, Ginecología-Eclampsia. Resultados: se obtuvo información variada en el ámbito de anestesiología, seleccionando aquellos que hacen referencia en al ámbito de anestesiología, realizando la combinación de palabras, se obtuvo en google académico de alrededor de 114 artículos relacionados, de los cuales se eligió aquellos ensayos clínicos y meta análisis. Conclusiones: se concluyó que el sulfato de magnesio ayuda en disminución de la dosis de los anestésicos, sin embargo, no es concluyente que como adyuvante ayude en la analgesia. Se observó que prolonga la acción de los relajantes musculares. Se sugiere permanecer con los estudios para revelar la dosis, inicio de administración, calidad para la inclusión en estudios de meta análisis.

Objectives: Explain the usefulness of magnesium sulphate in the area of anesthesiology with the freely available information. Material and methods: To achieve the objective, a bibliographic review of clinical trials was carried out, meta-analyzes published in important medical science data platforms. With search words like: anesthesiology and magnesium sulfate, analgesia, muscle relaxants, chills, Gynecology-Eclampsia. Results: A variety of information was obtained in the field of anesthesiology, selecting those that refer to the field of anesthesiology, it was obtained in academic google by combining the words of around 114 related articles, of which those clinical trials and also meta-analysis. Conclusions: It is concluded that magnesium sulfate helps in reducing the dose of anesthetics, however it is not conclusive that as an adjuvant it helps in analgesia. It was observed to prolong the action of muscle relaxants. It is suggested to stay with the studies to reveal the dose, initiation of administration, quality for inclusion in meta-analysis studies.

Prematuro con perforación intestinal espontánea de presentación muy precoz / Preterm neonate with spontaneous intestinal perforation of very early presentation

Resumen Introducción: La perforación intestinal espontánea es una condición que afecta principalmente a neonatos pretérmino. Caso clínico: Se presenta el caso de un neonato pretérmino de 26 semanas de gestación con neumoperitoneo en las primeras 24 horas de vida. Por lo precoz del cuadro y los hallazgos radiológicos, la primera hipótesis diagnóstica fue una perforación gástrica. Sin embargo, en la laparotomía se encontró una perforación ileal única, sin hallazgos de enterocolitis. Conclusiones: La perforación intestinal espontánea se ha asociado con intervenciones médicas, como el uso concomitante de esteroides e indometacina. Otras intervenciones, como el uso de magnesio prenatal y la colocación de surfactante pulmonar de forma mínimamente invasiva, se han propuesto como factores de riesgo para su desarrollo. En la actualidad, deben evaluarse la perforación intestinal espontánea y sus asociaciones. Las presentes y futuras investigaciones podrían contribuir a aclarar el papel de las intervenciones mencionadas en la revisión preliminar de la literatura.

Abstract Background: Spontaneous intestinal perforation is a condition that mainly affects preterm infants. Case report: The case of a preterm infant of 26 weeks of gestation with pneumoperitoneum in the first 24 hours of life is described. Due to the early symptoms and radiological findings, the first diagnostic hypothesis was gastric perforation. However, at laparotomy, a unique ileal perforation was found, without findings of enterocolitis. Conclusions: Spontaneous intestinal perforation is a complication associated with medical interventions such as the concomitant use of steroids and indomethacin. Recently, other interventions, such as the use of prenatal magnesium and treatment with exogenous pulmonary surfactants in a minimally invasive way have been proposed as risk factors for its development. At present, clinicians should evaluate spontaneous intestinal perforation and its associations, and ongoing and future research may clarify the role of the interventions mentioned in the review of preliminary literature.

Uso de sulfato de magnesio relacionado con la reanimación neonatal en prematuros / Use of magnesium sulfate in the neonatal reanimation of prematures / Uso de sulfato de magnésio relacionado à ressuscitação neonatal em prematuros

RESUMEN Introducción: La neuroprotección farmacológica se utiliza en el período antenatal para ayudar a disminuir el riesgo de parálisis cerebral o disfunciones motoras en el recién nacido (RN). El sulfato de magnesio (MgSO4) es de gran utilidad por los beneficios que proporciona como tocolítico, neuroprotector fetal en prematuros menores a 32 semanas y en el manejo de la preeclampsia. Sin embargo, durante su uso se observaron efectos adversos a dosis dependientes tanto para la madre como para el RN, lo que genera gran importancia para el trabajo del profesional de obstetricia y enfermería. Objetivo: Determinar la frecuencia de reanimación neonatal en prematuros menores de 32 semanas según el uso de neuroprotección con MgSO4. Métodos: Estudio retrospectivo, observacional, realizado en un hospital de Santiago de Chile. Se realizó un muestreo aleatorio simple. Se incluyeron prematuros menores a 32 semanas de edad gestacional con o sin tratamiento de MgSO4 que hayan requerido o no reanimación neonatal. La información fue recogida a partir de fichas clínicas con un instrumento propio. Análisis de los datos por determinación de frecuencias absolutas y relativas de las variables y su comparación directa. Resultados: Del total de los RN que recibieron MgSO4, 61.7 % requirió reanimación neonatal al nacer, de los que no recibieron este neuroprotector, el 52.8 % necesitó reanimación neonatal. Conclusiones: La mayor frecuencia de reanimación neonatal está asociada al uso de la neuroprotección con MgSO4 y ocurre más probablemente en recién nacidos de edad gestacional menor que 32 semanas. Los resultados contribuyen a la toma de decisiones basadas en pruebas.

ABSTRACT Introduction: Diverse drug-related neuroprotections are used during the prenatal period to help reduce the risk of cerebral palsy or motor dysfunctions in the newborn. Magnesium sulfate (MgSO4) is useful as a fetal neuroprotector in prematures with less than 32 weeks, as well as in the management of preeclampsia. Nevertheless, some dose-dependent adverse effects both on the mother and the newborn have been reported. This situation is necessarily of concern to the nursing and obstetrics professional. Objective: To determine the frequency of neonatal reanimation en prematures with less than 32 weeks with MgSO4 neuroprotection. Methods: This is a retrospective and observational study conducted in a hospital in Santiago, Chile. Simple random sampling was used. Prematures with less than 32 weeks of gestational age, with or without MgSO4 treatment and who had or had not required neonatal reanimation, were included in the study. Data were collected from clinical records. Absolute and relative frequencies and their direct comparisons were calculated. Results: From the total of newborns who received MgSO4, 61.7% required neonatal reanimation, while from those who did not receive MgSO4, 52.8% required neonatal reanimation. Conclusions: The higher frequency of neonatal reanimation is associated with the received MgSO4 as a neuroprotection with and occurs more likely in neonates with a gestational age less than 32 weeks. The results contribute to evidence-based decision making.

RESUMO Introdução: A neuroproteção farmacológica é utilizada no período pré-natal para ajudar a reduzir o risco de paralisia cerebral ou disfunções motoras no recém-nascido (RN). O sulfato de magnésio (MgSO4) é muito útil devido aos benefícios que proporciona como tocolítico, neuroprotetor fetal em prematuros com menos de 32 semanas e no tratamento da pré-eclâmpsia. Porém, durante seu uso, foram registrados efeitos adversos em doses dependentes tanto para a mãe quanto para o recém-nascido, o que gera grande importância para o trabalho do profissional obstétrico e de enfermagem. Objetivo: Determinar a frequência de reanimação neonatal em prematuros com menos de 32 semanas de acordo com o uso de neuroproteção com MgSO4. Métodos: Estudo retrospectivo e observacional realizado em um hospital de Santiago de Chile. Foi realizada uma amostragem aleatória simples. Foram incluídos bebês prematuros com menos de 32 semanas de idade gestacional com ou sem tratamento com MgSO4 que exigia ou não a reanimação neonatal. Coletou-se informação de prontuários clínicos com um instrumento proprietário. Análise dos dados através da determinação das frequências absolutas e relativas das variáveis e sua comparação direta. Resultados: Do total dos RN que receberam MgSO4, 61,7% necessitaram de reanimação neonatal ao nascimento, dos que não receberam esse neuroprotetor, 52,8% necessitaram de reanimação neonatal. Conclusões: A frequência de reanimação neonatal foi maior em recém-nascidos com menos de 32 semanas de idade gestacional que receberam neuroproteção com MgSO4, situação semelhante em cada estrato de idade gestacional.

Efectividad de un tratamiento acortado con sulfato de magnesio para prevención de eclampsia durante el puerperio / Effectiveness of a shortened treatment with magnesium sulfate for prevention of eclampsia during puerperium

Resumen OBJETIVO: Determinar si la administración de un tratamiento acortado, menor de 8 h, con sulfato de magnesio durante el puerperio es efectivo para prevenir eclampsia y conseguir algunas otras ventajas. MATERIAL Y MÉTODOS: Estudio de serie de casos, retrospectivo, transversal y comparativo efectuado en el Hospital Regional Materno Infantil de Nuevo León, México, de febrero de 2019 a enero de 2020. Criterios de inclusión: pacientes con embarazo único complicado con preeclampsia con datos de severidad o hipertensión crónica con preeclampsia severa sobreagregada a quienes se administró sulfato de magnesio como profilaxis para eclampsia antes del nacimiento y que, posteriormente, continuaron su administración en el puerperio. Las pacientes se dividieron en dos grupos según las horas que recibieron sulfato de magnesio durante el puerperio: grupo A: tratamiento acortado menor de 8 h y grupo B: con esquema de más de 8 h. Para comparar proporciones se utilizó la prueba de χ2. Se consideró con significación estadística el valor de p ≤ 0.05. RESULTADOS: Se analizaron 379 participantes: 76 en el grupo A y 303 en el B. No se registró ningún caso de eclampsia en ambos grupos. Las horas para iniciar la lactancia, deambulación, permanencia de la sonda Foley y en cuidados intensivos fueron significativamente menores en el grupo de tratamiento acortado (14.1 vs 26.06; p =.000), (15.1 vs 26.24; p = .000), (14.5 vs 25.3; p = 000), (13.8 vs 23.1; p = .000), respectivamente. No se observó diferencia en las complicaciones neonatales. CONCLUSIÓN: La administración de un tratamiento acortado de sulfato de magnesio durante el puerperio es igual de efectivo que un tratamiento mayor de 8 h para prevención de eclampsia.

Abstract OBJECTIVE: To determine whether the administration of a shortened treatment of less than 8 h with magnesium sulfate during the puerperium is effective to prevent eclampsia and to achieve some other advantages. MATERIAL AND METHODS: A retrospective, cross-sectional, comparative, retrospective, case series study performed at the Hospital Regional Materno Infantil of Nuevo León, Mexico, from February 2019 to January 2020. Inclusion criteria: patients with singleton pregnancy complicated with preeclampsia with data of severity or chronic hypertension with severe over-added preeclampsia who were administered magnesium sulfate as prophylaxis for eclampsia before birth and subsequently continued its administration in the puerperium. The patients were divided into two groups according to the hours that they received magnesium sulfate during the puerperium: group A: shortened treatment of less than 8 h and group B: with a schedule of more than 8 h. The proportions were compared by using the test for the proportion of patients who received magnesium sulfate during the puerperium. To compare proportions, we used the . A value of p ≤ 0.05 was considered statistically significant. RESULTS: 379 participants were analyzed: 76 in group A and 303 in group B. No cases of eclampsia were recorded in both groups. Hours to initiate breastfeeding, ambulation, Foley tube stay and intensive care were significantly lower in the shortened treatment group (14.1 vs 26.06; p = .000), (15.1 vs 26.24; p = .000), (14.5 vs 25.3; p = 000), (13.8 vs 23.1; p = .000), respectively. No difference in neonatal complications was observed. CONCLUSION: Administration of a shortened course of magnesium sulfate during the puerperium is as effective as a longer course of 8 h for prevention of eclampsia.

El paciente con estado migrañoso en urgencias / Patient with status migrainosus in emergency department

RESUMEN Se presentan dos casos de la práctica diaria, de pacientes con migraña con y sin aura que evolucionan a estado migrañoso (SM) y requieren atención hospitalaria. El manejo hospitalario es necesario luego de que se agotaran todas las medidas de manejo ambulatorio indicadas. Se describen los criterios diagnósticos del SM actuales por la ICDH-3, su fisiopatología y la reciente propuesta del SM episódico. Se ofrecen algunas sugerencias del manejo actual de acuerdo con la evidencia disponible que pueden ser de utilidad en la práctica diaria.

SUMMARY We describe two cases with migraine with and without aura who evolves to Migrainous State (MS) requiring hospital care. Admision for management is necessary after all outpatient management measures were exhausted. The current criteria for the diagnosis of MS by the ICDH -3, its pathophysiology and the recent proposal of episodic MS were described. We propose some suggestions of current management according to the available evidence that may be useful for daily practice.

Efectividad de la ketamina y el sulfato de magnesio en pacientes con temblor posanestesia subaracnoidea / Effectiveness of ketamine and magnesium sulfate in patients with shaking after subarachnoid anesthesia

Introducción: El temblor es frecuente. Además de agravar el dolor, aumenta la demanda metabólica y el consumo de oxígeno; varios fármacos son utilizados para eliminarlo. Objetivo: Determinar la efectividad de la ketamina y el sulfato de magnesio en pacientes con temblor posanestesia subaracnoidea. Métodos: Se realizó una investigación cuasi-experimental de 394 pacientes, quienes se encontraban bajo anestesia espinal de forma electiva, atendidos en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde septiembre de 2016 hasta igual periodo de 2018. Se dividieron en 2 grupos aleatorios con 197 integrantes cada uno: A (ketamina 0,4 mg/kg) y B (sulfato de magnesio 50 mg/kg), a los cuales se le suministraron los medicamentos una vez iniciado el temblor. Resultados: En ambos grupos predominaron los pacientes de 45-64 años de edad. Hubo homogeneidad entre hombres y mujeres, sin significación estadística (p= 0,5378). La mayoría de los afectados se encontraban en el grupo de riesgo anestésico II (88,1 %). En los 2 grupos primó del grado III del temblor antes de la terapia, solo 3,5 % del grupo B a los 30 minutos mantuvo igual condición. En los primeros 10 minutos de suministrar el sulfato de magnesio despareció el temblor en la mayoría de los pacientes (74,5 %). Dicho fármaco resultó efectivo en 83,8 % de los afectados y en aquellos que recibieron ketamina fue de 42,1 %, ambos sin efectos secundarios. Conclusiones: La incidencia del temblor fue alta. La ketamina y el sulfato de magnesio fueron efectivos al permitir la desaparición del temblor en un corto periodo de tiempo, pero el segundo fármaco superó al primero en magnitud considerable.

Introduction: The shaking is frequent. Besides increasing the pain, it increases the metabolic demand and the oxygen consumption; several drugs are used to eliminate it. Objective: To determine the effectiveness of ketamine and magnesium sulfate in patients with shaking after subarachnoid anesthesia. Methods: A quasi-experimental investigation of 394 patients who received spinal anesthesia in an elective way, assisted at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital was carried out in Santiago de Cuba, from September, 2016 to the same period in 2018. They were divided in 2 random groups with 197 members each one: A (ketamine 0.4 mg/kg) and B (magnesium sulfate 50 mg/kg), to whom the medications were given once shaking began. Results: In both groups the 45-64 years patients prevailed. There was homogeneity between men and women, without statistical significance (p = 0.5378). Most of those affected were in the group of anesthetic risk II (88.1 %). In the 2 groups the degree III of shaking before therapy prevailed, just 3.5 % in group B maintained the same condition at 30 minutes. In the first 10 minutes of giving the magnesium sulfate shaking disappeared in most of the patients (74.5 %). This drug was effective in 83.8 % of those affected and in those that received ketamine it was of 42.1 %, both without side effects. Conclusions: The incidence of shaking was high. The ketamine and magnesium sulfate were effective when allowing the disappearance of shaking in a short period of time, but the second drug overcame the first one in a considerable magnitude.

Evaluation of the comparative influence of magnesium sulfate single and combination with ritodrine hydrochloride in the prevention of preterm delivery / Avaliação da influência comparativa de sulfato de magnésio único e combinação com cloridrato de ritodrina na prevenção de parto prematuro

This project was designedto explore the effects of ritodrine hydrochloride combined with magnesium sulfate in the prevention of preterm delivery of patients with threatened premature birth. 128 cases of threatened premature birth were randomly divided into two groups according to the number table method. The control group was treated with magnesium sulfate, while the study group was treated with ritodrine hydrochloride combined with magnesium sulfate. The data (p > 0.05) was analyzed using SPSS 18.0 and was subjected to Chi-square and t-test. The onset time and prolonged gestation time of the study group were shorter than those of the control group (p < 0.05). There was no difference in the incidence of myocardial ischemia between the study group and the control group (p > 0.05). The heart rate per minute of the study group was higher than that of the control group (p < 0.05). There was no difference in blood pressure between the study group and the control group. Nevertheless, the neurological function, pregnancy outcome, and neonatal status of the group were better than those of the control group (p < 0.05).(AU)

Este projeto foi desenvolvido para explorar os efeitos do cloridrato de ritodrina combinado com sulfato de magnésio na prevenção do parto prematuro de pacientes com risco de nascimento prematuro. 128 casos de nascimento prematuro ameaçado foram divididos aleatoriamente em dois grupos, de acordo com o método da tabela numérica. O grupo de controle foi tratado com sulfato de magnésio, enquanto o grupo de estudo foi tratado com cloridrato de ritodrina combinado com sulfato de magnésio. Os dados (p > 0,05) foram analisados pelo SPSS 18.0 e submetidos ao teste do qui-quadrado e ao teste t. O tempo de início e o tempo prolongado de gestação do grupo de estudo foram menores que os do grupo de controle (p < 0,05). Não houve diferença na incidência de isquemia miocárdica entre o grupo de estudo e o grupo de controle (p > 0,05). A frequência cardíaca por minuto do grupo de estudo foi superior à do grupo controle (p < 0,05). Não houve diferença na pressão arterial entre o grupo de estudo e o grupo de controle. No entanto, a função neurológica, o resultado da gravidez e o status neonatal do grupo foram melhores do que os do grupo de controle (p < 0,05).(AU)

Estudios de imagen cerebral en el diagnóstico diferencial de enfermedades hipertensivas del embarazo y convulsiones. Reporte de dos casos / Brain imaging studies in the differential diagnosis of patients with hypertensive diseases of pregnancy and seizures. Report of two cases

Resumen ANTECEDENTES: Las crisis convulsivas durante el embarazo son la complicación neurológica más frecuente. Casi todas ocurren en pacientes con epilepsia; cuando aparece la primera durante el embarazo debe establecerse su causa. PRIMER CASO: Paciente de 28 años, con antecedente de hipertensión arterial. Cursaba el puerperio posquirúrgico tardío con preeclampsia sobreagregada cuando tuvo tres crisis convulsivas. Acudió a urgencias y la trataron con sulfato de magnesio: evolucionó a estatus epiléptico. Los estudios de neuroimagen reportaron trombosis de la vena cortical frontal izquierda. Se aplicaron medidas de neuroprotección con adecuada evolución clínica y fue dada de alta del hospital sin déficit motor, sensitivo y cognoscitivo. SEGUNDO CASO: Paciente de 22 años, con antecedente de citopatía mitocondrial del fenotipo oftalmoplejía externa progresiva crónica. Cursaba su primer embarazo sin control prenatal. A la semana 28 sufrió cefalea y una crisis convulsiva. Acudió a urgencias debido a la hipertensión arterial; le prescribieron un antihipertensivo y sulfato de magnesio. Los estudios de neuroimagen reportaron: síndrome de encefalopatía reversible posterior, secundario a eclampsia. Se interrumpió el embarazo y la paciente evolucionó favorablemente. CONCLUSIÓN: Las convulsiones en el embarazo y puerperio en mujeres con enfermedades hipertensivas pueden tener un comportamiento benigno o ser potencialmente mortales. Se propone un algoritmo diagnóstico para tratar a estas pacientes, resalta la sospecha clínica de otras causas de convulsiones como la principal indicación de estudios de imagen.

Abstract BACKGROUND: Seizures during pregnancy are the most frequent neurological complication. Most occur in patients with epilepsy. When the first crisis appears during pregnancy, the cause must be determined. FIRST CASE: A 28-year-old patient with a history of high blood pressure. She was in the late puerperium with over-added preeclampsia when she presented three seizures. She went to the emergency room and started magnesium sulfate, evolving to epileptic status. Neuroimaging studies were performed and reported thrombosis of the left frontal cortical vein. Neuroprotection measures were applied with adequate clinical evolution. She was discharge without motor, sensory and cognitive deficits. SECOND CASE: A 22-year-old patient with a history of a chronic progressive external ophthalmoplegia mitochondrial cytopathy. She was in her first pregnancy without prenatal control. At the 28 week she began with headache and had a seizure. She went to the emergency department with high blood pressure, so she was given antihypertensive therapy and magnesium sulfate. Neuroimaging studies reported a posterior reversible encephalopathy syndrome secondary to eclampsia. The pregnancy was interrupted, and she evolved favorably. CONCLUSION: Seizures in pregnancy and puerperium in women with hypertensive diseases of pregnancy may have benign behavior or may be life-threatening. We propose a diagnostic algorithm for the approach of these patients, highlighting the clinical suspicion of other causes of seizures as the main indication of imaging studies.

Evaluación del sulfato de magnesio en el tratamiento del broncoespasmo / Assessment of magnesium sulfate in bronchospasm treatment

Introducción: Una de las urgencias más temidas durante la instrumentación de la vía respiratoria es el broncoespasmo. El sulfato de magnesio, administrado por vía endovenosa, tiene un efecto broncodilatador al antagonizar los canales del calcio, inhibir la contracción muscular mediada por el calcio y favorecer la relajación del músculo liso bronquial. Objetivo: Evaluar la eficacia del sulfato de magnesio endovenoso en pacientes con broncoespasmo durante broncoscopias. Métodos: Estudio observacional, descriptivo y transversal en 20 pacientes, con broncoespasmo, desencadenado por manipulación de la vía respiratoria con broncoscopio flexible, tratados con sulfato de magnesio 50 mg/kg, (máximo 2 g), por vía endovenosa durante 5 min. Resultados: Predominaron los hombres entre 50-59 años (75 por ciento), todos los pacientes eran fumadores, 15 pacientes fueron clasificados como estado físico ASA III. Sufrieron broncoespasmo de intensidad moderada 60 por ciento, clasificado según la clínica y monitorización de SpO2. En 75 por ciento de los pacientes cedió el broncoespasmo tras el tratamiento sin administrar otro medicamento. No se registraron efectos adversos. Ningún paciente necesitó intubación orotraqueal para ventilación ni requirió hospitalización por más de 8 h. Conclusiones: El sulfato de magnesio es una buena opción farmacológica para el tratamiento de urgencia del broncoespasmo desencadenado por manipulación de la vía respiratoria(AU)

Introduction: One of the most feared emergencies during the instrumentation of the respiratory tract is bronchospasm. Magnesium sulfate, administered intravenously, has a bronchodilation effect by antagonizing calcium channels, inhibiting muscle contraction mediated by calcium and promoting bronchial smooth muscle relaxation. Objective: To evaluate the efficacy of magnesium sulfate administered intravenously in patients with bronchospasm during bronchoscopy. Methods: Observational, descriptive and cross-sectional study carried out with 20 patients, with bronchospasm, triggered by airway manipulation with flexible bronchoscope, treated with 50 mg/kg of magnesium sulfate, (maximum 2 g), administered intravenously for 5 min. Results: Men between 50-59 years (75 percent) predominated. All patients were smokers. 15 patients were classified with physical state ASA III. They suffered bronchospasm of mild intensity 60 percent, classified according to the clinic and monitoring of oxygen saturation. In 75 percent of the patients, the bronchospasm ceased after the treatment without administering any other medication. No adverse effects were recorded. No patient needed orotracheal intubation for ventilation or required hospitalization for more than 8 hours. Conclusions: Magnesium sulfate is a good pharmacological option for the emergency treatment of bronchospasm triggered by manipulation of the respiratory tract(AU)

Eficacia del sulfato de magnesio como coadyuvante en la analgesia postoperatoria en pacientes sometidos a colecistectomía abierta / Efficacy of magnesium sulphate as a coadyuvant in postoperative analgesia in patients undergoing open cholecystectomy

Con el objetivo de evaluar la eficacia del sulfato de magnesio como coadyuvante en la analgesia postoperatoria en pacientes sometidos a colecistectomía abierta que ingresaron al Hospital Central Universitario Dr. Antonio María Pineda durante el período mayo­agosto de 2018, se realizó un ensayo clínico controlado simple ciego cuya muestra estuvo formada por 50 pacientes asignados aleatoriamente en dos grupos (relación 1:1): grupo experimental quienes recibieron sulfato de magnesio a una dosis de 50 mg/kg vía intravenoso (IV) más ketoprofeno 100 mg IV y grupo control a quienes se les administró solo ketoprofeno 100 mg IV. La intensidad del dolor se estimó a través de la escala visual análoga (EVA). La intensidad basal del dolor fue menor en el grupo experimental. Las dosis analgésicas de rescate requeridas fueron superiores en el grupo control (p  0,05) mientras que las náuseas se presentaron sólo en el grupo control. El 62,5% de los pacientes del grupo control con EVA > 4 ameritó medicación de rescate entre 30 minutos a 12 horas post-cirugía y el 37,5% de los pacientes del grupo experimental la requirió entre 8 a 24 horas (p < 0,05). Los resultados evidencian que el sulfato de magnesio es una alternativa efectiva en el tratamiento del dolor postoperatorio.

In order to evaluate the efficacy of magnesium sulphate as a coadjuvant in postoperative analgesia in patients undergoing open cholecystectomy admitted to the Hospital Central Universitario Dr. Antonio Maria Pineda during the May - August 2018 period, we performed a controlled single blind study with a sample of 50 patients randomly assigned to two groups (1:1 ratio): experimental group which received 50 mg/kg intravenous magnesium sulfate plus ketoprofen 100 mg IV and control group which only received ketoprofen 100 mg IV. The intensity of pain was estimated through the visual analogue scale (VAS). Basal pain intensity was less in the experimental group. Analgesic rescue doses were higher in the control group (p  0.05) while nausea was only seen in this group. 62.5% of patients of the control group with VAS > 4 required rescue medication between 30 minutes and 12 hours post-surgery while 37.5% of patients of the experimental group received rescue medication between 8 to 24 hours post-surgery (p < 0.05). The results show that magnesium sulphate is an effective alternative in the treatment of postoperative pain.

Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study / Efeitos do sulfato de magnésio e da milrinona sobre o vasoespasmo cerebral após hemorragia subaracnoidea por aneurisma: estudo randômico

Abstract Background: Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. Methods: The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500 mg.day-1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5 µg.kg-1.min-1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity ≥ 120 cm.s-1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%). Results: The mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p < 0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p = 0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p = 0.036, p = 0.012, p = 0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p = 0.012). Conclusions: The incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.

Resumo Justificativa: A hemorragia subaracnoidea por aneurisma é uma importante causa de morte prematura e de incapacidade em todo o mundo. O sulfato de magnésio mostra um efeito neuroprotetor e reverte o vasoespasmo cerebral. A milrinona também é usada no tratamento de vasoespasmo cerebral. O objetivo do presente estudo foi comparar o efeito profilático do sulfato de magnésio e da milrinona sobre a incidência de vasoespasmo cerebral após hemorragia subaracnoidea. Métodos: O estudo incluiu 90 pacientes com hemorragia subaracnoidea por aneurisma randomicamente distribuídos (randomização simples) em dois grupos: sulfato de magnésio foi administrado em infusão de 500 mg.dia-1 sem dose de ataque durante 21 dias. O Grupo B recebeu milrinona em infusão de 0,5 µg.kg-1·min-1 sem dose de ataque durante 21 dias. O vasoespasmo cerebral foi diagnosticado pela velocidade média do fluxo sanguíneo cerebral na artéria cerebral envolvida (velocidade média do fluxo ≥ 120 cm.s-1), a deterioração neurológica por escala de coma de Glasgow ou angiografia (diminuição do diâmetro da artéria cerebral envolvida > 25%). Resultados: A velocidade média do fluxo sanguíneo cerebral diminuiu significativamente no grupo magnésio em comparação com o grupo milrinona nos dias 7, 14 e 21 (p < 0,001). A incidência de vasoespasmo cerebral diminuiu significativamente com o magnésio em comparação com milrinona (p = 0,007). A escala de coma de Glasgow melhorou significativamente no grupo magnésio em comparação com o grupo milrinona nos dias 7, 14 e 21 (p = 0,036, p = 0,012, p = 0,016, respectivamente). A incidência de hipotensão foi maior com milrinona do que com magnésio (p = 0,012). Conclusões: A incidência de vasoespasmo cerebral após hemorragia subaracnoidea por aneurisma foi significativamente menor e a escala de coma de Glasgow significativamente melhor com magnésio em comparação com milrinona. A milrinona foi associada a uma maior incidência de hipotensão e necessidade de dopamina e norepinefrina em comparação com o magnésio.

Infiltración intraarticular con sulfato de magnesio y bupivacaína en fracturas de radio distal. Estudio piloto / Intrarticular infiltration of bupivacaine and magnesium sulfate in distal radius fractures. A pilot study

Resumen: Antecedentes: Las fracturas de radio distal constituyen hasta 15% de todas las lesiones óseas en los adultos. La rehabilitación es clave en la recuperación de la movilidad y la capacidad funcional. El sulfato de magnesio intraarticular ha sido utilizado para control postoperatorio del dolor; el objetivo fue determinar la mejoría del dolor y la capacidad funcional de los pacientes con fractura de radio distal usando sulfato de magnesio intraarticular. Material y métodos: Pacientes con fractura de radio distal tratados con clavos percutáneos e inmovilización fueron incluidos al azar en dos grupos. Grupo 1 infiltrado con 1.0 ml de sulfato de magnesio y 1.5 ml de agua estéril; en el grupo 2 esta última fue sustituida por 1 ml de bupivacaína (5 mg/ml). La infiltración se realizó al retiro de la inmovilización. El dolor, funcionalidad y rangos de movimiento fueron evaluados. Resultados: 20 pacientes, ocho masculinos y 12 femeninos con edad promedio de 53 años (± 17 DE) fueron evaluados. Se encontró disminución significativa en el dolor al primer minuto y a los tres minutos después de la infiltración en el grupo 2 (p < 0.05). Ambos grupos presentaron una mejoría significativa en la funcionalidad articular a las dos semanas (p < 0.05), así como una mejoría gradual en la movilidad articular en ese mismo período (p < 0.05). Conclusiones: La infiltración de sulfato de magnesio en combinación con bupivacaína ayuda a disminuir el dolor.

Abstract: Background: The distal radius fracture represent until 15% of all bone injuries in adults. The key in the recovery of mobility and functional outcomes are rehabilitation. The intra-articular application of magnesium sulphate has been used for postoperative pain. The objective was to determinate the improvement in pain and functional outcome of patients with distal radius fracture using intra-articular magnesium sulphate. Material and methods: Patients with distal radius fracture treated with percutaneous pinning and cast immobilization was included and randomized into two groups. The group 1 was applied 1.0 ml of magnesium sulphate and 1.5 ml of injectable water; meanwhile the group 2, the water was replaced with 1 ml of bupivacaine (5 mg/ml). The intra-articular infiltration was applied at the end of immobilization. Pain, functionality and movement of the wrist was evaluated for two weeks. Results: Twenty patients, 8 male and twelve females, with a mean age of 53 years (± 17 SD) was evaluated. A significative reduction of pain during the first minute and at three minutes after intra-articular infiltration in group 2 (p < 0.05). Both groups presented better articular outcomes at the two weeks (p < 0.05), and a better articular movement at same point (p < 0.05). Conclusions: The intra-articular infiltration of magnesium sulphate plus bupivacaine help to reduces the pain.

Sulfato de magnesio inhalado en el tratamiento del asma aguda / INHALED MAGNESIUM SULFATE FOR THE TREATMENT OF ACUTE ASTHMA

Antecedentes: Las exacerbaciones del asma pueden ser frecuentes y variar en gravedad, desde relativamente leves hasta el estado asmático. El uso del sulfato de magnesio (MgSO4) es una de las muchas opciones de tratamiento disponibles para las exacerbaciones agudas que no se ha estudiado vía inhalada. Objetivo: Determinar la utilidad del sulfato de magnesio inhalado, administrado en el asma aguda, sobre la función pulmonar y en las horas de estancia intrahospitalaria. Métodos: Previa firma de consentimiento informado se incluyó a los pacientes con asma ingresados a urgencias los cuales respondieron un cuestionario sobre cuestiones generales. Por aleatorización simple 1:1 se formaron 2 grupos: a) al que se le aplicó el tratamiento estándar para este padecimiento b) al que además del tratamiento estándar se le administró 500mcgrs de S. Magnesio inhalado por 3 dosis con intervalo de 20 minutos. Se realizaron mediciones clínicas y por flujometría al ingreso, 20, 40 y 60 minutos. Resultados: No se observaron diferencias estadísticamente significativas iniciales entre los grupos de tratamiento con el género, turno o mortalidad. En cuanto a las horas de estancia intrahospitalaria se vio una disminución significativa en el grupo de casos. El Tiempo de Apnea Voluntaria de forma inicial en el grupo tratado con Sulfato de Magnesio alcanzaron mayores tiempos en mayor cantidad de participantes, con una diferencia significativa (p=0.01). Los valores de la FEM se comportaron de forma similar, siendo mayores y con diferencia significativa (0.05) en el grupo de casos. Conclusiones: El magnesio nebulizado no ha sido ampliamente probado, sin embargo en nuestro estudio, parece ser eficaz al mejorar la función pulmonar de los pacientes que ingresan con crisis asmática, disminuir el tiempo de estancia intrahospitalaria y mejoría en la clínica del paciente

Background: Asthma exacerbations can be frequent and range in severity from relatively mild to asthmatics status. The use of magnesium sulphate (MgSO4) is one of the many treatment options available during acute exacerbations has not been studied inhaled. Objective: To determine the utility of inhaled magnesium sulfate, administered in acute asthma on lung function and hours of hospital stay. Methods: After obtaining informed consent were included patients admitted to the emergency department with asthma who answered a questionnaire on general issues. For simple randomization 1: 1 2 groups were formed: a) to which was applied the standard treatment for this condition b) that in addition to standard treatment was administered 500mcgrs S. Magnesium inhaled by 3 doses with an interval of 20 minutes. Clinical measurements were made and flowmetry at admission, 20, 40 and 60 minutes. Results: No statistically significant differences between initial treatment group gender, shift or mortality were observed. As for the hours of hospital stay was a significant decrease in the case group. The Apnea Time Volunteer initial shape in the treated group achieved Magnesium Sulfate older times more participants, with a significant difference (p = 0.01). EMF values behaved similarly, with higher and significant difference (0.05) in the case group. Conclusions: nebulized magnesium has not been extensively tested, but in our study, appears to be effective in improving lung function in patients admitted with acute asthma, decrease hospital stay time and improvement in clinical patient

Sulfato de magnesio y el cerebro en la preeclampsia / Magnesium sulfate and brain in preeclampsia

El sulfato de magnesio ha sido el medicamento de elección en la profilaxis y tratamiento de la eclampsia. Sin embargo, la compresión de las manifestaciones neurológicas producidas por la preeclampsia englobadas dentro de la leucoencefalopatía posterior reversible ha puesto en evidencia que los mecanismos propuestos basados en estudios en animales son ciertos, revalorando más a este antiguo fármaco. Desde el estudio MAGPIE hasta nuestros días son muchas las interrogantes aun no resueltas con respecto al sulfato de magnesio en la preeclampsia, pero es indudable su valor como tratamiento de primera línea para las manifestaciones cerebrales en dicha complicación.

Magnesium sulfate is the drug of choice in the prophylaxis and treatment of eclampsia. The recent understanding of the neurological manifestations within the reversible posterior leukoencephalopathy produced by preeclampsia has confirmed mechanisms that had been previously based on animal studies, thus adding value to this old drug. From the MAGPIE study to this day, many questions regarding the use of magnesium sulfate in preeclampsia remain ulsolved, but its value as a first-line treatment for brain manifestations in preeclampsia is undoubtedly high.

Effects of lidocaine and magnesium sulfate in attenuating hemodynamic response to tracheal intubation: single-center, prospective, double-blind, randomized study / Os efeitos da lidocaína e do sulfato de magnésio na atenuação da resposta hemodinâmica à intubação orotraqueal: estudo unicêntrico, prospectivo, duplamente encoberto e aleatorizado

Abstract Background and objectives: Hemodynamic response to airway stimuli is a common phenomenon and its management is important to reduce the systemic repercussions. The objective of this study is to compare the efficacy of intravenous magnesium sulfate versus lidocaine on this reflex hemodynamics after laryngoscopy and tracheal intubation. Methods: This single-center, prospective, double-blind, randomized study evaluated 56 patients ASA 1 or 2, aged 18-65 years, scheduled for elective surgeries under general anesthesia with intubation. The patients were allocated into two groups: Group F received 30 mg·kg-1 of magnesium sulphate and Group L, 2 mg·kg-1 of lidocaine, continuous infusion, immediately before the anesthetic induction. Blood pressure (BP), heart rate (HR), and bispectral index (BIS) were measured in both groups at six different times related to administration of the study drugs. Results: In both groups there was an increase in HR and BP after laryngoscopy and intubation, compared to baseline. Group M showed statistically significant increase in the values of systolic and diastolic blood pressure after intubation, which was clinically unimportant. There was no difference in the BIS values between groups. Among patients receiving magnesium sulfate, three (12%) had high blood pressure versus only one among those receiving lidocaine (4%), with no statistical difference. Conclusion: Magnesium sulfate and lidocaine have good efficacy and safety for hemodynamic management in laryngoscopy and intubation.

Resumo Justificativa e objetivos: A resposta hemodinâmica aos estímulos das vias aéreas é um fenômeno comum e seu controle é importante para diminuir as repercussões sistêmicas. O objetivo deste trabalho é comparar os efeitos da administração endovenosa de sulfato de magnésio versus lidocaína na hemodinâmica desse reflexo após a laringoscopia e intubação orotraqueal. Métodos: Este estudo duplamente encoberto, aleatorizado, unicêntrico e prospectivo avaliou 56 pacientes, ASA 1 ou 2, entre 18 e 65 anos, escalados para cirurgias eletivas sob anestesia geral com intubação orotraqueal. Foram alocados em dois grupos, o M recebeu 30 mg·kg-1 de sulfato de magnésio e o L, 2 mg·kg-1 de lidocaína, em infusão contínua, imediatamente antes da indução anestésica. Os valores de pressão arterial (PA), frequência cardíaca (FC) e índice biespectral (BIS) foram aferidos nos dois grupos em seis momentos relacionados com a administração dos fármacos do estudo. Resultados: Em ambos os grupos houve aumento na FC e PA após a laringoscopia e intubação, em relação aos valores basais. No Grupo M observou-se elevação estatisticamente significativa, mas clinicamente pouco importante, nos valores das pressões arteriais sistólica e diastólica após a intubação. Não houve diferença nos valores de BIS entre os grupos. Dos pacientes que receberam o sulfato de magnésio, 3 (12%) apresentaram episódio de hipertensão, ao passo que apenas um dos que receberam lidocaína (4%) apresentou esse sinal, sem diferença estatística. Conclusão: Sulfato de magnésio e a lidocaína apresentam boa eficácia e segurança no controle hemodinâmico à laringoscopia e intubação.

Magnesium sulfate infusion for acute asthma in the emergency department / Infusão de sulfato de magnésio para asma aguda no serviço de emergência

Abstract Objectives: To describe the role of intravenous magnesium sulfate (MgSO4) as therapy for acute severe asthma in the pediatric emergency department (ED). Source: Publications were searched in the PubMed and Cochrane databases using the following keywords: magnesium AND asthma AND children AND clinical trial. A total of 53 publications were retrieved using this criteria. References of relevant articles were also screened. The authors included the summary of relevant publications where intravenous magnesium sulfate was studied in children (age <18 years) with acute asthma. The NAEPP and Global Initiative for Asthma expert panel guidelines were also reviewed. Summary of the data: There is a large variability in the ED practices on the intravenous administration of MgSO4 for severe asthma. The pharmacokinetics of MgSO4 is often not taken into account with a consequent impact in its pharmacodynamics properties. The cumulative evidence points to the effectiveness of intravenous MgSO4 in preventing hospitalization, if utilized in a timely manner and at an appropriate dosage (50-75 mg/kg). For every five children treated in the ED, one hospital admission could be prevented. Another administration modality is a high-dose continuous magnesium sulfate infusion (HDMI) as 50 mg/kg/h/4 h (200 mg/kg/4 h). The early utilization of HDMI for non-infectious mediated asthma may be superior to a MgSO4 bolus in avoiding admissions and expediting discharges from the ED. HDMI appears to be cost-effective if applied early to a selected population. Intravenous MgSO4 has a similar safety profile than other asthma therapies. Conclusions: Treatment with intravenous MgSO4 reduces the odds of hospital admissions. The use of intravenous MgSO4 in the emergency room was not associated with significant side effects or harm. The authors emphasize the role of MgSO4 as an adjunctive therapy, while corticosteroids and beta agonist remain the primary acute therapeutic agents.

Resumo Objetivos: Descrever o papel do sulfato de magnésio intravenoso (MgSO4) como terapia para asma grave aguda em serviço de emergência pediátrica (SE). Fonte: As publicações foram pesquisadas nos bancos de dados PubMed e Cochrane com as seguintes palavras-chave: magnésio E asma E crianças E ensaio clínico. Foram encontradas 53 publicações. As referências de artigos relevantes também foram examinadas. Incluímos o resumo de publicações relevantes quando o sulfato de magnésio intravenoso foi estudado em crianças (idade < 18 anos) com asma aguda. Revisamos também as diretrizes do Programa Nacional para a Educação e Prevenção da Asma (NAEPP) e do painel de especialistas da Iniciativa Global para Asma. Resumo dos dados: Há uma grande variabilidade nas práticas do SE na administração intravenosa do MgSO4 para asma grave. A farmacocinética do MgSO4 normalmente não leva em conta um impacto posterior em suas propriedades farmacodinâmicas. A comprovação cumulativa aponta para a eficácia do MgSO4 intravenoso na prevenção da internação, se usado quando necessário e em uma dosagem adequada (50-75 mg/kg). Uma internação hospitalar pode ser evitada para cada cinco crianças tratadas no SE. Outra modalidade de administração é a infusão prolongada de alta dose de sulfato de magnésio (HDMI) a 50 mg/kg/hora/4 horas (200 mg/kg/4 horas). O uso precoce da HDMI, para asma não infecciosa mediada, pode ser superior a um MgSO4 em bólus para evitar internações e antecipar as altas do SE. A HDMI parece ter bom custo-benefício se aplicada precocemente em uma população selecionada. O MgSO4 intravenoso tem um perfil de segurança semelhante a outras terapias de asma. Conclusões: O tratamento com MgSO4 intravenoso reduz as chances de internações hospitalares. O uso de MgSO4 intravenoso no pronto socorro não é associado a efeitos colaterais ou danos significativos. Enfatizamos o papel do MgSO4 como uma terapia adjuvante, ao passo que os corticosteroides e as beta-agonistas continuam os agentes terapêuticos agudos primários.

Aproximación a la farmacología del sulfato de magnesio desde la perspectiva obstétrica / An approach to the pharmacology of magnesium sulfate from an obstetric perspective / Abordagem farmacológica do sulfato de magnésio apartir da perspectiva obstétrica

Introducción: Desde su primer uso en 1926 en el manejo de la eclampsia el sulfato de magnesio ha sido un medicamento utilizado y estudiado ampliamente por obstetras. Durante mucho tiempo se mantuvo escepticismo sobre sus potenciales beneficios, pero la aparición de estudios bien estructurados aportó evidencia a favor o en contra de algunos de estos. Objetivo: Realizar una revisión de la literatura acerca dela farmacología, fisiología, farmacocinética, mecanismos de acción, principales usos y regímenes de administración del sulfato de magnesio en obstetricia. Metodología: Búsqueda bibliográfica en Medline, a través de PubMed, utilizando los términos Magnesium Sulfate, Pharmacology, Obstetrics, Pre-eclampsia, Eclampsia, Neuroprotective Agents. Se adicionaron otros artículos con el fin de ampliar información en ciertos temas. Conclusiones: Las propiedades farmacológicas que expresa el sulfato de magnesio se relacionan directamente con su efecto antagónico con el calcio. Muestra efectos a nivel muscular, neuronal, cardiovascular, entre otros. Sus usos en obstetricia abarcan principalmente el manejo de la preeclampsia, prevención de la eclampsia, y prevención de la parálisis cerebral del recién nacido prematuro. El uso como agente tocolítico en el trabajo de parto prematuro aun es discutido ya que la evidencia es inconclusa.

Introduction: Since its first use in 1926 in eclampsia´s management magnesium sulphate has been a drug used and studied extensively by obstetricians. For a long time, practitioners remained sceptical about its potential benefits but the emergence of well-structured studies provided evidence in favor and against. Objective: A review of the literature on the pharmacology, physiology, pharmacokinetics, mechanisms of action, main applications and schemes of administration of the sulfate of magnesium in obstetrics. Methodology: Search in the database MEDLINE via PubMed, using the terms: Magnesium Sulfate, pharmacology, Obstetrics, Preeclampsia, Eclampsia, Neuroprotective Agents. Other papers were added in order to expand information on some topics. Conclusions: The pharmacological properties that express the magnesium sulfate is linked directly with its effect antagonistic with the calcium. Shows effects to level muscle, neuronal, cardiovascular, among others. Its uses in obstetrics include mainly the management of preeclampsia, prevention of eclampsia, and prevention of cerebral palsy in the premature neonate. The magnesium sulphate tocolytic effects even is discussed because the evidence is inconclusive.

Introdução: Desde que o sulfato de magnésio foi utilizado em 1926, no tratamento de eclampsia, tem sido usado e amplamente estudado por obstetras. Longo o ceticismo sobre seus potenciais benefícios permaneceu, mas tarde o aparecimento de estudos bem estruturados forneceram evidências a favor ou contra algum destes. Objetivo: Revisar a literatura sobre a farmacologia, fisiologia, fármaco cinética, mecanismos de ação, principais usos e administração de sulfato de magnésio em obstetrícia. Metodologia: Pesquisa bibliográfica Medline via PubMed utilizando os termos sulfato de magnésio, farmacologia, obstetrícia, pré-eclâmpsia, eclâmpsia, agentes neuroprotectores. Foram adicionados outros itens, a fim de obter maior informação sobre determinados temas. Conclusões: As propriedades farmacológicas que expressa o sulfato de magnésio estão diretamente relacionadas com o efeito antagônico do cálcio. Mostra os efeitos a nível muscular, neuronal, cardiovascular, entre outros. Em obstetrícia o uso abrange principalmente o tratamento da pré-eclampsia, a prevenção da eclampsia, e prevenção de paralisia cerebral no recém-nascido prematuro. Usa-lo como agente toco lítico no trabalho de parto prematuro é incerto porque a evidência é inconclusa.