ABSTRACT
BACKGROUND: Magnesium sulfate displays numerous characteristics that make it a useful drug in anesthesiology (N-methyl-d-aspartate receptor antagonist, vasodilator, antiarrhythmic, inhibitor of catecholamine release and of acetylcholine in the terminal motor plate). The perioperative use of this drug as an adjuvant capable of decreasing the required dose of anesthetics, has been proposed. OBJECTIVES: To assess the influence of intravenous magnesium sulfate administration during general anesthesia on the overall dose of required anesthetics. DESIGN: A systematic review of controlled randomized trials and meta-analysis. DATA SOURCES: An electronic bibliography search in MEDLINE and in the Cochrane Database of Controlled trials (CENTRAL) up to 2015. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Randomized, double-blind trials relating to general anesthesia in elective surgery using intravenous magnesium sulfate that provide information about the anesthetic requirements in ASA I and II patients. RESULTS: 20 clinical trials were selected for the qualitative analysis and 19 for the quantitative one. The use of perioperative intravenous magnesium sulfate reduces the requirement of the anesthetic, propofol during induction (-28.52mg; CI 95% -35.22-1.82; p<0.001) and maintenance (-213.56mg; CI 95% -322.93, -104.18; p<0.001) of anesthesia. Additionally, magnesium sulfate reduces the requirement of neuromuscular non-despolarizing blocking agents (-2.99mg; CI 95% -44.47, -1.99; p<0.001) and the intraoperative consumption of fentanile(-53.57 mcg; CI 95% -75.01, -32.12; p<0.001). CONCLUSIONS: We conclude that perioperative magnesium sulfate acts as a coadjuvant drug capable of reducing anesthetic requirements.
Subject(s)
Anesthesia, General/methods , Anesthetics, Intravenous/administration & dosage , Magnesium Sulfate/administration & dosage , Dose-Response Relationship, Drug , Humans , Perioperative Care , Propofol/administration & dosage , Randomized Controlled Trials as TopicABSTRACT
OBJECTIVE: Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability. MATERIAL AND METHODS: This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP). All adult patients admitted to the unit during the referred months were included. Patients in whom the protocol was not adequately followed were excluded. A total of 557 patients were reviewed, of whom they had needed intravenous insulin 73 in the first group and 52 in the second group. Four and two patients were excluded in each group respectively. RESULTS: Glycemic variability for both day 1 (DS1) and total stay (DST) was lower in SSBIIP patients compared to SBIIP patients: SD1 34.88 vs 18.16 and SDT 36.45 vs 23.65 (P<.001). CONCLUSION: A glycemic management protocol in critically ill patients based on sliding scales decreases glycemic variability.
Subject(s)
Blood Glucose/analysis , Critical Illness , Insulin/administration & dosage , APACHE , Adult , Aged , Clinical Protocols , Contraindications, Drug , Female , Humans , Infusions, Intravenous/methods , Insulin/therapeutic use , Male , Middle Aged , Retrospective StudiesABSTRACT
Objetivo: La variabilidad glucémica es un predictor independiente de la mortalidad en pacientes críticos. El objetivo del presente estudio es comparar 2 protocolos de administración de insulina intravenosa en críticos en cuanto a la variabilidad glucémica se refiere. Material y métodos: Se trata de un estudio observacional retrospectivo realizado mediante revisión de historias clínicas de los pacientes de una unidad de críticos durante 4 meses consecutivos. Primero se revisó un protocolo de insulina más simple o protocolo de insulina intravenosa basado en una escala (PIVBE), que fue comparado con los mismos meses del siguiente año donde se utilizó protocolo insulina intravenosa basado en escalas dinámicas (PIVBED). Se incluyó a todos los pacientes, adultos, ingresados en la unidad durante los meses referidos. Se excluyó a los pacientes en los que el protocolo no se siguió correctamente. Se revisó a 557 pacientes, de los cuales habían necesitado insulina intravenosa 73 en el primer grupo y 52 en el segundo. Fueron excluidos 4 y 2 pacientes en cada grupo, respectivamente. Resultados: La variabilidad glucémica tanto del primer día (DS1) como la total de la estancia (DST) fue menor en aquellos pacientes tratados con el PIVBED frente al PIVBE: DS1 34,88 frente a 18,16 y DST 36,45 frente a 23,65 (p<0,001). Conclusión: Un protocolo de manejo de glucemia en pacientes críticos basado en escalas dinámicas disminuye la variabilidad glucémica (AU)
Objective: Glycemic variability is an independent predictor of mortality in critically ill patients. The objective of this study was to compare two intravenous insulin protocols in critically ill patients regarding the glycemic variability. Material and methods: This was a retrospective observational study performed by reviewing clinical records of patients from a Critical Care Unit for 4 consecutive months. First, a simpler Scale-Based Intravenous Insulin Protocol (SBIIP) was reviewed and later it was compared for the same months of the following year with a Sliding Scale-Based Intravenous Insulin Protocol (SSBIIP). All adult patients admitted to the unit during the referred months were included. Patients in whom the protocol was not adequately followed were excluded. A total of 557 patients were reviewed, of whom they had needed intravenous insulin 73 in the first group and 52 in the second group. Four and two patients were excluded in each group respectively. Results: Glycemic variability for both day 1 (DS1) and total stay (DST) was lower in SSBIIP patients compared to SBIIP patients: SD1 34.88 vs 18.16 and SDT 36.45 vs 23.65 (P<.001). Conclusion: A glycemic management protocol in critically ill patients based on sliding scales decreases glycemic variability (AU)
