the Effect of Intraoperative Magnesium Infusion on Postoperative Cognitive Functions in Adult Patients After Elective Pelvi-abdominal Surgeries Clinical Trial
Official title:
Effect of Intraoperative Magnesium Infusion on Postoperative Pain and Cognitive Function After Pelvi-abdominal Surgeries :an Observational Study
The aimof this study is to observe the effect of intraoperative magnesium infusion on peri-operative pain and postoperative cognitive functions in adult patients after elective pelvi-abdominal surgeries.
This study will be conducted at Beni-Suef University Hospital after approval of the
anesthesiology, surgical ICU and pain management department, and the local ethics and
research committee, and obtaining written informed consents from the patients .
The inclusion criteria:
1. Male and female patients (age 20-60 years)
2. American Society of Anesthesiology(ASA) physical status I-II
3. Patients scheduled for elective pelvi-abdominal surgeries
The Exclusion criteria
1. Patients having significant cardiovascular (cardiomyopathy or moderate to severe
valvular heart lesion) , significant hepatic disease (Child-Pugh score B or C ), renal
or CNS disease
2. Patients with uncontrolled hypertension or diabetes
3. History of hypersensitivity to the drugs to be used
4. Control MMSE score ≤23
5. Women who are pregnant or breastfeeding
6. Patients taking Ca2+ channel blockers, opioids, antidepressants, or antipsychotics or
alcohol
7. Patients having difficulty understanding , vision or hearing problems or CNS disorder as
parkinson's disease .
8. Morbidly obese patients with a body mass index of >40
9. Patients who refused to be involved within the scope of the research. Management of the
patients in the operation room All patients will be informed about the tests and written
informed consent will be obtained from each of them. The MMSE will be applied. After
arrival to the operation theater the monitors will be applied including will be applied
including 5 leads ECG, non invasive arterial blood pressure and pulse oximetry. Urinary
catheter will be inserted for urine output monitoring. Train of four (TOF) monitoring
and Bispectral index (BIS) monitoring will be done in order to evaluate the depth of
hypnosis (A-2000 Bispectral Index, Aspect Medical Systems, the Netherlands).
Following 100% oxygen of 5 L/min for 3 min, 1% lidocaine at 0.5 mg/kg will be given
intravenously in order to prevent potential injection pain due to propofol and to suppress
hemodynamic response to endotracheal intubation. Propofol 2 mg/kg, midazolam 0.03 mg/kg,
fentanyl 3μg/kg and 0.6 mg /kg atracurium will be given followed by intubation and Mechanical
ventilation with 6 mL/kg tidal volume and a frequency of 8-12/min with total of 4 L/min in
40% O2 air mixture to keep EtCO2 between 36 and 40 mmHg. Anesthesia will be maintained using
oxygen and 1-1.5 minimum alveolar concentration (MAC) of isoflurane.
After the induction of anesthesia, a loading dose of magnesium sulfate 50mg/kg in 100mL of
isotonic saline as within 5 to 10 minutes followed by a maintenance dose of 10 mg/kg/hr up to
the end of surgery .24 In case of a patient with hypotension (mean arterial pressure ˂55
mmHg), 5 mg ephedrine will be injected so that the mean arterial pressure could reach higher
than 55 mm Hg. If arrhythmia occured in any of the patients during operation, proper
treatment will be be performed and the patient will be excluded from the study. The magnesium
sulphate and anaesthetic agent infusions will be discontinued at skin closure. The relaxant
effect of magnesium sulfate will be considered so train of four (TOF) monitoring will be used
to monitor the muscle relaxation during the surgery and patients will be extubated at the end
of the operation based on the TOF > 0.9 to ensure the complete reversal of relaxants by
neostigmin.
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