Articles  |   November 2015
SEE Question
Article Information
Neuromuscular Diseases and Drugs / Pain Medicine / Pharmacology / Articles
Articles   |   November 2015
SEE Question
ASA Monitor 11 2015, Vol.79, 46.
ASA Monitor 11 2015, Vol.79, 46.
According to a recent study, which of the following best describes the effect of adding a magnesium infusion (8 mg/kg/h) to an anesthetic regimen for scoliosis repair?
Scoliosis surgery is frequently associated with a painful recovery. Although opioids are the mainstay of postoperative analgesia, they are associated with many side effects, including nausea, pruritus, constipation, respiratory depression and hyperalgesia. Recent evidence suggests that a multimodal pharmacologic approach to pain management that includes acetaminophen and N-methyl-d-aspartate (NMDA) antagonists (e.g., ketamine, magnesium) is effective in providing adequate analgesia, minimizing opioid consumption and mitigating the undesirable side effects of opioid analgesics.
A recent prospective, double-blind, randomized study investigated the morphine-sparing effect of the addition of a magnesium infusion to the anesthetic for 50 patients undergoing scoliosis repair. All patients received a standardized induction and anesthetic maintenance titrated to a bispectral index value between 40 and 60 and mean arterial pressure between 65 and 70 mm Hg. Anesthesia maintenance consisted of a continuous infusion of remifentanil (0.05-0.25 µg/kg/min), sevoflurane (1.2 minimum alveolar concentration), 60 percent nitrous oxide, and 40 percent oxygen. Rocuronium was titrated to one twitch on train-of-four. After induction, all patients received a ketamine bolus of 0.2 mg/kg, followed by continuous infusion of 0.15 mg/kg/h until extubation. Patients in the intervention group also received an intravenous (I.V.) bolus of magnesium 50 mg/kg, followed by a continuous infusion of 8 mg/kg/h until extubation. Those in the placebo group received an equal volume of normal saline. Upon extubation, patients were treated with I.V. acetaminophen, ketoprofen, and morphine, titrated until a score of three was reached on a 10-point visual analog scale (VAS) for pain. Morphine consumption, VAS scores, side effects, sleep quality and patient satisfaction were recorded until 48 hours postoperatively.
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