ZONA KEDOKTERAN VOL 15 NO 2 MEI 2025
COMPARISON OF THE EFFECTIVENESS OF MGSO4 30 MG/KGBW AND
INTRAVENOUS LIDOCAINE 1.
5 MG/KGBW TO PREVENT POSTINTUBATION HEMODYNAMICS FLUCTUATION
MHD Mustafa LBS1.
Bambang Novianto P2 .
Th Supraptomo2 Authors' affiliation:
Resident.
Department of Anesthesiology and Intensive Therapy Study Program.
Faculty of Medicine.
Sebelas Maret University.
Surakarta Cardiothoracic Anesthesiologist.
Department of Anesthesiology and Intensive Therapy Study Program.
Faculty of Medicine.
Sebelas Maret University.
Surakarta
ABSTRACT
Background: Intubation can cause hemodynamic fluctuations such as increases of systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate.
MgSO4 and lidocaine can be used as premedication drugs to reduce the hemodynamic response to intubation.
Objective: To compare the efficacy of intravenous MgSO4 30 mg/kgBW with 5 mg/kgBW to prevent hemodynamic fluctuations after endotracheal Methods: This double-blind randomized controlled trial was conducted in 52 patients meeting the inclusion criteria who underwent surgery with general anesthesia using an endotracheal tube.
These subjects were grouped into group A receiving intravenous MgSO4 30 mg/kgBW treatment and group B receiving intravenous lidocaine 1.
mg/kgBW treatment.
Hemodynamic fluctuation was recorded 1 minute after Results: Subjects receiving MgSO4 had lower increments of SBP .
O0.
DBP
=0.
MAP .
O0.
, and HR .
=0.
than those of receiving lidocaine.
Conclusion: Intravenous MgSO4 30 mg/kgBW is more effective than intravenous 5 mg/kgBW in preventing hemodynamic fluctuations after endotracheal Keywords: Intubation.
MgSO4, lidocaine, systolic and diastolic blood pressure, arterial pressure, and heart rate.
INTRODUCTION
Laryngoscopy and intubation can cause stress responses in significant The stress response in patients receiving general anesthesia can be seen as a phenomenon that may be associated with the endocrine or Universitas Batam Batam Batam (Butterworth, 2.
It is thought that stretching of the larynx
and pharynx tissue during laryngoscopy and intubation is the leading cause of hemodynamic response due to catecholamine secretion and cardiac
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vagal reflexes' inhibition in the presence of symptoms of tachycardia, hypertension, dysrhythmia as well as disorders of the respiratory and neurological systems (Smith 2008.
Teong 2.
These hemodynamic changes usually begin within 5 seconds after laryngoscopy, and their peak occurs one minute after the start of intubation and lasts for 5-10 minutes.
This condition can lead to a serious problem in high risk patients (Teong Sakilar 2.
laryngoscopy and intubation, we can use deep anesthesia technique or provide local anesthetic drugs, opioids .
entanyl, alfentani.
, beta-adrenergic blockers, vasodilators .
itroglycerin, sodium nitroprussid.
, calcium channel .
, alpha-2adrenergic .
hlorine, dexmedetomidin.
and magnesium sulfate (Teong 2020.
Ongewe 2019.
Goarya 2014.
Kumar 2.
Administering lidocaine is one of the common ways to reduce cardiovascular Lidocaine, administered systemically, will have antagonist effect on sodium channel and N-Methyl-D-Aspartate (NMDA) receptor, reduce the release of substance P, and have a glycinergic action which can decrease reactivity in the airway (Mendonca 2017.
Kurabe Intravenous lidocaine administration at a dose of 1.
5 mg/kgBW administered 3 minutes before laryngoscopy and intubation can produce optimal hemodynamics (Mendonca, 2.
Magnesium sulfate (MgSO.
can be used as an alternative medicine to prevent post-intubation hemodynamic Universitas Batam Batam Batam Administering MgSO4 before endotracheal intubation effectively reduces the increase in blood pressure and heart rate (Goarya 2014.
Mendonca.
MgSO4 has been shown to have antinociceptive mainly due to its antagonistic effect on NMDA receptors as well as calcium ions and inhibits the release of catecholamines from adrenergic terminal nerves and adrenal medulla (Goarya 2014.
Kothari 2.
Considering the severity of complications that can occur due to uncontrolled hemodynamic responses, especially in patients with comorbid diseases, anesthesiologists need to know the most appropriate and effective premedication interventions for patients' hemodynamic response endotracheal intubation.
On that account we conducted this study to compare MgSO4 30 mg/kgBW with 5 mg/kgBW which are given intravenously as premedication to prevent hemodynamic fluctuation after endotracheal intubation.
METHODS
double-blind randomized clinical trial study in subjects undergoing elective surgery endotracheal intubation from October to November 2020 at the Central Surgical Installation of Dr.
Moewardi Surakarta Hospital.
We used software Open Source Epidemiologic Statistics for Public Health.
Version 3.
0, with the formula of Sample Size for Comparing Two Means to estimate the sample size.
The number of samples required were 52 These subjects were randomly assigned into two groups, lidocaine and MgSO4 groups.
Patients aged 18-65
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year old with no allergy to either lidocaine or MgSO4, who underwent general anesthesia with the duration of surgery less than three hours were included in this study.
While the exclusion criteria were patients with cerebrovascular disorders, a history of respiratory distress, and impaired renal as well as liver functions.
Lastly, the drop-out criteria were cardiac and pulmonary emergencies during surgery, intubation difficulties, more than twice reactions to MgSO4 and lidocaine.
Intravenous magnesium sulfate 30 mg/kg was administered 3 mins before induction, while IV lignocaine 5 mg/kg was administered 1 min before induction.
We used propofol 1.
mg/kg and rocuronium 1.
2 mg/kg for the induction.
Direct laryngoscopy and endotracheal intubation used oral ETT size of 7.
0 for female and 7.
5 for male.
They were performed 90 s after Furthermore, cuff developed with air in a syringe 20 ml until cuff pressure of 30 mmhg.
Anesthesia was maintained with sevoflurane 1 MAC in O2 and N2O 50%.
The noninvasive arterial pressure and HR was recorded using Bedside Monitor before the study drugs were given and in the first minute after intubation.
The data obtained were analyzed with the SPSS version 23.
for Windows program.
The normality test used the Shapiro-wilk test because the sample size of each group was less Unpaired T-test was used for normal distribution data.
Universitas Batam
Batam
Batam
RESULTS
Fifty-two patients met the inclusion criteria of the study.
There were no baseline demographic characteristics of the study subjects in groups L and M (Table .
Table 1 Demographic characteristics of the study subjects Charact Drug Lidocaine .
p-value MgSO4 .
Gender Male 9 .
Femal 17 .
4%) 17 .
Age
BMI
ASA
0%) 26 .
Table 2 The increments of SBP.
DBP.
MAP, and HR of Lidocaine and MgSO4 Drug Variable Lidocaine .
Increment
Systolic pressure (%) Increment
Diastolic pressure (%) Increment
MAP (%)
Increment Heart rate 10.
(%)
MgSO4 .
<0.
<0.
Statistically significant differences in SBP.
DBP.
MAP, and HR between L and M
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ZONA KEDOKTERAN VOL 15 NO 2 MEI 2025
groups, with p values of <0.
001, 0.
<0.
001, and 0.
001, respectively.
Higher increments of SBP.
DBP.
MAP, and HR were observed in L group than those of in M group (Table .
DISCUSSION
In this study we tried to analyze the hemodynamic response differences between patients receiving MgSO4 30 mg/kgBW and those with lidocaine 1.
mg/kgBW given intravenously as This study showed that both agents MgSO4 30 mg/kgBW and 5 mg/kgBW increase hemodynamic response observed by the increases of SBP.
DBP.
MAP, and HR at the 1st minute post-intubation.
These increases were below 20% and statistically significant .
<0.
This finding is similar to that of in a study conducted by Nooraei et al in They found subjects in groups MgSO4 and lidocaine had increments in hemodynamic parameters by 20% from The highest increment was observed at the 1st and 2nd minutes while the lowest was at 5th minute.
Nevertheless, when both of them were compared.
MgSO4 group had lower hemodynamic volatility.
Increased hemodynamic response after intubation occurs due to catecholamine hormone effect appearing after the first 5 seconds post-intubation and reaches its peak after 1-2 minutes post-intubation and lasts for 5-10 minutes.
Then hemodynamic response will return to normal as catecholamine hormone decreases (Smith 2008.
Nooraei 2.
Magnesium serves as a competitive Inositol 1,4,5-triphosphate (IP.
gate inhibitor on calcium Universitas Batam Batam Batam channels and prevents IP3 bonding with its receptors.
Therefore, magnesium is a calcium antagonist at the cellular level of the IP3 channel (Kothari 2008.
Do.
Magnesium is thought to play a role in inhibiting NMDA receptor activity so that such receptor activity does not occur (Do, 2.
This study used lidocaine because it has a mechanism of action through voltage-gated-sodium channel blocks in nerve tissue to affect nerve transmission (Eipe, 2.
The heart muscle's contractility and conduction are also suppressed by local anesthetic drugs, in which the drug's effect arises due to changes in the cell membranes of the heart muscle .
odium channel blockad.
and inhibition of the (Butterworth 2013.
Stoelting 2.
These sympathoadrenal activation resulting in a change in blood pressure response and heart rate (Stoelting, 2.
Administration of MgSO4 30 mg/ kgBW intravenously successfully controlled hemodynamic changes during laryngoscopy and intubation administering larger doses increased the risk of transient tachycardia.
study by Panda et al.
in 2013 has reported the effectiveness of MgSO4 30 mg/ kg BW, 40 mg/ kgBW, and 5 mg/ kgBW in preventing post-intubation fluctuation in patients with a history of controlled hypertension.
They found that MgSO4 30 mg/kgBW is the optimal dose used in preventing hemodynamic turbulence, and subsequently, increased doses can lead to hypotensive risk (Boham, 2.
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Another supportive study is Montazeri and Falah's research in 2005, which premedicated MgSO4 and lidocaine in lowering cardiovascular intubation (Montazeri, 2.
In their studies using MgSO4 dosages of 10, 20, 30, 40, and 50 mg/kg BW compared to lidocaine 1 mg/kg BW obtained the results a dose of MgSO4 30 mg/kgBW intubation measures better than doses 10 and 20 mg/kgBW but no significant difference to Magnesium sulfate 40 and 50 mg/kgBW (Montazeri, 2.
Magnesium sulfate has been shown to reduce hypertensive response in MgSO4 plays important role catecholamines from adrenergic nerve terminals and adrenal medulla which then reduce adverse cardiovascular effects during laryngoscopy and intubation (Mendonca 2017.
Montazeri Magnesium sulfate has been reported to be effective in treating perioperative pain and lowering somatic, autonomic, and endocrine reflexes stimulated at the time of action (Goarya 2014.
Do 2.
MgSO4 has been shown to have antinociceptive mainly due to its antagonistic effect on NMDA receptors, calcium ions and inhibits of catecholamines from adrenergic terminal nerves and adrenal medulla (Do, 2.
STRENGTH AND LIMITATIONS
This study was performed in healthy patients scheduled for elective The technique used for anesthesia induction caused some Universitas Batam Batam Batam degree of hypotension, which was well tolerated in this population.
Therefore, our results may not extend to emergency surgery or elderly patients or patients with ASA 3 or 4 in which the hemodynamic change may be poorly Another limitation is that we did not evaluate the effect on hypertensive and cardiac patients.
In addition, plasma catecholamine level, a point of response, was not measured in our study as we did not have catecholamine kits in our hospital.
CONCLUSION
Both intravenous MgSO4 30 mg/kgBW and lidocaine 1.
5 mg/kgBW can be used to blunt the hemodynamic response due to intubation action.
However, the administration of MgSO4 dose 30 mg/kgBW bolus intravenously is more effective in lowering intravenous lidocaine 1.
5 mg/kgBW.
CONFLICT OF INTERESTS
The study was supported by the Faculty of Medicine of Sebelas Maret University and Dr.
Moewardi General Hospital Surakarta.
No other party than those mentioned were involved in this AUTHORS CONTRIBUTION The first author did the idea, writing, research, and report making.
The second author assisted in drafting ideas, giving direction in research, as well as improving reports.
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REFERENCE