Multimodal: Magnesium

Question 1

Which patients receive magnesium sulfate most often per Castillo?

Answer 1

Preeclamptic & eclamptic OB patients.

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Question 2

Mg++ regulates which four cellular functions?

Answer 2

• Ca++ access intracellularly.
• Neurotransmission
• Cell signaling
• Enzyme function

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Question 3

Which ion has limited movement across the BBB?

Answer 3

Mg⁺⁺

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Question 3

What conditions are contraindicative for magnesium administration?

Answer 3

Myasthenia Gravis & Renal Failure

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Question 4

What adverse side effects could occur with Mg++?

Answer 4

- Hypotension
- bradycardia
* ataxia
* somnolence
* decreased muscular tone – check DTR

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Question 5

What is Mg⁺⁺ dosing for the following two situations?

Preop:
Intraop:

Answer 5

• Preop: 50 mg/kg IV
• Intraop: 8 mg/kg/hr IV

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Question 6

What opioid requirement does the use of Mg++ significantly decrease?

Answer 6

Fentanyl

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Question 7

Evidence-based slide

What evidence based conclusion was found with the study “Perioperative systemic magnesium to minimize postoperative pain”?

Answer 7

a lot of these procedures used Fentanyl, Morphine PCA, Toradol, Tramadol and Meperadine as part of their pain pathway (not specific multimodal)

they did test for early and late pain at rest and movement

further findings: there is significant pain relief or pain control or reduction at intraop and post-op vs intraop only

also cited in their findings that there are opioid side effects of dizziness headache and post op nausea and vomiting

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