From the Faculty of Medicine, Menoufia University, Shibin El Kom, Menofia (HEE); Faculty of Medicine, Ain Shams University, Cairo (MCM); Faculty of Medicine, Menoufia University, Shibin El Kom (HAA); and Faculty of Medicine Al-Azhar University, Cairo, Egypt (AAH).
Eur J Anaesthesiol. 2017 Oct;34(10):658-664. doi: 10.1097/EJA.0000000000000642.
Postoperative agitation is harmful for the patient as it may be associated with removal of catheters, nasal packs, oxygen masks and self-injury, and pose a danger to operating theatre staff.
The current study investigated the potential role of magnesium sulphate in treatment of postoperative agitation following functional endoscopic sinus surgery.
A randomised, double-blinded, placebo-controlled trial.
ENT operating room, Menofia University Hospitals, Egypt.
A total of 312 adult patients (171 men and 141 women) were enrolled in the study. Eighteen patients (10 men and eight women) were excluded; data from 294 patients were analysed. Inclusion criteria were age between 20 and 60 years, American Society of Anesthesiologists' physical status 1 or 2 scheduled for functional endoscopic sinus surgery. Exclusion criteria were hypertension, cardiac ischaemia, cerebrovascular insufficiency, neuromuscular diseases, pregnancy, prolonged treatment with calcium-channel blockers, diabetic neuropathy or a known allergy to magnesium compounds.
Patients were allocated randomly to either the magnesium group (a magnesium infusion of 30 mg kg in the first hour followed by 9 mg kg h until the end of the surgical procedure) or the control group (0.9% saline at the same volume and rate). Hypotensive anaesthesia was induced by nitroglycerine 5 to 20 μg kg min. In the postanaesthetic care unit (PACU), patients were assessed for agitation and pain using the Richmond agitation-sedation scale and numerical rating scale, respectively.
The incidence and severity of agitation measured 5 min after admission to the PACU.
Magnesium reduced postoperative agitation at time 0 (P = 0.009) and 5, 10, 15 and 30 min after PACU admission (P < 0.0001) as well as total agitation score [3 (0 to 6) versus 9 (0 to 12), P < 0.0001]. Magnesium also reduced pain [4.5 (4 to 5) versus 6 (5 to 6.25), P < 0.0001] and length of PACU stay (88 ± 23 versus 111 ± 31 min, P < 0.0001). The magnesium group consumed less pethidine in PACU compared with the control group (43 ± 15 and 59 ± 19 mg, respectively, P < 0.0001). The intraoperative end-tidal CO2 tension was comparable between groups (4.7 ± 0.7 versus 4.8 ± 1.2 kPa).
Intraoperative infusion of magnesium in patients undergoing endoscopic sinus surgery reduced postoperative agitation, pethidine consumption and pain assessed in the PACU. It also decreased the length of stay in PACU compared with the control group.
The current study was registered according to WHO and ICMJE standards on 7 January 2014, under registration number PACTR 201402000737691.
术后躁动会对患者造成伤害，因为它可能与导管、鼻内填塞物、氧气面罩和自伤的移除有关，并对手术室工作人员构成危险。
本研究旨在探讨硫酸镁在功能性鼻窦内窥镜手术后治疗术后躁动中的作用。
随机、双盲、安慰剂对照试验。
埃及曼菲娅大学医院耳鼻喉科手术室。
共纳入 312 例成年患者（男 171 例，女 141 例）。18 例患者（男 10 例，女 8 例）被排除在外；294 例患者的数据被分析。纳入标准为年龄 20-60 岁，美国麻醉医师协会身体状况 1 或 2 级，计划行功能性鼻窦内窥镜手术。排除标准为高血压、心肌缺血、脑血管功能不全、神经肌肉疾病、妊娠、长期使用钙通道阻滞剂、糖尿病性神经病或已知对镁化合物过敏。
患者随机分为硫酸镁组（首小时内静脉注射 30mg/kg 硫酸镁，然后以 9mg/kg/h 的速度持续至手术结束）或对照组（0.9%生理盐水，体积和速度相同）。低血压性麻醉通过硝酸甘油 5-20μg/kg/min 诱导。在麻醉后恢复室（PACU）中，分别使用 Richmond 躁动镇静量表和数字评分量表评估患者的躁动和疼痛。
PACU 入院后 5 分钟评估躁动和镇静的发生率和严重程度。
镁组在 PACU 入院后即刻（P=0.009）和 5、10、15 和 30 分钟时术后躁动减轻（P<0.0001），总躁动评分也降低[3（0-6）比 9（0-12），P<0.0001]。镁组还减轻了疼痛[4.5（4-5）比 6（5-6.25），P<0.0001]和 PACU 停留时间（88±23 比 111±31 分钟，P<0.0001）。与对照组相比，镁组在 PACU 中使用的哌替啶更少（分别为 43±15 和 59±19mg，P<0.0001）。两组术中呼气末 CO2 张力相当（4.7±0.7 比 4.8±1.2kPa）。
在接受内窥镜鼻窦手术的患者中，术中输注镁可减轻术后躁动、哌替啶用量和 PACU 评估的疼痛，并与对照组相比，减少 PACU 的停留时间。
本研究于 2014 年 1 月 7 日根据世界卫生组织和 ICMJE 标准进行注册，注册号为 PACTR 201402000737691。
