1 Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Republic of Korea.
2 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Otolaryngol Head Neck Surg. 2018 Jan;158(1):27-35. doi: 10.1177/0194599817730354. Epub 2017 Sep 12.
Objectives The perioperative administration of magnesium is known to reduce postoperative morbidities in adults, such as pain, agitation, and laryngospasm. The objective is to assess the effects of perioperative magnesium as the adjuvant to tonsillectomy as compared with tonsillectomy in children. Data Source Five databases (PubMed, SCOPUS, Embase, Web of Science, Cochrane). Method Two authors independently searched databases up to January 2017. We compared perioperative magnesium administration (magnesium groups) with no administration of magnesium (control group). The following outcomes were measured: postoperative pain intensity, analgesics administration, or other morbidities (laryngospasm, agitation, postoperative bleeding) in the postoperative 24 hours. Additionally, to evaluate the discrepancy of effects according to different administration routes, subgroup analyses regarding effects according to systemic or local administration of magnesium were performed. Results Nine prospective randomized controlled studies (n = 615) that evaluated the effect of magnesium in children having undergone tonsillectomy met inclusion criteria. Compared with control group, the time for first analgesic requirement was significantly delayed in magnesium groups (standardized mean difference = 0.75; 95% CI, 0.20-1.31; P = .0079). Laryngospasm (log odds ratio = -1.09; 95% CI,-2.11 to -0.07; P = .0362) and agitation score (standardized mean difference = -0.67; 95% CI, -0.97 to -0.36; P < .0001) in the recovery room also significantly decreased in magnesium groups. In subgroup analyses regarding pain and laryngospasm-related measurements, local administration of magnesium was shown to be more effective at reducing postoperative morbidities. Conclusions Perioperative magnesium regardless of route may offer pain, agitation, and laryngospasm relief without adverse effects in pediatric tonsillectomy. Based on the high heterogeneity of results within some parameters, further studies need to be performed to affirm these results.
目的 围手术期镁的应用已被证实可降低成人术后疼痛、躁动和喉痉挛等并发症。本研究旨在评估围手术期镁作为小儿扁桃体切除术辅助治疗的效果。
资料来源 5 个数据库（PubMed、SCOPUS、Embase、Web of Science、Cochrane）。
方法 两位作者独立检索数据库至 2017 年 1 月。我们比较了围手术期镁（镁组）与不给予镁（对照组）的给药方式。主要结局为术后 24 小时内的术后疼痛强度、镇痛药物使用或其他并发症（喉痉挛、躁动、术后出血）。此外，为了评估不同给药途径对疗效的差异，还进行了局部和全身镁给药的亚组分析。
结果 9 项评估镁对行扁桃体切除术的儿童影响的前瞻性随机对照研究（n = 615）符合纳入标准。与对照组相比，镁组首次使用镇痛药物的时间明显延迟（标准化均数差 = 0.75；95%置信区间，0.20-1.31；P =.0079）。镁组在恢复室中的喉痉挛（对数比值比 = -1.09；95%置信区间，-2.11 至 -0.07；P =.0362）和躁动评分（标准化均数差 = -0.67；95%置信区间，-0.97 至 -0.36；P <.0001）也明显降低。在针对疼痛和与喉痉挛相关的测量的亚组分析中，局部镁给药在减轻术后并发症方面效果更显著。
结论 围手术期镁无论给药途径如何，都可能在小儿扁桃体切除术中缓解疼痛、躁动和喉痉挛，且无不良反应。由于某些参数的结果存在高度异质性，需要进一步的研究来证实这些结果。
