Magnesium sulfate reduces sevofl urane-induced emergence agitation in pediatric patients

Abstract EN

Background Despite the fact that sevofl urane is widely used in pediatric anesthesia due to its fast and welltolerated inhaled induction and rapid emergence, sevofl urane -induced emergence agitation (EA) in children is not uncommon.

This study aims to test the effect of intraoperative magnesium sulfate on reducing the incidence of EA in children anesthetized with sevofl urane.

Materials and methods The study included 50 male children, aged 3–6 years, with ASA status I or II, scheduled for elective inguinal herniorrhaphy under GA through laryngeal mask airway ( LMA).

The patients were allocated into two groups : group M (25 patients) received intravenous magnesium sulfate 10% (0.2 ml/kg), followed by a continuous infusion of 0.1 ml/kg till the end of surgery; group C (25 patients) received a similar volume of intravenous normal saline (0.2 ml/kg), followed by a continuous infusion of 0.1 ml / kg till the end of surgery.

Anesthesia was induced using 6 l/min of O2 100% with sevofl urane 8 vol%.

Anesthesia was maintained with sevofl urane 1.5–2 vol% in an oxygen–air mixture.

After LMA removal, the agitation scoring scale was used for assessing the quality of emergence.

Agitation parameters were measured using a four-point scale.

Agitated children were managed by giving intravenous midazolam (0.1 mg/kg).

Results The study was completed by 42 children.

Magnesium concentrations in group M were signifi cantly higher [2.95 (0.50) mg / dl] compared with group C [2.01 (0.42) mg / dl; P < 0.001].

The emergence time was signifi cantly longer in group M [19.11 (7.45) min] compared with group C [15.421 (6.54) min; P < 0.001].

Other recovery characteristics in terms of the time to LMA removal and the time to reach full Aldrete score were comparable between both groups.

Heart rate and systolic blood pressure variables were signifi cantly higher in group C compared with group M at the time of LMA removal (P < 0.01).

At the postanesthesia care unit, there was no incidence of agitation reported in group M as compared with 11 patients in group C (P < 0.001).

In group C, the mean duration of agitation was 16.4 (8.2) min and the mean dose of midazolam administered was 0.09 (0–0.2) mg/kg per child.

No patients in group M complained of pain compared with group C at 5, 10, and 30 min after emergence from anesthesia (P < 0.001).

Conclusion Intravenous magnesium sulfate infusion signifi cantly reduced the incidence of sevofl uraneinduced EA.