Lidocaine versus magnesium sulfate infusion during isoﬂurane anesthesia for brain tumor resection, effect on minimum alveolar concentration reduction guided by bispectral index: a prospective randomized controlled trial
1Lecturer of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, 35516 Mansoura, Egypt
Submitted: 09 March 2021 Accepted: 01 April 2021
Online publish date: 14 May 2021
Objective: Goals of neuro-anesthesia include smooth induction, stable perioperative hemodynamics, early and quiet recovery with adequate analgesia. Intraoperative use of co-sedatives allows reduction of anesthetic agents consumption while maintaining a desirable depth of anesthesia. Many drugs like opioids and dexmedetomidine had been studied in different surgeries. Using such drugs enhances rapid recovery for early postoperative assessment and detection of complications.
Methods: This study enrolled 50 adult patients undergoing supratentorial brain tumor surgery. Patients of the lidocaine group (group L) received 1.5 mg.kg−1 of lidocaine as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 1.5 mg.kg−1.h−1. Patients of the magnesium group (group M) received 30 mg.kg−1 of magnesium sulfate as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 10 mg.kg−1.h−1. Depth of anesthesia was guided by bispectral index in a range of 50 ± 2, with the primary outcome objective, minimum alveolar concentration reduction of inhaled isoflurane.
Results: No significant difference was found regarding patient demographics, basal hemodynamic data, and anesthesia duration. The used isoflurane concentration at the matching time points (every 15 min intraoperatively) and the total dose of muscle relaxant (160 ± 15 mg, 175 ± 18 mg respectively, p 0.003) were statistically lower in group M than in group L. The time required for recovery was statistically shorter in group M than in group L (5.1 ± 0.99 min vs 9.8 ± 1.9 min, respectively, p 0.00).
Conclusion: Compared to lidocaine infusion, magnesium sulfate (MgSO4) infusion during anesthesia for brain surgery resulted in lower anesthetic consumption, muscle relaxant requirement, a shorter recovery time, and a better postoperative pain profile. MgSO4 can be used effectively as a co-sedative adjuvant with superior clinical properties than lidocaine infusion.
Magnesium; Lidocaine; Bispectral index; Supratentorial neoplasm; Deep sedation; Anesthetics; Inhalation
Mohamed Adel Aboelela,Alrefaey Kandeel Alrefaey. Lidocaine versus magnesium sulfate infusion during isoﬂurane anesthesia for brain tumor resection, effect on minimum alveolar concentration reduction guided by bispectral index: a prospective randomized controlled trial. Signa Vitae. 2021.doi:10.22514/sv.2021.086.
 Goma H. Anesthetic considerations of brain tumor surgery. 2011. Available at: https://doi.org/10.5772/21276 (Accessed: 22 September 2011).
 Ho S, Hambidge O, John R. Anaesthesia for neurosurgery. Anaesthesia & Intensive Care Medicine. 2020; 21: 33–38.
 Dinsmore J. Anaesthesia for elective neurosurgery. British Journal of Anaesthesia. 2007; 99: 68–74.
 Weibel S, Jetting Y, Pace NL, Helf A, Eberhart LH, Hahnenkamp K, et al. Continuous intravenous perioperative lidocaine infusion postoperative pain and recovery in adults. 2018. Available at: https://doi.org/10. 1002/14651858.CD009642.pub3 (Accessed: 4 June 2018).
 Kranke P, Jokinen J, Pace NL, Schnabel A, Hollmann MW, Hahnenkamp K, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. 2015. Available at: https://doi. org/10.1002/14651858.CD009642.pub2 (Accessed: 16 July 2015).
 Herroeder S, Schönherr ME, De Hert SG, Hollmann MW, Warner DS. Magnesium—Essentials for Anesthesiologists. Anesthesiology. 2011; 114: 971–993.
 Sirvinskas E, Laurinaitis R. Use of magnesium sulfate in anesthesiology. Medicine. 2002; 38: 695–698.
 Srivastava VK, Mishra A, Agrawal S, Kumar S, Sharma S, Kumar R. Comparative evaluation of dexmedetomidine and magnesium sulphate on propofol consumption, haemodynamics and postoperative recovery in spine surgery: a prospective, randomized, placebo controlled, double-blind Study. Advanced Pharmaceutical Bulletin. 2016; 6: 75–81.
 Mahajan C, Mishra R, Jena B, Kapoor I, Prabhakar H, Rath G, et al. Effect of magnesium and lignocaine on post-craniotomy pain: A comparative, randomized, double-blind, placebo-controlled study. Saudi Journal of Anaesthesia. 2019; 13: 299–305.
 Rodríguez-Rubio L, Solis Garcia Del Pozo J, Nava E, Jordán J. Interaction between magnesium sulfate and neuromuscular blockers during the perioperative period. A systematic review and meta-analysis. Journal of Clinical Anesthesia. 2016; 34: 524–534.
 Telci L, Esen F, Akcora D, Erden T, Canbolat AT, Akpir K. Evaluation of magnesium sulphate effects in reducing intraoperative anaesthetic requirements. British Journal of Anaesthesia. 2002; 89: 594–598.
 M. Manaa E. Effect of magnesium sulfate on the total anesthetic and analgesic requirements in neurosurgery. Journal of Neurology & Neurophysiology. 2012; S11–001.
 Oguzhan N, Gunday I, Turan A. Effect of magnesium sulfate infusion on sevoflurane consumption, hemodynamics, and perioperative opioid consumption in lumbar disc surgery. Journal of Opioid Management. 2008; 4: 105–110.
 Cernak I, Savic VJ, Kotur J, Prokic V, Veljovic M, Grbovic D. Characterization of plasma magnesium concentration and oxidative stress following graded traumatic brain injury in humans. Journal of Neurotrauma. 2000; 17: 53–68.
 Mirrahimi B, Mortazavi A, Nouri M, Ketabchi E, Amirjamshidi A, Ashouri A, et al. Effect of magnesium on functional outcome paraclinical parameters of patients undergoing supratentorial craniotomy for brain tumours: a randomized controlled trial. Acta Neurochirurgica. 2015; 157: 985–991.
 Do S. Magnesium: a versatile drug for anesthesiologists. Korean Journal of Anesthesiology. 2013; 65: 4–8.
 Fahmy N, Azer T. The effect of intraoperative magnesium sulphate infusion on the course of neuromuscular blockade of atracurium. Journal of the Egyptian National Cancer Institute. 2002; 14: 137–144.
 Schulz-Stübner S, Wettmann G, Reyle-Hahn SM, Rossaint R. Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients. European Journal of Anaesthesiology. 2001; 18: 723–729.
 Olgun B, Oǧuz GO, Kaya M, Şalvi S, Eskiçirak HE, Güney I, et al. The effects of magnesium sulphate on desflurane requirement, early recovery and postoperative analgesia in laparoscopic cholecystectomy. Magnesium Research. 2012; 25: 72–78.
 Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology and pharmacology. British Journal of Anaesthesia. 1999; 83: 302–320.
 Riaz MR, Mahajan V, Syed S, Ahmad R. Effect of intravenous magnesium sulfate on the minimum alveolar concentrations of desflurane using bispectral index monitoring: a prospective randomized double-blind controlled study. Anesthesia, Essays and Researches. 2017; 11: 1004–1008.
 Ryu J, Kang M, Park K, Do S. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. British Journal of Anaesthesia. 2008; 100: 397–403.
 Vacas S, Van de Wiele B. Designing a pain management protocol for craniotomy: a narrative review and consideration of promising practices. Surgical Neurology International. 2017; 8: 291.
 Christine Lalenoh D, Dewi Yulianti B. Glasgow coma scale improvement after lidocaine infusion in moderate traumatic brain injury. Journal of Anesthesia & Clinical Research. 2016; 7: 1–7.
 Peng Y, Zhang W, Kass IS, Han R. Lidocaine reduces acute postoperative pain after supratentorial tumor surgery in the pacu: a secondary finding from a randomized, controlled trial. Journal of Neurosurgical Anesthesiology. 2016; 28: 309–315.
 McIntosh TK, Faden AI, Yamakami I, Vink R. Magnesium deficiency exacerbates and pretreatment improves outcome following traumatic brain injury in rats: 31P magnetic resonance spectroscopy and behavioral studies. Journal of Neurotrauma. 1989; 5: 17–31.
 Kim MH, Kim MS, Lee JH, Kim ST, Lee J. Intravenously administered lidocaine and magnesium during thyroid surgery in female patients for better quality of recovery after anesthesia. Anesthesia and Analgesia. 2018; 127: 635–641.
 Groudine SB, Fisher HA, Kaufman RP, Patel MK, Wilkins LJ, Mehta SA, et al. Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesthesia and Analgesia. 1998; 86: 235–239.
 McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs. 2010; 70: 1149–1163.
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