The Impact Of Magnesium Sulfate In Elderly Patients With Endotracheal Intubation Response

Objective: This double-blind, randomized, controlled method, drip before anesthesia induction of different concentrations of magnesium sulfate, was designed to investigate basic parameters of patients with various time points, cortisol concentration changes,the concentration of magnesium and the number of cases of hemodynamic not smooth need intervention. Explore magnesium sulfate reducing of elderly patients with tracheal intubation response relatively safe dose, so as to provide some reference for clinical.Methods: 100 patients surgery under elective general anesthesia, elderly(≥65 years)patients, ASA gradeⅠ~Ⅱ,were randomly assigned into five groups :group M1(saline,n=25),group M2(magnesium sulfate,20 mg/kg), group M3(magnesium sulfate, 30mg/kg), group M4(magnesium sulfate,40 mg/kg),group M5(magnesium sulfate,50mg/kg). Configuration by assistant drug, the researchers concentration was unknown.All patients were connected to the USA space monitor, routine monitoring of HR, BP,ECG, open the vein channel. After the above operation was completed, the patient waited a smooth 10 min( baseline measurements), first drawn peripheral blood,labeled A1. Followed by intravenous anesthesia with midazolam 0.05 mg / kg, fentanyl4 ug / kg, propofol 2mg / kg, vecuronium 0.1mg / kg induction of general anesthesia. 3minutes before intubation drip of study drug, endotracheal intubation(performed by the same experienced anesthesiologists). Intubation, drawn by an assistant second peripheral blood( non- transfusion-side), labeled A2. Mechanical ventilation after intubation success, VT 8-10 ml / kg, RR 10-12 beats / min, maintaining the PET CO235~ 45 mm Hg. During the induction and maintenance of anesthesia if systolic blood pressure(SBP) decreased by 25% over baseline, the intravenous injection of ephedrine6-12 mg; if HR≤50 times / min, the intravenous injection of atropine 0.3 mg; if SBP rose to baseline values of 25% or more, or HR≥120 times / min, and then acted accordingly. 10 minutes after induction extracting peripheral venous blood for the third time, marked as A3. Recorded baseline(T1), infusion of magnesium sulfate(T2),magnesium sulfate infusion is completed(T3), after infusion of muscle relaxants(T4),infusion of muscle relaxants 1min(T5), infusion of muscle relaxants 2min(T6),intubation(T7), after intubation 1min(T8), after intubation 3min(T9), 5min(T10) at various time points after intubation SBP, DBP, HR, MAP, and sent the A1, A2, A3, the blood samples at various points detection cortisol concentration and the concentration of magnesium ions; simultaneously recorded instability during anesthesia induction and maintenance, hemodynamic intervention measures and the number of times. All data were analyzed with the statistical software of SPSS 11.5,. The measurement data with the standard deviation indicated, the intra and inter group comparisons with repeated measure data analysis of variance. A P-value below 0.05 was considered significant.Results: Five groups of patients with ASA score, age, height, weight, gender were not statistically different. M1 group of HR, MAP increased significantly at intubation compared with the basic value.(P<0.05)The rest of each group compared with no significant change in the underlying value.( P>0.05) M4, M5 group significantly decreased blood pressure before intubation and compared to basic values or the other groups. M1 group cortisol concentrations increased significantly at intubation, the rest of the group decreased. Each experimental group after intubation magnesium lower than baseline cortisol concentrations were significantly different.Compared with the number of group M2, M3, M4, M5 group had statistically significant hypotension.(P<0.01)Magnesium test group after intubation magnesium ion concentration increased, but were lower than the minimum toxic dose clinical.Conclusion: 20 mg/kg magnesium sulfate is to reduce the best dose of elderly patients with tracheal intubation reaction. Underuse may cause endotracheal intubation blood pressure increases, further increase the dose of magnesium can lead to significant hypotension and the change of hemodynamics of harmful.