Smooth Extubation With Magnesium Sulphate for General Anesthesia With Endotracheal Intubation
Condition: Smooth Extubation
Study type: Interventional
Phase: Phase 4

Summary: 
      Tracheal extubation is a critical event in the anaesthetic management of patients undergoing
      general anaesthesia with endotracheal intubation for elective procedures. It the state of art
      to provide suitable conditions for smooth extubation and avoid coughing, bucking, straining
      and/or laryngospasm. Several methods have been described to provide a smooth extubation,
      including the use of remifentanil infusion, dexmedetomidine or fentanyl. Because of its
      anti-inflammatory and analgesic effects and lack of respiratory depressant actions, magnesium
      sulphate could be an attractive alternative.
    

Detailed description: 
      A written informed consent will be obtained from all the patients. On arrival to the
      preparation room intravenous cannula will be inserted, no sedation will be given. In the
      operating theater standard monitors, non-invasive blood pressure, oxygen saturation and
      electrocardiogram will be applied before induction of anesthesia, capnography after induction
      of anesthesia and baseline heart rate (HR), mean arterial blood pressure (MAP) and oxygen
      saturation (SpO2 ) will be recorded.

      All patients in both groups will receive standardized anesthetic technique in the form of
      intravenous (i.v.) propofol 2 mg/kg, i.v. fentanyl 1-2 lg/kg and atracurium 0.5 mg/kg to
      facilitate endo-tracheal intubation, mechanical ventilation will be adjusted to keep end
      tidal carbon dioxide (EtCO2) between 30 and 35 mmHg, and all drugs will be based on ideal
      body weight. Isoﬂurane 1% in 50% oxygen and air, and 0.15 mg/kg atracurium every 20 min will
      be given for maintenance of anesthesia. Intraoperative HR, MAP, EtCO2 and SpO2 values will be
      recorded at 5- minute intervals till the end of operation. HR and MAP will be maintained
      within ±20% of the baseline values. Hypotension (deﬁned as MAP < 20% of the baseline value)
      will be treated by a bolus of 200 ml Ringer's solution if not responding increments of 3-9 mg
      ephedrine will be given. Hypertension (deﬁned as MAP > 20% of the baseline value) and/or
      tachycardia (deﬁned as HR > 20% of the baseline value) a supplemental dose (25-50 µg)
      fentanyl will be given or increasing concentration of isoﬂurane. Bradycardia (HR < 50 beat
      per minute) persisting for >2 min will be treated with atropine, 0.4 mg i.v. boluses.
      Intra-operatively i.v. ondansetron, 4 mg (Zofran, GlaxoSmithKline) will be given for
      prevention of postoperative nausea and vomiting. After induction of anaesthesia patients will
      be divided into 2 groups: group C (control group) n= 30 patients will receive 10 ml of
      saline, then infusion of 50 ml of normal saline over one hour. Group M (magnesium group n=30
      patients) will receive 1 gm of magnesium in 10 ml over 5 minutes then infusion of 1 gm in 50
      ml over one hour.

      By the end of surgery isoﬂurane will be discontinued and the residual neuromuscular block
      will be antagonized with neostigmine 0.05 mg/kg, given with atropine 0.02 mg/kg, the
      endotracheal tube will be removed after return of spontaneous breathing, and the patient will
      obey commands in semi-sitting position, then the patient will be transferred to the
      post-anesthesia care unit (PACU)
    

Intervention name(s): Magnesium sulfate; Normal saline
Intervention type(s): Drug; Drug
Intervention description(s): Patients will receive 1 gm of magnesium in 10 ml over 5 minutes then infusion of 1 gm in 50 ml over one hour.; Patients will receive 10 ml of saline, then infusion of 50 ml of normal saline over one hour.
Other intervention name(s): Magnesium Group; Placebo Group
Intervention MeSH terms: Magnesium Sulfate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Prevention
Keywords: Magnesium Sulphate; General Anesthesia; Endotracheal Intubation