Magnesium and Intraoperative Blood Loss in Meningioma Surgery
Condition: Meningioma
MeSH terms: Meningioma; Hemorrhage
Intervention: Magnesium group; Normal saline group
Intervention description: We will dilute magnesium 6 gram with 0.9% sodium chloride to 30 ml. The patient will receive magnesium sulfate 40 mg/kg infuse over 30 min started at skin incision and continuous drip 10 mg/kg/hr until the dura is closed. Anesthesia is standardized with propofol, fentanyl, cisatracurium and sevoflurane. Vasopressor or antihypertensive drug are used to control hemodynamics.; The patient will receive 0.9% sodium chloride the same amount of magnesium sulphate infuse over 30 min started at skin incision and continuous drip until the dura is closed. Anesthesia is standardized with propofol, fentanyl, cisatracurium and sevoflurane. Vasopressor or antihypertensive drug are used to control hemodynamics.
Phase: Phase 3
Study type: Interventional
Primary purpose: Other
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: We compare intraoperative blood loss in two group between the magnesium (study group) and 0.9% sodium chloride group (control group)
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Masking description: The study drug will prepared by the investigator in the same character and amount. So the patient and care provider will not know the study drug is magnesium or 0.9% sodium chloride.
Enrollment: 80.0
Sex: All
Minimum age: 18 Years
Maximum age: 70 Years
Healthy volunteers: No
Keywords: Meningioma; Magnesium; Montreal cognitive assessment; blood loss; controlled hypotension; blood transfusion; neuroprotective; anesthesia

Summary:

      Meningioma is the most common central nervous system tumor and craniotomy with tumor removal
      was associated with moderate blood loss and blood transfusion. Magnesium has hypotensive
      effect and probably reduce intraoperative blood loss. Whether or not magnesium sulphate can
      reduce intraoperative blood loss and improve postoperative cognitive function is still
      inconclusive. So the investigators conduct the randomized control trial to compare the effect
      of magnesium with placebo control in blood loss and cognitive function in meningioma patient
      undergoing craniotomy.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Meningioma patient

          -  Schedule for supratentorial craniotomy with tumor removal

          -  American society of anesthesiologists physical status 1-3

          -  Age 18-70 years

          -  No alteration of conscious (full Glasgow coma score) and well cooperate

          -  Expected to extubation after operation

        Exclusion Criteria:

          -  Unstable hemodynamic (severe hypotension or hypertension who receive antihypertensive
             and vasopressor before surgery but not include baseline oral antihypertensive drug)

          -  Known cardiac disease from either history, physical examination or investigation

          -  Patient who have heart block

          -  Hepatic disease (Child Pugh Score Class C)

          -  Renal insufficiency (eGFR < 60 ml/min from Chronic Kidney Disease Epidemiology
             Collaboration equation)

          -  Allergy to magnesium or other drugs use in the study

          -  Patient who receive calcium channel blocker drug

          -  Pregnancy

          -  Patient who receive magnesium for treatment such as arrhythmia or preeclampsia

          -  Hypermagnesemia (more than 2.6 mg/dL) before surgery

          -  BMI more than 30 kg/m2

          -  Patient who probably have brain herniation from increase intracranial pressure