Magnesium and Intraoperative Blood Loss in Meningioma Surgery

Mahidol University80 enrolled

Overview

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.

The investigators enroll 120 patient who admitted for craniotomy for meningioma removal. Then, the patients will be divided into two groups. The first group or group Mg will receive magnesium sulphate 40 mg/kg infuse for 30 min (started at skin incision), and then infuse magnesium sulphate 10 mg/kg/hr until the dura will be closed. The another group or normal saline group will receive the same amount of 0.9% sodium chloride. The anesthesia and surgery are standardized. The recorded data include patient demographic data, intraoperative blood loss, hemodynamics and pre and postoperative Montreal cognitive assessment score.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

TRIPLE

Enrollment

Conditions

Meningioma

Interventions

Magnesium groupDRUG

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.

Normal saline groupDRUG

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.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

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

Locations (1)

Faculty of medicine, Siriraj hospital, Mahidol University

Bangkok, Thailand

Outcomes

Primary Outcomes

Intraoperative Blood Loss

We measure the amount of blood loss in the operative room in suction box, gauze and plastic bag. The unit measure is millimeter.