Magnesium Sulfate for Prevention of Emergence Agitation in Lumbar Disc Surgery

Overview

In this retrospective study, the effect of intraoperative magnesium sulfate infusion on the incidence of postoperative emergence agitation was evaluated in adult patients who underwent elective lumbar microdiscectomy under general anesthesia. The medical records of patients aged 18-70 years with an ASA physical status of I-II were retrospectively reviewed. Patients were evaluated according to whether they received intraoperative magnesium sulfate infusion as part of anesthetic management. The primary outcome measure was the incidence of emergence agitation in the post-anesthesia care unit; this assessment was based on Ramsay Sedation Scale scores recorded in the post-anesthesia care unit at admission and at 5, 10, 15, and 30 minutes. Secondary outcome measures included postoperative pain scores assessed using the Numeric Rating Scale, intraoperative remifentanil consumption, recovery and extubation times, tramadol requirement in the post-anesthesia care unit, and possible adverse events related to magnesium infusion.

This retrospective study was conducted at Giresun Training and Research Hospital. The aim of the study was to evaluate the effect of intraoperative magnesium sulfate infusion on postoperative emergence agitation in patients undergoing elective lumbar microdiscectomy under general anesthesia. After institutional ethics committee approval was obtained, the medical records of adult patients aged 18-70 years, classified as ASA physical status I or II, who underwent single-level elective lumbar microdiscectomy under general anesthesia were retrospectively reviewed. Patients were evaluated in two groups according to intraoperative anesthetic management: Magnesium Group (Group M): Patients who received a 30 mg/kg intravenous bolus of magnesium sulfate over 15 minutes after induction, followed by a continuous magnesium sulfate infusion at a dose of 10 mg/kg/h until the end of surgery. Control Group (Group K): Patients who did not receive magnesium sulfate infusion and were managed with a standard anesthesia protocol. The primary outcome measure was the incidence of emergence agitation in the post-anesthesia care unit (PACU). Emergence agitation was retrospectively assessed from PACU records using the Ramsay Sedation Scale (RSS) at admission to the PACU (T0) and at 5 (T1), 10 (T2), 15 (T3), and 30 (T4) minutes after admission. Secondary outcome measures included Numeric Rating Scale (NRS) pain scores recorded at the same PACU time points, total intraoperative remifentanil consumption, recovery time defined as the time from discontinuation of sevoflurane to eye opening, extubation time defined as the time from discontinuation of sevoflurane to extubation, meperidine requirement in the PACU, and possible adverse events related to magnesium infusion. These adverse events included arrhythmia, prolonged neuromuscular blockade, and respiratory difficulty.