Discussion
lethargy, biliary and pancreatic diseases, bradycardia, nausea or vomiting, arrhythmia, hypermagnesemia, eclampsia, brain injury, hypotension, respiratory depression
CARDIOPULMONARY DISEASES, ARRHYTHMIA, HYPERMAGNESEMIA, MYOCARDIAL ISCHEMIA, COMPLICATIONS, ECLAMPSIA, ADVERSE EFFECTS, RESPIRATORY DEPRESSION, PREECLAMPSIA
ERCP is a gold standard diagnostic and treatment method for patients with biliary and pancreatic diseases which are common in the elderly. Elders are often comorbid with cardiopulmonary diseases. Studies have shown that the high prevalence of cardiopulmonary complications may be associated with mortality, brain injury, myocardial ischemia, and the risk of mechanical ventilation during perioperative period [Intravenous magnesium is used to treat preeclampsia, eclampsia, and arrhythmia in clinical practice, but it has also been demonstrated to reduce the requirements for inhalation anesthetics, opioids and propofol during general anesthesia in various types of surgery [In current study, magnesium was only applied before the procedure. The predefined target level of sedation was maintained with propofol infusion alone. It was observed that although the duration of consciousness recovery was delayed by maximum 84 s with magnesium administration, the duration of PACU stay was not prolonged compared with that in saline group. As a consequence, the lower doses of magnesium combined with low dose propofol may not cause the clinically significant oversedation effect. Moreover, our results demonstrated that intravenous administration of magnesium could relieve respiratory depression in older patients during ERCP procedure. In addition, though there was no significant difference in peripheral blood oxygen saturation between magnesium and saline groups, we still found a tendency that oxygen saturation in magnesium group was slightly higher. One possible explanation might be that magnesium significantly decreased the requirement for propofol during the procedure. Propofol is associated with a high risk of respiratory depression in a dose-dependent manner in elders [It is well known that magnesium might induce hypotension and bradycardia by directly inhibiting cardiac and vascular sympathetic activities and indirectly depressing catecholamine release [There is a possibility of hypermagnesemia following magnesium administration. Studies have shown that magnesium-related adverse effects such as lethargy, nausea or vomiting, hypotension, bradycardia, and respiratory depression may occur when serum magnesium concentration exceeds 2 mmol/L [This study has several limitations. Firstly, we did not measure serum magnesium concentrations before and after magnesium administration. However, it was previously reported that there is very little correlation between intra- and extracellular magnesium concentration [