Discussion
bleeding, CRBD, gastrointestinal cancer, eclampsia, pain, agitation, dehiscence of the surgical incision, neuromuscular and cardiovascular effects
GASTROINTESTINAL CANCER, CARDIAC ARRHYTHMIAS, BLEEDING, MUSCLE RELAXATION, POSTOPERATIVE COMPLICATIONS, CONTRACTION, ECLAMPSIA, ADVERSE EFFECTS
In this randomized controlled trial, magnesium sulfate administration significantly decreased the incidence and severity of CRBD and remifentanil requirement among male patients with laparoscopic radical resection of gastrointestinal cancer. In addition, the early postoperative NRS score of the control group was higher than that of the magnesium group. No significant differences were observed in magnesium-related adverse effects.The discomfort and abnormal behavioral responses caused by CRBD often lead to agitation during the awakening period, which in turn leads to increased postoperative complications, such as dehiscence of the surgical incision, bleeding, circulatory instability, cardiac arrhythmias, prolonged hospital stay, and increased mortality during hospitalization [Two different mechanisms may exist for CRBD. The first mechanism is that the catheter causes activation of urethral M receptors, which in turn leads to the contraction of urethral smooth muscle, resulting in CRBD [In the prsent study, magnesium sulfate administration effectively reduced the incidence and severity of CRBD after laparoscopic radical resection of gastrointestinal cancer. However, intravenous magnesium sulfate administration has been associated with several concerns, including the risk of neuromuscular and cardiovascular effects. The recommended doses in the treatment of eclampsia are loading doses ranging from 4–6 g, and the maintenance dose was 1–2 g/h, which maintains the plasma concentrations at < 3.5 mmol/L to avoid magnesium poisoning [In this study, we enrolled male patients who underwent laparoscopic radical resection of gastrointestinal cancer using a 14 or 16 French Foley catheter. The incidence of CRBD at 0, 1, 2, and 6 h postoperatively was 67.4%, 69.8%, 51.2%, and 32.6% in the control group. Intraoperative magnesium sulfate decreased the incidence of CRBD to 40%, 37.8%, 17.8%, and 8.9%, respectively. This result was similar to that reported previously [We observed that intravenous magnesium sulfate administration reduces sufentanil requirement and decreases the NRS score in male patients undergoing radical resection of gastrointestinal cancer. Although there is a statistically significant difference between the two interventions, it is not major clinical relevance. As our pain management is well-executed, intravenous magnesium sulfate did not further improvement in pain management. However, the difference in the remifentanil requirement (albeit small 0.2 mg) was clinically significant. Magnesium is the antagonist of the N-methyl-D-aspartate receptor [Nevertheless, the current study has several limitations. First, we did not measure plasma magnesium concentrations and hence, could not determine the therapeutic concentrations. Second, it is a major concern that magnesium sulfate enhances muscle relaxation, and muscle relaxation monitoring was carried out in all our studies. The requirement of rocuronium in the magnesium group was lower than that in the control group; however, the difference was not statistically significant. Importantly, a large trial is required to clarify whether magnesium sulfate reduces the rocuronium requirement. Third, we could not determine the optimal timing and dosage of the drug, which needs to be proved by additional studies. Previous studies have shown that intraoperative intravenous magnesium sulfate is safe [