Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000100013
Brazilian Journal of Anesthesiology
Review Article

Usos do sulfato de magnésio em obstetrícia e em anestesia

Applications of Magnesium Sulfate in Obstetrics and Anesthesia

Fabiano Timbó Barbosa; Luciano Timbó Barbosa; Mário Jorge Jucá; Rafael Martins da Cunha

http://dx.doi.org/10.1590/S0034-70942010000100013 Braz J Anesthesiol, vol.60, n1, p.104-110, 2010
PDF Português
PDF English
Downloads: 7
Views: 1713

Resumo

JUSTIFICATIVA E OBJETIVOS: O magnésio é um íon predominantemente intracelular. Seu efeito bloqueador do receptor NMDA lhe confere características analgésicas e sedativas. O objetivo desse artigo foi revisar a fisiologia, a farmacologia e a diminuição da concentração plasmática do magnésio, assim como algumas das suas aplicações em obstetrícia e em anestesia. CONTEÚDO: O magnésio é um cátion intracelular que possui múltiplas funções: é cofator de enzimas do metabolismo glicídico e de enzimas da degradação dos ácidos nucleicos, proteínas e ácidos graxos; regula a passagem de íons transmembrana e intervém na atividade de várias enzimas. O paciente em estado crítico apresenta tendência à hipomagnesemia e o tratamento consiste em corrigir a causa quando possível acompanhada da reposição do magnésio. Já foi demonstrada a redução da concentração alveolar mínima (CAM) dos agentes inalatórios em animais e do uso de opioides em humanos sob anestesia. CONCLUSÕES: O sulfato de magnésio vem sendo utilizado em obstetrícia com boa efetividade para inibição do trabalho de parto prematuro e para o tratamento das crises convulsivas associadas ao quadro de eclâmpsia. É um fármaco com potencial analgésico e sedativo que pode ser utilizado como coadjuvante durante a anestesia geral atenuando a resposta pressórica à intubação traqueal e diminuindo a necessidade de anestésicos.

Palavras-chave

ANESTESIA, Geral, DOENÇAS, DOENÇAS, DROGAS, FARMACOLOGIA, FARMACOLOGIA

Abstract

BACKGROUND AND OBJECTIVES: Magnesium is predominantly an intracellular ion. Its blocking effects on NMDA receptors are responsible for the analgesic and sedative characteristics of this ion. The objective of this study was to review the physiology, pharmacology, and decreased plasma levels of magnesium, as well as its applications in obstetrics and anesthesia. CONTENTS: Magnesium is an intracellular cation with multiple functions: it is a cofactor for enzymes of the glucose metabolism and those that participate in the degradation of nucleic acids, proteins, and fatty acids; it regulates the movements of transmembrane ions; and it intervenes in the activity of several enzymes. Critical patients have a tendency to develop hypomagnesemia, and the treatment consists in correcting the cause, whenever possible, and replacement of magnesium. A reduction in the minimum alveolar concentration (MAC) of inhalational agents in animals and the use of opioids in humans under anesthesia has been demonstrated. CONCLUSIONS: Magnesium sulfate has been used in obstetrics with good results, inhibiting premature labor and in the treatment of eclampsia-associated seizures. It is potentially analgesic and sedative, and could be used as adjuvant during general anesthesia, attenuating the blood pressure response to tracheal intubation and decreasing the need of anesthetics.

Keywords

ANESTHESIA, General, DISEASES, DISEASES, DRUGS, PHARMACOLOGY, PHARMACOLOGY

Referencias

Telci L, Esen F, Akcora D. Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth. 2002;89:594-598.

Bahar M, Chanimov M, Grinspun E. Spinal anaesthesia induced by intrathecal magnesium sulphate. Anaesthesia. 1996;51:627-633.

Schutz-Stubner S, Wettmann G, Reyle-Hahn SM. Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients. Eur J Anaesthesiol. 2001;18:723-729.

Chanimoy M, Cohen ML, Grinspun Y. Neurotoxicity after spinal anaesthesia induced by serial intrathecal injections of magnesium sulphate: An experimental study in a rat model. Anaesthesia. 1997;52:223-228.

Alday Muñoz E, Una Orejón R, Redondo Calvo FJ. Magnesio en anestesia y reanimación. Rev Esp. Anestesiol Reanim. 2005;52:222-234.

Marino PL. Magnésio. Compêndio de UTI. 2000:529-538.

Nácul FE. Distúrbios eletrolíticos em medicina intensiva. Medicina intensiva: abordagem prática. 2004:309-318.

Roscoe A, Ahmed AB. A survey of peri-operative use of magnesium sulphate in adult cardiac surgery in the UK. Anaesthesia. 2003;58:363-365.

Pascarella PJ, Pineda M. Efectos del sulfato de magnesio en la respuesta hemodinamica durante la laringoscopia e intubación traqueal. Rev Venez Anestesiol. 1998;3:8-12.

Kara H, Sahin N, Ulusan V. Magnesium infusion reduces perioperative pain. Eur J Anaesthesiol. 2002;19:52-56.

Elsharnouby NM, Elsharnouby MM. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anaesth. 2006;96:727-731.

Booth CC, Babouris N, Hanna S. Incidence of hypomagnesaemia in intestinal malabsorption. Br Med J. 1963;2:141-144.

Glover ML, Machado C, Totapally BR. Magnesium sulfate administered via continuous intravenous infusion in pediatric patients with refractory wheezing. J Crit Care. 2002;17:255-258.

Ganem EM, Castiglia YMM. Anestesia na pré-eclampsia. Rev Bras Anestesiol. 2002;52:481-497.

McKee JA, Brewer RP, Macy GE. Analysis of the brain bioavailability of peripherally administered magnesium sulfate: A study in humans with acute brain injury undergoing prolonged induced hypermagnesemia. Crit Care Med. 2005;33:661-666.

Barbosa FT, Barbosa LT, Cunha RM. Uso do sulfato de magnésio por via venosa e nebulização para o tratamento da asma aguda na emergência. Rev Bras Ter Intensiva. 2007;19:369-373.

Gonçalves MM. Doença hipertensiva específica da gravidez. Medicina intensiva. 1997:66-76.

Cardoso RL, Correa CM. Pacientes obstétricos em UTI. Medicina intensiva: abordagem prática. 2004:542-548.

Euser AG, Cipolla MJ. Magnesium sulfate for a treatment of eclampsia: a brief review. Stroke. 2009;40:1169-1175.

Ramanathan J, Sibai BM, Pillai R. Neuromuscular transmission studies in preeclamptic women receiving magnesium sulfate. Am J Obstet Gynecol. 1998;158:40-46.

Somjen G, Hilmy M, Stephen CR. Failure to anesthetize human subjects by intravenous administration of magnesium sulfate. J Pharmacol Exp Ther. 1966;154:652-659.

Sibai BM, Spinnato JA, Watson DL. Effect of magnesium sulfate on electroencephalographic findings in preeclampsia-eclampsia. Obstet Gynecol. 1984;64:261-266.

Koontz WL, Reid KH. Effect of parenteral magnesium sulfate on penicillin- induced seizure foci in anesthetized cats. Am J Obstet Gynecol. 1985;153:96-99.

Which anticonvulsant for women with eclampsia?: Evidence from the collaborative eclampsia trial. Lancet. 1995;345:1455-1463.

Karumanchi SA, Lindheimer MD. Advances in the understanding of eclampsia. Curr Hypertension Rep. 2008;10:305-312.

Quick AM, Cipolla MJ. Pregnancy-induced up-regulation of aquaporin-4 protein in brain its role in eclampsia. FASEB J. 2005;19:170-175.

Ghabriel MN, Thomas A, Vink R. Magnesium restores altered quaporin: 4 immunoreactivity following traumatic brain injury to a pre-injury state. Acta Neurochir Suppl. 2006;96:402-406.

Lewis DF. Magnesium sulfate: the first-line tocolytic. Obstet Gynecol Clin North Am. 2005;32:485-500.

Wadhwa A, Sengupta P, Durrani J. Magnesium sulphate only slightly reduces the shivering threshold in humans. Br J Anaesth. 2005;94:756-762.

Simpson JI, Eide TR, Schiff GA. Intrathecal magnesium sulfate protects the spinal cord from ischemic injury during thoracic aortic cross-clamping. Anesthesiology. 1994;81:1493-1499.

Breen TW, Yang T. The changing role of magnesium sulphate therapy. Curr Opin Anaesthesiol. 1999;12:283-287.

Dohi K, Ohtaki H, Shioda S. Magnesium sulfate therapy in patients with acute neuronal damage: the problem of intravenous administration. Crit Care Med. 2005;33:698-699.

Bilotta F, Rosa G. Magnesium sulfate and neuroprotection. Anesth Analg. 2003;96.

Pivalizza EG. Magnesium sulfate and epidural anesthesia in pheochromocytoma and severe coronary artery disease. Anesth Analg. 1995;81:414-416.

Ramirez Paesano C, Gonzalez O, Rodriguez B. Laringoscopia e intubación traqueal: uso de sulfato de magnesio para atenuar la respuesta cardiovascular refleja. Rev Venez Anestesiol. 1998;3:66-71.

Stacey MR, Barclay K, Asai T. Effects of magnesium sulphate on suxamethonium-induced complications during rapid-sequence induction of anaesthesia. Anaesthesia. 1995;50:933-936.

Altan A, Turgut N, Yildiz F. Effects of magnesium sulphate and clonidine on propofol consumption, haemodynamics and postoperative recovery. Br J Anaesth. 2005;94:438-441.

Lysakowski C, Dumont L, Czarnetzki C. Magnesium as an adjuvant to postoperative analgesia: a systematic review of randomized trials. Anesth Analg. 2007;104:1532-1539.

5dd2f1640e8825e857c63494 rba Articles
Links & Downloads
2352-2291 (Electrónico) 0104-0014 (Impreso)
Braz J Anesthesiol ©2024 Todos los derechos reservados.

Braz J Anesthesiol

Share this page
Page Sections