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Beneficial effect of intravenous magnesium during endoscopic submucosal dissection for gastric neoplasm

Authors
 Ji Eun Kim  ;  Cheung Soo Shin  ;  Young Chan Lee  ;  Hye Sun Lee  ;  Mingi Ban  ;  So Yeon Kim 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.29(12) : 3795-3802, 2015 
Journal Title
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 
ISSN
 0930-2794 
Issue Date
2015
MeSH
Abdominal Pain/etiology ; Abdominal Pain/prevention & control* ; Adenocarcinoma/surgery ; Adenoma/surgery ; Adult ; Aged ; Aged, 80 and over ; Analgesics/administration & dosage* ; Analgesics/therapeutic use ; Dissection/methods ; Double-Blind Method ; Female ; Gastric Mucosa/surgery ; Gastroscopy* ; Humans ; Hypnotics and Sedatives/administration & dosage* ; Hypnotics and Sedatives/therapeutic use ; Infusions, Intravenous ; Magnesium Sulfate/administration & dosage* ; Magnesium Sulfate/therapeutic use ; Male ; Middle Aged ; Pain, Postoperative/prevention & control* ; Prospective Studies ; Stomach Neoplasms/surgery* ; Treatment Outcome
Keywords
Blood pressure ; Early gastric cancer ; Endoscopic submucosal resection ; Magnesium ; Pain ; Sedation
Abstract
BACKGROUND: Endoscopic submucosal dissection (ESD) has been revealed as an effective treatment of early gastric neoplasm and should be performed under sedation with adequate pain control. Magnesium sulfate has analgesic, sedative, and sympatholytic properties. This study examined the effects of intravenous magnesium 50 mg/kg administered before ESD for gastric neoplasm on analgesic and sedative consumptions during ESD and pain after ESD. METHODS: In this randomized, double-blind, and prospective study, patients undergoing ESD randomly received either intravenous magnesium sulfate 50 mg/kg (magnesium group n = 30) or the same volume of normal saline (control group n = 30) over 10 min before the start of sedation. Fentanyl consumption during ESD was the primary end point. Hemodynamics was recorded during the procedure, and abdominal pain was evaluated at 30 min, 6 h, and 24 h after ESD. RESULTS: During ESD, fentanyl consumption was 24% less in the magnesium group than in the control group (96 ± 27 vs. 126 ± 41 μg, mean ± SD; p = 0.002), although there was no significant difference in propofol consumption (p = 0.317). In addition, magnesium attenuated the elevation of mean blood pressure at the time of epinephrine submucosal injection (p = 0.038) and 5 min after submucosal dissection (p = 0.004). Less patients of the magnesium group compared to the control group requested for additional analgesics in the recovery room (14 vs. 38 %, p = 0.043), and the intensity of abdominal pain was lower at 30 min after ESD in the magnesium group (p = 0.034). CONCLUSIONS: A single-dose intravenous administration of magnesium 50 mg/kg before sedation reduced analgesic requirements both during and after ESD for gastric neoplasm without adverse effects. In addition, magnesium contributed to stable hemodynamics throughout the procedure. TRIAL REGISTRATION: ClinicalTrials.gov NCT02235246.
Full Text
https://link.springer.com/article/10.1007%2Fs00464-015-4514-1
DOI
10.1007/s00464-015-4514-1
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Kim, Ji Eun(김지은)
Ban, Min Gi(반민지) ORCID logo https://orcid.org/0000-0002-1116-9472
Shin, Cheung Soo(신증수) ORCID logo https://orcid.org/0000-0001-7829-8458
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/156769
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