Sulfato de Magnesio para Reducir la Respuesta Hemodinámica a la Laringoscopia Directa en Pacientes ASA I–II en Cirugía No Cardiaca

Vollständiger Abstract

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Direct laryngoscopy and endotracheal intubation elicit a sympathetic response that rapidly raises heart rate and blood pressure, changes that may become clinically relevant in vulnerable patients. This study examined whether magnesium sulfate, used as an adjuvant, reduced that hemodynamic response compared with a control group. An experimental, prospective, comparative and randomized study was conducted with 52 adult ASA I–II patients undergoing non-cardiac surgery under balanced general anesthesia, allocated to an intervention group (n = 31), which received a 30 mg/kg loading dose of magnesium sulfate before induction, and a control group (n = 21), which received placebo. Heart rate and blood pressure were recorded at baseline and at 1, 3 and 5 minutes after intubation; the primary outcome was the maximum change in mean arterial pressure. Treated patients showed a substantially smaller maximum change in mean arterial pressure than controls (−2.37 ± 8.73 mmHg vs. 17.32 ± 5.50 mmHg; p < 0.001) and fewer adverse hemodynamic events: tachycardia in 3.2 % vs. 42.9 % and hypertension in 9.7 % vs. 52.4 % (p < 0.001 for both comparisons). It was concluded that magnesium sulfate was useful for attenuating the cardiovascular response to laryngoscopy, although its effect on sympathetic tone required individualized dosing and continuous hemodynamic monitoring.