Magnesium Sulfate in Children Undergoing Laparoscopic Appendectomy

Pain in the perioperative period is associated with surgical stimuli but also with laryngoscopy and intubation. According to the currently applicable ERAS (Enhanced Recovery After Surgery) doctrine, the recommended method of anesthesia is multimodal, low-opioid anesthesia. The essence of multimodal anesthesia is to combine different methods (e.g. general and regional anesthesia) and various anesthetic drugs in order to reduce the intraoperative use of opioids. The one of commonly used co-analgetic is magnesium. The use of magnesium infusion before induction of anesthesia may enhance the analgesic effect of the opioid administered before intubation. In current guidelines for the relief of acute pain in children, magnesium sulfate may be considered as a coanalgesic. It is based only on expert consensus opinion and/or data from small studies, retrospective studies, registries.

According to available data magnesium sulfate is superior to placebo in decreasing analgesic consumption and pain scores during the first 48 h after operation without any adverse effects in children with cerebral pals. In other groups of pediatric patients, the effectiveness of magnesium as a co-analgetic has not been proven. High quality randomized controlled trials are still missing.

The primary outcome of this study is to assess opioid consumption during the laparoscopic appendectomy. Number of patients requiring rescue dose of opioids will be measured.

The secondary aim is to examine total intraoperative fentanyl consumption, fluctuations of heart rate and blood pressure, metabolic, hormonal and inflammatory response (glucose, cortisol and IL-6 concentrations) and occurrence of side effects that may result from magnesium intake (decrease in blood pressure, bradycardia or allergic reaction).

In the pediatric population, the optimal perioperative magnesium dosage is 50 mg/kg as a bolus followed by an infusion of 15 mg/kg/hour until the end of the operation.

The general aim of the study is to evaluate the analgesic efficacy of intravenous magnesium sulfate as an adjunct to standard general anesthesia (involving intravenous induction and opioid with sevoflurane maintenance) for intubation and surgical trauma during anesthesia for laparoscopic appendectomy in children.

• The requirement for opioids during anesthesia [Срок оценки: From operating theatre admission through to postanesthesia care unit admission (10 minutes after extubation).]
• Hemodynamic reaction to tracheal intubation [Срок оценки: Pre-intubation - immediately after intubation.]
• Metabolic response to laparoscopic procedure [Срок оценки: From 5 minutes after tracheal intubation until the end of surgery, defined as the completion of dressing application.]
• Hormonal response to laparoscopic procedure [Срок оценки: From 5 minutes after tracheal intubation until the end of surgery, defined as the completion of dressing application.]
• Inflammatory response to laparoscopic procedure [Срок оценки: From 5 minutes after tracheal intubation until the end of surgery, defined as the completion of dressing application.]
• Magnesium blood level [Срок оценки: From 5 minutes after tracheal intubation until the end of surgery, defined as the completion of dressing application.]
• Side effects of magnesium sulfate [Срок оценки: From the beginning of magnesium sulfate application until transfer to the postanesthesia care unit (10 minutes after extubation).]