Download PDF
Anästhesiol Intensivmed Notfallmed Schmerzther 2015; 50(6): 380-387
DOI: 10.1055/s-0041-102214
Fachwissen
Anästhesiologie
© Georg Thieme Verlag Stuttgart · New York

Adjuvanzien in der modernen Anästhesie – Magnesium

Adjuvants in modern anesthesia – magnesium
Susanne Picardi
,
Philipp Lirk
,
Manfred Blobner
,
Marianne E Schönherr
,
Markus W Hollmann
Further Information

Publication History

Publication Date:
06 July 2015 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Magnesium spielt eine Schlüsselrolle in vielen verschiedenen enzymatischen und zellulären Prozessen und ist daher von wachsendem Interesse für die perioperative Medizin. Während experimentelle Studien vielversprechende Ansätze für verschiedene Krankheitsbilder liefern, sind die Ergebnisse großer klinischer Studien widersprüchlich. Potentielle Indikationen und Therapieempfehlungen werden ebenso wie die zugrundeliegende Physiologie in vorliegendem Übersichtsartikel vorgestellt.

Abstract

Magnesium plays a key role in many cellular functions and there is growing interest in its role in perioperative medicine. While experimental studies provided promising results for several disease states, clinical trials mainly gave conflicting results. This review article summarizes current knowledge on the homeostasis of magnesium as well as on its proposed indications and recommendations in the clinical setting.

Kernaussagen

  • Magnesium ist ein essenzielles Mineralsalz und als zweithäufigstes intrazelluläres Kation an > 600 enzymatischen Prozessen und zahlreichen biologischen Funktionen, wie Proteinbiosynthese und Energiestoffwechsel, beteiligt.

  • Magnesium ist Kofaktor verschiedener ATPasen und moduliert sowohl Ionenkanäle als auch die Signalübertragung ionotroper und metabotroper Rezeptoren.

  • Der menschliche Körper enthält 24 g (1 mol) Magnesium, wovon sich nur 0,3 % im Plasma befinden.

  • Die Magnesium-Homöostase wird v. a. durch enterale Absorption und renale Exkretion aufrechterhalten.

  • Magnesium scheint analgetische und anästhetikasparende Eigenschaften zu besitzen.

  • Magnesium verlängert die neuromuskuläre Blockade durch nicht depolarisiernde Muskelrelaxanzien und verkürzt deren Anschlagszeit: Im klinischen Alltag ist ein Relaxometer daher unerlässlich.

  • Die schwere Präeklampsie und Eklampsie sind neben der Torsades-de-pointes-Arrhythmie die klassischen Indikationen einer systemischen Magnesiumgabe.

  • Magnesium besitzt keinen Stellenwert in der Therapie des Herzinfarkts und des Herz-Kreislauf-Stillstands.

  • Beim schweren Asthmaanfall kann bei Kindern und Erwachsenen die Gabe von i. v. Magnesium erwogen werden.

  • Patienten mit Schlaganfall oder Subarachnoidalblutung scheinen von einer Therapie mit i. v. Magnesium nicht zu profitieren.

Schlüsselwörter:

Magnesium - klinische Indikationen - Homöostase

Key words:

magnesium - clinical indications - homeostasis

Ergänzendes Material

 

  • Literatur

  • 1 Elin RJ.. Magnesium.The fifth but forgotten electrolyte. Am J ClinPathol 1994; 102: 616-622
    PubMedGoogle Scholar
  • 2 Fine KD, Santa Ana CA et al. Intestinal absorption of magnesium from food and supplements. Clin Invest 1991; 88: 396-402
    CrossrefPubMedGoogle Scholar
  • 3 Konrad M, Schlingmann KP, Gudermann T. Insights into the molecular nature of magnesium homeostasis. Am JPhysiol Renal Physiol 2004; 286: 599-605
    PubMedGoogle Scholar
  • 4 Kausalya PJ, Amasheh S, Gunzel D et al. Disease-associated mutations affect intracellular traffic and paracellularMg2+ transport function of Claudin-16. J Clin Invest 2006; 116: 878-891
    CrossrefPubMedGoogle Scholar
  • 5 Simon DB, Lu Y, Choate KA et al. Paracellin-1, a renal tight junction protein required for paracellular Mg2+ resorption. Science 1999; 285: 103-106
    CrossrefPubMedGoogle Scholar
  • 6 Voets T, Nilius B, Hoefs S et al. TRPM6 forms the Mg2+ influx channel involved in intestinal and renal Mg2+ absorption. J BiolChem 2004; 279: 19-25
    PubMedGoogle Scholar
  • 7 de Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in Man: Implications for Health and Disease. Physiol Rev 2015; 95: 1-46
    CrossrefPubMedGoogle Scholar
  • 8 Agus ZS. Hypomagnesemia. J Am SocNephrol 1999; 10: 1616-1622
    PubMedGoogle Scholar
  • 9 Sanders GT, Huijgen HJ, Sanders R. Magnesium in disease: A review with special emphasis on the serum ionized magnesium. ClinChem Lab Med 1999; 37: 1011-1033
    PubMedGoogle Scholar
  • 10 Schwarz RE, Nevarez KZ. Hypomagnesemia after major abdominal operations in cancer patients: clinical implications. Arch Med Res 2005; 36: 36-41
    CrossrefPubMedGoogle Scholar
  • 11 Wilson RB, Erskine C, Crowe PJ. Hypomagnesemia and hypocalcemia after thyroidectomy: A prospective study. World J Surg 2000; 24: 722-726
    CrossrefPubMedGoogle Scholar
  • 12 Scott VL, De Wolf AM et al. Ionized hypomagnesemia in patients undergoing orthotopic liver transplantation: A complication of citrate intoxication. Liver TransplSurg 1996; 2: 343-347
    PubMedGoogle Scholar
  • 13 Rubeiz GJ, Thill-Baharozian M, Hardie D et al. Association of hypomagnesemia and mortality in acutely ill medical patients. Crit Care Med 1993; 21: 203-209
    CrossrefPubMedGoogle Scholar
  • 14 Chernow B, Bamberger S, Stoiko M et al. Hypomagnesemiain patients in postoperative intensive care. Chest 1989; 95: 391-397
    CrossrefPubMedGoogle Scholar
  • 15 Huijgen HJ, Soesan M, Sanders R et al. Magnesium levels in critically ill patients. What should we measure?. Am J ClinPathol 2000; 114: 688-695
    PubMedGoogle Scholar
  • 16 Onishi S, Yoshino S. Cathartic-induced fatal hypermagnesemiain the elderly. Intern Med 2006; 45: 207-210
    CrossrefPubMedGoogle Scholar
  • 17 Herroeder S, Schönherr ME, De Hert SG et al. Magnesium-essentials for anesthesiologists. Anesthesiology 2011; 114: 971-979
    CrossrefPubMedGoogle Scholar
  • 18 Albrecht E, Kirkham KR, Liu SS et al. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis. Anaesthesia 2013; 68: 79-90
    CrossrefPubMedGoogle Scholar
  • 19 De Oliveira Jr GS, Castro-Alves LJ, Khan JH et al. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 2013; 119: 178-190
    CrossrefPubMedGoogle Scholar
  • 20 McCartney CJ, Sinha A, Katz J. A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. AnesthAnalg 2004; 98: 1385-400
    PubMedGoogle Scholar
  • 21 Jabbour HJ, Naccache NM, Jawish RJ et al. Ketamine and magnesium association reduces morphine consumption after scoliosis surgery: prospective randomiseddoubleblindstudy. ActaAnaesthesiolScand 2014; 58: 572-579
    PubMedGoogle Scholar
  • 22 Telci L, Esen F, Akcora D et al. Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements. Br J Anaesth 2002; 89: 594-598
    CrossrefPubMedGoogle Scholar
  • 23 Gupta K, Vohra V, Sood J. The role of magnesium as an adjuvant during generalanaesthesia. Anaesthesia 2006; 61: 1058-1063
    CrossrefPubMedGoogle Scholar
  • 24 Khafagy HF, Ebied RS, Osman ES et al. Perioperative effects of various anesthetic adjuvants with TIVA guided bybispectralindex. Korean J Anesthesiol 2012; 63: 113-119
    CrossrefPubMedGoogle Scholar
  • 25 Puri GD, Marudhachalam KS, Chari P et al. The effect of magnesium sulphate on hemodynamics and its efficacy in attenuating the response to endotracheal intubation in patients with coronary artery disease. AnesthAnalg 1998; 87: 808-811
    PubMedGoogle Scholar
  • 26 Pinard AM, Donati F, Martineau R et al. Magnesium potentiates neuromuscular blockade with cisatracurium during cardiac surgery. Can J Anaesth 2003; 50: 172-178
    CrossrefPubMedGoogle Scholar
  • 27 Czarnetzki C, Lysakowski C, Elia N et al. Time course of rocuronium-induced neuromuscular block after pre-treatment with magnesium sulphate: A randomised study. ActaAnaesthesiolScand 2010; 54: 299-306
    PubMedGoogle Scholar
  • 28 Ghodraty MR, Saif AA, Kholdebarin AR et al. The effects of magnesium sulfate on neuromuscular blockade by cisatracuriumduring induction of anesthesia. J Anesth 2012; 26: 858-856
    CrossrefPubMedGoogle Scholar
  • 29 Fuchs-Buder T, Wilder-Smith OH, Borgeat A et al. Interaction of magnesium sulphate with vecuronium-induced neuromuscular block. Br J Anaesth 1995; 74: 405-409
    CrossrefPubMedGoogle Scholar
  • 30 Fuchs-Buder T, Tassonyi E. Magnesium sulphate enhances residual neuromuscular block induced by vecuronium. Br J Anaesth 1996; 76: 565-566
    CrossrefPubMedGoogle Scholar
  • 31 Czarnetzki C, Tassonyi E, Lysakowski C et al. Efficacy of sugammadexfor the reversal of moderate and deep rocuronium-induced neuromuscular block in patients pretreated with intravenous magnesium: a randomized controlled trial. Anesthesiology 2014; 121: 59-56
    CrossrefPubMedGoogle Scholar
  • 32 Kumar M, Talwar N, Goyal R et al. Effect of magnesium sulfate with propofol induction of anesthesia on succinylcholine- induced fasciculations and myalgia. J AnaesthesiolClinPharmacol 2012; 28: 81-85
    PubMedGoogle Scholar
  • 33 James MF. Use of magnesium sulphate in the anaestheticmanagement of phaeochromocytoma: A review of 17 anaesthetics. Br J Anaesth 1989; 62: 616-623
    CrossrefPubMedGoogle Scholar
  • 34 Minami T, Adachi T, Fukuda K. An effective use of magnesium sulfate for intraoperative management of laparoscopic adrenalectomy for pheochromocytoma in a pediatric patient. AnesthAnalg 2002; 95: 1243-1244
    PubMedGoogle Scholar
  • 35 James MF, Cronje L. Pheochromocytoma crisis: The use of magnesium sulfate. AnesthAnalg 2004; 99: 680-686
    PubMedGoogle Scholar
  • 36 Dean C, Douglas J. Magnesium and the obstetric anaesthetist. Int J ObstetAnesth 2013; 22: 52-63
    PubMedGoogle Scholar
  • 37 Witlin AG, Friedman SA, Sibai BM. The effect of magnesium sulfate therapy on the duration of labor in women with mild preeclampsia at term: A randomized, doubleblind, placebo-controlled trial. Am J ObstetGynecol 1997; 176: 623-627
    PubMedGoogle Scholar
  • 38 Alexander JM, McIntire DD, Leveno KJ et al. Selective magnesium sulfate prophylaxis for the prevention of eclampsia in women with gestational hypertension. ObstetGynecol 2006; 108: 826-832
    PubMedGoogle Scholar
  • 39 Cahill AG, Macones GA, Odibo AO et al. Magnesium for seizure prophylaxis in patients with mild preeclampsia. ObstetGynecol 2007; 110: 601-607
    PubMedGoogle Scholar
  • 40 Altman D, Carroli G, Duley L et al. Do women with preeclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: A randomised placebo-controlled trial. Lancet 2002; 359: 1877-1890
    CrossrefPubMedGoogle Scholar
  • 41 Duley L, Gulmezoglu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev CD 000025 2003;
    PubMedGoogle Scholar
  • 42 The Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet 1995; 345: 1455-1463
    CrossrefPubMedGoogle Scholar
  • 43 Duley L, Henderson-Smart D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev CD 000128 2003;
    PubMedGoogle Scholar
  • 44 Duley L, Henderson-Smart D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev CD 000127 2003;
    PubMedGoogle Scholar
  • 45 Duley L, Gulmezoglu AM. Magnesium sulphate versus lytic cocktail for eclampsia. Cochrane Database Syst Rev CD 002960 2001;
    PubMedGoogle Scholar
  • 46 Cook RC, Yamashita MH, Kearns M et al. Prophylactic magnesium does not prevent atrial fibrillation after cardiac surgery: a meta-analysis. Ann ThoracSurg 2013; 95: 533-541
    CrossrefPubMedGoogle Scholar
  • 47 Dunning J, Treasure T, Versteegh M et al. EACTS Audit and Guidelines Committee. Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery. Eur J CardiothoracSurg 2006; 30: 852-872
    PubMedGoogle Scholar
  • 48 Huang Y, He Q, Yang M et al. Antiarrhythmia drugs for cardiac arrest: a systemic review and meta-analysis. Crit Care 2013; 17
    PubMedGoogle Scholar
  • 49 Rasmussen HS, McNair P, Norregard P et al. Intravenous magnesium in acute myocardial infarction. Lancet 1986; 1: 234-6
    PubMedGoogle Scholar
  • 50 Woods KL, Fletcher S, Roffe C et al. Intravenous magnesium sulphate in suspected acute myocardial infarction: Results of the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 1992; 339: 1553-1558
    CrossrefPubMedGoogle Scholar
  • 51 ISIS-4. A randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group. Lancet 1995; 345: 669-685
    CrossrefPubMedGoogle Scholar
  • 52 The Magnesium in Coronaries (MAGIC) Trial Investigators. Early administration of intravenous magnesium to highriskpatients with acute myocardial infarction in the Magnesium in Coronaries (MAGIC) Trial: A randomised controlled trial. Lancet 2002; 360: 1189-1196
    CrossrefPubMedGoogle Scholar
  • 53 Li J, Zhang Q, Zhang M, Egger M. Intravenous magnesium for acute myocardial infarction. Cochrane Database SystRev CD 002755 2007;
    PubMedGoogle Scholar
  • 54 Powell C, Kolamunnage-Dona R, Lowe J et al. Magnesium sulphate in acute severe asthma in children (MAGNETIC): a randomised, placebo-controlled trial. Lancet Respir Med 2013; 1: 301-308
    CrossrefPubMedGoogle Scholar
  • 55 Goodacre S, Cohen J, Bradburn M et al. Intravenous or nebulized magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomized controlled trial. Lancet Respir Med 2013; 1: 293-230
    CrossrefPubMedGoogle Scholar
  • 56 Powell CV. The role of magnesium sulfate in acute asthma: does route of administration make a difference?. CurrOpinPulm Med 2014; 20: 103-108
    PubMedGoogle Scholar
  • 57 Muir KW, Lees KR, Ford I et al. Magnesium for acute stroke (Intravenous Magnesium Efficacy in Stroke trial): Randomisedcontrolled trial. Lancet 2004; 363: 439-445
    CrossrefPubMedGoogle Scholar
  • 58 Saver JL, Starkman S, Eckstein M et al. Prehospital use of magnesium sulfate as neuroprotection in acute stroke. N Engl J Med 2015; 372: 528-523
    CrossrefPubMedGoogle Scholar
  • 59 van den Bergh WM, Algra A van KF et al. Magnesium sulfate in aneurysmal subarachnoid hemorrhage: A randomized controlled trial. Stroke 2005; 36: 1011-1015
    CrossrefPubMedGoogle Scholar
  • 60 DorhoutMees SM, Rinkel GJ, Feigin VL et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev CD 000277 2007;
    PubMedGoogle Scholar
  • 61 Wong GK, Poon WS, Chan MT et al. Intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage (IMASH): a randomized, double-blinded, placebo-controlled, multicenter phase III trial. Stroke 2010; 41: 921-926
    CrossrefPubMedGoogle Scholar
  • 62 DorhoutMees SM, Algra A, Vandertop WP et al. Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomised placebo-controlled trial. Lancet 2012; 380: 44-49
    CrossrefPubMedGoogle Scholar
  • 63 Hallak M, Berman RF, Irtenkauf SM et al. Peripheral magnesium sulfate enters the brain and increases the threshold for hippocampal seizures in rats. Am J ObstetGynecol 1992; 167: 1605-1610
    PubMedGoogle Scholar
  • 64 Fuchs-Buder T, Tramer MR, Tassonyi E. Cerebrospinal fluidpassage of intravenous magnesium sulfate in neurosurgical patients. J NeurosurgAnesthesiol 1997; 9: 324-328
    PubMedGoogle Scholar
  • 65 McKee JA, Brewer RP, Macy GE et al. 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: 661-6
    CrossrefPubMedGoogle Scholar
  • 66 Dohi K, Ohtaki H, Shioda S et al. Magnesium sulfate therapy in patients with acute neuronal damage: The problem of intravenous administration. Crit Care Med 2005; 33: 698-699
    CrossrefPubMedGoogle Scholar
  • 67 Chang JJ, Mack WJ, Saver JL et al. Magnesium: potential roles in neurovascular disease. Front Neurol 2014; 5: 52-52
    PubMedGoogle Scholar
  • 68 Doyle LW, Crowther CA, Middleton P et al. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev CD 004661 2009;
    PubMedGoogle Scholar