Intraoperative MgSO4 infusion protects oxygenation and lung mechanics in COPD patients during general anesthesia. A randomized clinical trial

Abstract

Background: The purpose of this study was to examine the effects of an intraoperative MgSO₄ infusion on arterial oxygenation and lung mechanics in patients with moderate COPD undergoing cancer larynx surgery under general anesthesia (GA). Our primary outcome was arterial oxygenation determined by the PaO₂ and PaO₂ /FiO₂ . The secondary outcomes were lung mechanics (peak airway pressure, airway plateau pressure, dead space, lung compliance, airway resistance) and postoperative complications.

Methods: In this randomized controlled double-blinded trial, 40 patients with an ASA classifications II and/or III who were diagnosed with moderate COPD and who were scheduled for cancer larynx surgery under GA were randomly allocated into two equal groups, the target (Mg group) and control group (C group). In the Mg group, 30 mg/kg of 10% MgSO₄ solution was administered intravenously for over 20 minutes as the loading dose, followed by the continuous infusion of 10 mg/kg/hr In the C group, the same loading and maintenance infusion rates were administered using 0.9% saline.

Results: Unlike the C group (baseline "T0" to post-infusion "T1" interval 294 ± 97 vs 238 ± 71 mm Hg, respectively, P = .04 ± SD), the Mg group exhibited preserved intraoperative PaO₂ (T0 to T1 interval 271 ± 89 vs 257 ± 53 mm Hg, respectively, P = .54 ± SD) and PaO₂ /FiO₂ (C group T0 to T1 interval 404 ± 81 vs 349 ± 84, P = .04 and Mg group 394 ± 91 vs 379 ± 95, P = .61, respectively), and these effects were modest. Further, compared to the C group, the Mg group exhibited lower airway resistance, dead space, airway plateau pressure, and peak airway pressure, and higher dynamic compliance. The postoperative PaO₂ and PaO₂ /FiO₂ were higher in the Mg group compared to the C group.

Conclusions: Intraoperative infusion of MgSO₄ in patients with moderate COPD undergoing laryngectomy surgery under GA produces mild perioperative protective effects on both arterial oxygenation and lung mechanics.

Trial registration: ClinicalTrials.gov identifier: NCT03461328; registration date: 8 March 2018.