Magnesium sulfate is increasingly recognized for its multifaceted role in anesthesia, particularly concerning its interaction with ketamine. The use of magnesium in anesthetic protocols can enhance analgesic efficacy and potentially reduce the need for higher doses of anesthetic agents. Magnesium sulfate acts as a non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, which is involved in pain transmission, thus providing a theoretical basis for its utility alongside ketamine, which also exhibits NMDA antagonistic effects (Bansal, 2015; Do, 2013).
Recent studies underscore the adjunctive benefits of magnesium in combination with ketamine during various surgical procedures. For instance, a study involving dogs demonstrated that the combination of magnesium sulfate and ketamine resulted in enhanced perioperative analgesia, suggesting a synergistic interaction between the two agents (Galosi et al., 2024). This is supported by preclinical findings indicating that magnesium can effectively modulate hyperalgesia in conjunction with ketamine, particularly in scenarios involving morphine (Vujović et al., 2017). These interactions may lead to reduced opioid consumption in postoperative settings, highlighting the analgesic-sparing properties of magnesium when used with ketamine (Delage et al., 2017).
Conflicting results have emerged regarding the effectiveness of this magnesium-ketamine combination in humans, with some reports suggesting that magnesium may lead to increased opioid requirements due to potential antagonistic interactions (Vujović et al., 2017). Nonetheless, the consensus generally supports the beneficial role of magnesium in enhancing ketamine’s analgesic effects, especially in specific surgical contexts such as spinal anesthesia, where magnesium has shown promise in prolonging the effects of local anesthetics like bupivacaine (Kathuria et al., 2014; Shukla et al., 2011).
Additionally, research demonstrates magnesium’s role in attenuating hemodynamic responses during anesthesia induction, which can enhance overall patient stability and reduce perioperative complications. Studies have indicated that magnesium sulfate pre-treatment significantly mitigates catecholamine release and blunts hemodynamic spikes associated with tracheal intubation, thereby supporting its application in general anesthesia (Shin et al., 2011; Amer et al., 2015). Furthermore, magnesium has been associated with improved sedation and recovery metrics, which indicates its potential to enhance patient outcomes during anesthesia ("Evaluating the Effect of Various Doses of Magnesium Sulfate on Quality of Cataract Intra Operative Sedation and Recovery", 2017).
In summary, the incorporation of magnesium into anesthetic regimens, specifically alongside ketamine, highlights its potential to lower anesthetic requirements, enhance analgesia, and stabilize hemodynamic parameters. Continued exploration of this interaction through rigorous clinical trials is essential for refining dosing and application strategies for optimized patient care.
References:
- 2017. Evaluating the effect of various doses of magnesium sulfate on quality of cataract intra operative sedation and recovery. Journal of Anesthesia & Pain Medicine, 2(2).
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- Kathuria, B., Luthra, N., Gupta, A., Grewal, A., & Sood, D. (2014). Comparative efficacy of two different dosages of intrathecal magnesium sulphate supplementation in subarachnoid block. Journal of Clinical and Diagnostic Research.
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- Shin, Y., Choi, S., Jeong, H., & Kim, M. (2011). Evaluation of dose effects of magnesium sulfate on rocuronium injection pain and hemodynamic changes by laryngoscopy and endotracheal intubation. Korean Journal of Anesthesiology, 60(5), 329.
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