Effect Of The Association Of Magnesium And Ketamine On Morphine Consumption In Bariatric Surgery  

Abstract Category: Science
Course / Degree: Doctor in Pharmacy
Institution / University: Saint-Joseph Universoty, Lebanon
Published in: 2011

Thesis Abstract / Summary:

Introduction: Obesity is considered a postoperative risk factor for cardiovascular, thromboembolic and respiratory complications. Respiratory morbidity can be worsened by morphine analgesia. Magnesium (Mg) and ketamine (K) are used as additive analgesics. The purpose of the study is to evaluate the effect of association of Mg and K on the morphine consumption in the bariatric surgery.

Material and Methods: 60 patients with a BMI> 40 programmed for a gastric bypass were randomized in a prospective double-blind study. These patients were divided into 3 groups (Gr). Gr I: Mg+K, Gr II: Placebo (P)+ K and Gr III: P+P. The patients received after induction, according to theoretical ideal weight's (TIW= 22x(height)2) in Gr I an intravenous (IV) bolus of Mg 50mg/kg in 30 minutes followed by a continuous perfusion (CP) of 8mg/kg/h up to 3 hours (H) after extubation, as well as a bolus of K 0.2mg/kg followed by a CP of 0.15mg/kg/h until extubation. The patients in Gr II received the same amount of K but they got a normal saline serum (NSS) bolus and CP instead of Mg. The pts of the Gr III received NSS in the place of Mg and K. All the patients received hydroxyzine 1mg/kg per os one hour before surgery. The anesthesia was induced by: propofol 3mg/kg (TIW), remifentanil (R): bolus of 1 g/kg (TIW) in 1 minute and succinylcholine 1mg/kg (actual weight). The anesthesia was maintained by a mixture of oxygen and nitrous oxide (40/60), sevoflurane and R (0.05 and 0.25 g/kg/min according to the TIW). 40 minutes before the end all pts received 0.1 mg/kg morphine sulfate (TIW) and 1 g of paracetamol IV. The time between the end of the anesthesia and the extubation was noted. In the Post-Anesthesia Care Unit PACU, pain score (analogical visual scale (AVS) at rest, movement, cough), sedation score, the morphine needs and the occurrence of side effects were noted until H3. The morphine needs during the first 48 postoperative hours were also monitored. P< 0.05 was considered significant.

Results: The demographic and surgical characteristics were similar between the 3 groups. The doses of remifentanil used were lower in the group Mg + K, but without significant difference (p=0,166). Extubation times were similar between the 3 groups (p = 0,174). Pain scores were lower in the group Mg + K, but without significant difference. Morphine consumption in the PACU for the group Mg + K was lower compared to the 2 other groups (p = 0.045), same as for morphine consumption during the 24 first postoperative hours (p = 0.028). No side effects of morphine or ketamine were observed.

Conclusion: The combination of magnesium with ketamine reduces morphine needs in the PACU and during the 24 first postoperative hours, and tends to decrease the pain scores of the patients and the remifentanil needs during bariatric surgery. It would be useful to conduct a larger study to monitor other parameters, such as the respiratory functions and the blood gases.

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Bernard SROUR

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Submission Details: Thesis Abstract submitted by Bernard Srour from Lebanon on 06-Jul-2011 23:49.
Abstract has been viewed 3419 times (since 7 Mar 2010).

Bernard Srour Contact Details: Email: bernard.srour@hotmail.com Phone: 0096170940161

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