주요 복강수술 환자에서 황산 마그네슘의 아편유사제 내성 감소에 대한 효과
Magnesium Sulfate Attenuate Opioid Tolerance in Patients undergoing Major Abdominal Surgery
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Background: Magnesium is a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptor. Magnesium is thought to be involved in opioid tolerance by way of inhibiting calcium entry into cells. Methods: The patients were randomly assigned to three groups according to the anesthetic regimens: Group M received magnesium sulfate and Group C received saline intravenously under remifentanil-based anesthesia. Group S received saline intravenously under sevoflurane based anesthesia in place of remifentanil. The patients in the group M received 25% magnesium sulfate 50 ㎎/㎏ in 100 ㎖ of saline, and those patients in groups C and S received an equal volume of saline before induction of anesthesia; this was followed by 10 ㎎/㎏/h infusion of either magnesium sulfate (group M) or an equal volume of saline (groups C and S) until the end of surgery. Pain was assessed on a visual analog scale at 1, 6, 12, 24, and 36 hours after the operation. The time to the first postoperative analgesic requirement and the cumulative analgesic consumption were evaluated in the three groups. Results: The visual analog scales for pain and the cumulative analgesic consumption were significantly greater in group C than in other groups. The time to first postoperative analgesic requirement was significantly shorter in group C than that in the other groups. There were no differences between group M and S for side effects. Conclusions: A relatively high dose and continuous remifentanil infusion is associated with clinically relevant evidence of acute opioid tolerance. NMDA-receptor antagonist, magnesium sulfate as an adjuvant analgesic prevents opioid tolerance in patients who are undergoing major abdominal surgery under high dose and continuous remifentanil infusion-based anesthesia.
Abstract
Background: Magnesium is a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptor. Magnesium is thought to be involved in opioid tolerance by way of inhibiting calcium entry into cells. Methods: The patients were randomly assigned to three groups according to the anesthetic regimens: Group M received magnesium sulfate and Group C received saline intravenously under remifentanil-based anesthesia. Group S received saline intravenously under sevoflurane based anesthesia in place of remifentanil. The patients in the group M received 25% magnesium sulfate 50 ㎎/㎏ in 100 ㎖ of saline, and those patients in groups C and S received an equal volume of saline before induction of anesthesia; this was followed by 10 ㎎/㎏/h infusion of either magnesium sulfate (group M) or an equal volume of saline (groups C and S) until the end of surgery. Pain was assessed on a visual analog scale at 1, 6, 12, 24, and 36 hours after the operation. The time to the first postoperative analgesic requirement and the cumulative analgesic consumption were evaluated in the three groups. Results: The visual analog scales for pain and the cumulative analgesic consumption were significantly greater in group C than in other groups. The time to first postoperative analgesic requirement was significantly shorter in group C than that in the other groups. There were no differences between group M and S for side effects. Conclusions: A relatively high dose and continuous remifentanil infusion is associated with clinically relevant evidence of acute opioid tolerance. NMDA-receptor antagonist, magnesium sulfate as an adjuvant analgesic prevents opioid tolerance in patients who are undergoing major abdominal surgery under high dose and continuous remifentanil infusion-based anesthesia.
참고문헌 (34)
- Jordan B, "Molecular mechanisms of opioid receptor signal transduction", Br J Anaesth, 81, pp.12~19 (1998)
- Koenig JA, "Endocytosis and recycling of G protein-coupled receptors", Trends Pharmacol Sci, 18, pp.276~287 (1997)
- Watkins LR, "Reversal of spinal cord non-opiate analgesia by conditioned anti-analgesia in the rat", Pain, 71, pp.237~241 (1997)
- Shimoyama N, "Ketamine attenuates and reverses morphine tolerance in rodents", Anesthesiology, 85, pp.1357~1366 (1996)
- McCarthy RJ, "Antinociceptive potentiation and attenuation of tolerance by intrathecal co-infusion of magnesium sulfate and morphine in rats", Anesth Analg, 86, pp.830~836 (1998)
- Telci L, "Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements", Br J Anaesth, 89, pp.594~598 (2002)
- Ryu JH, "Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia", Br J Anaesth, 100, pp.397~403 (2008)
- Rubeiz GJ, "Association of hypomagnesemia and mortality in acutely ill medical patients", Crit Care Med, 21, pp.203~209 (1993)
- Shiga T, "Magnesium prophylaxis for arrhythmias after cardiac surgery: a meta-analysis of randomized controlled trials", Am J Med, 117, pp.325~333 (2004)
- 이철, "The effect of magnesium sulfate on postoperative pain in patients undergoing major abdominal surgery under remifentanil-based anesthesia", Korean Journal of Anesthesiology, 53(3), pp.286~290 (2008), 대한마취과학회
- Crawford MW, "Development of acute opioid tolerance during infusion of remifentanil for pediatric scoliosis surgery", Anesth Analg, 102, pp.1662~1667 (2006)
- Angst MS, "No evidence for the development of acute tolerance to analgesic, respiratory depressant and sedative opioid effects in humans", Pain, 142, pp.17~26 (2009)
- Chia YY, "Intraoperative high dose fentanyl induces postoperative fentanyl tolerance", Can J Anaesth, 46, pp.872~877 (1999)
- Guignard B, "Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement", Anesthesiology, 93, pp.409~417 (2000)
- Kissin I, "Magnitude of acute tolerance to opioids is not related to their potency", Anesthesiology, 75, pp.813~816 (1991)
- Kissin I, "Acute tolerance in morphine analgesia: continuous infusion and single injection in rats", Anesthesiology, 74, pp.166~171 (1991)
- Ho ST, "The magnitude of acute tolerance to morphine analgesia: concentration-dependent or time-dependent?", Analg, 95, pp.948~951 (2002)
- Célèrier E, "Long-lasting hyperalgesia induced by fentanyl in rats: preventive effect of ketamine", Anesthesiology, 92, pp.465~472 (2000)
- Whang R, "Magnesium deficiency: Pathogenesis, prevalence, and clinical implications", Am J Med, 82, pp.24~29 (1987)
- Lanzinger MJ, "The relationship between ionized and total serum magnesium concentrations during abdominal surgery", J Clin Anesth, 15, pp.245~249 (2003)
- 장철호, "척추 수술 시 이온화마그네슘과 총마그네슘의 변화", Korean Journal of Anesthesiology, 52(6), pp.37~41 (2007), 대한마취과학회
- Nowak L, "Magnesium gates glutamate-activated channels in mouse central neurones", Nature, 307, pp.462~465 (1984)
- Koinig H, "Magnesium sulfate reduces intra- and postoperative analgesic requirements", Anesth Analg, 87, pp.206~210 (1998)
- Levaux CH, "Effect of intraoperative magnesium sulphate on pain relief and patient comfort after major lumbar orthopaedic surgery", Anaesthesia, 58, pp.131~135 (2003)
- Bahar M, "Serum electrolyte and blood gas changes after intrathecal and intravenous bolus injections of magnesium sulphate. An experimental study in a rat model", Anaesthesia, 52, pp.1065~1069 (1997)
- Zarauza R, "A comparative study with oral nifedipine, intravenous nimodipine and magnesium sulfate in postoperative analgesia", Anesth Analg, 91, pp.938~943 (2000)
- Wilder-Smith CH, "Perioperative magnesium infusion and postoperative pain", Acta Anaesthesiol Scand, 41, pp.1023~1027 (1997)
- Goto T, "Volatile anaesthetics antagonize nitrous oxide and morphine-induced analgesia in the rat", Br J Anaesth, 76, pp.702~706 (1996)
- Tomi K, "Alterations in pain threshold and psychomotor response associated with subanaesthetic concentrations of inhalation anaesthetics in humans", Br J Anaesth, 70, pp.684~686 (1993)
- Petersen-Felix S, "Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain", Br J Anaesth, 75, pp.55~60 (1995)
- Galinkin JL, "Subjective, psychomotor, cognitive, and analgesic effects of subanesthetic concentrations of sevoflurane and nitrous oxide", Anesthesiology, 87, pp.1082~1088 (1997)
- Fuchs-Buder T, "Interaction of magnesium sulphate with vecuronium-induced neuromuscular block", Br J Anaesth, 74, pp.405~409 (1995)
- Wadhwa A, "Magnesium sulphate only slightly reduces the shivering threshold in humans", Br J Anaesth, 94, pp.756~762 (2005)
- Kranke P, "Single- dose parenteral pharmacological interventions for the prevention of postoperative shivering: a quantitative systematic review of randomized controlled trials", Anesth Analg, 99, pp.718~727 (2004)