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Beneficial Effects of Intravenous Magnesium Administration During Robotic Radical Prostatectomy: A Randomized Controlled Trial

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Abstract

Introduction

Robotic radical prostatectomy requires prolonged pneumoperitoneum and a steep Trendelenburg position. Magnesium can attenuate the stress response and hemodynamic perturbations. This study aimed to evaluate the effects of intravenous magnesium administration on hemodynamics and the stress response in patients undergoing robotic radical prostatectomy.

Methods

In this prospective, double-blind, randomized controlled study, 52 patients undergoing robotic radical prostatectomy were randomized into two groups: 26 in the magnesium group and 26 in the control group. The patients in the magnesium group received magnesium sulfate 50 mg/kg intravenously, followed by infusion at a rate of 10 mg/kg/h during surgery. The patients in the control group received an equal volume of 0.9% saline. The primary outcomes were the changes in heart rate and mean arterial pressure (MAP) during surgery. The serum stress hormones (adrenocorticotropic hormone, cortisol, epinephrine, and norepinephrine) were also measured.

Results

MAP showed a significant intergroup difference over time (Pgroup*time = 0.017); it increased significantly at 5 min after Trendelenburg position in the control group and decreased significantly at 30 min after Trendelenburg position in the magnesium group. The intergroup difference in the change in cortisol concentrations was significant over time (Pgroup*time = 0.006). The cortisol concentration decreased significantly from baseline to 24 h after surgery in the magnesium group but did not change significantly in the control group. The requirement for intraoperative remifentanil was 35% lower in the magnesium group (P = 0.011), and the severity of postoperative pain at 30 min and 6 h after surgery was also lower in the magnesium group (P = 0.024 and P = 0.015).

Conclusion

There is a possibility that intravenous magnesium administration during robotic radical prostatectomy reduces the increases in arterial pressure, cortisol concentrations, opioid requirements, and postoperative pain.

Trial Registration

ClinicalTrials.gov identifier, NCT02833038

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References

  1. Cao L, Yang Z, Qi L, Chen M. Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: a systematic review and meta-analysis. Medicine (Baltimore). 2019;98:e15770.

    Article  Google Scholar 

  2. Demasi CL, Porpiglia F, Tempia A, D’Amelio S. Ocular blood flow in steep Trendelenburg positioning during robotic-assisted radical prostatectomy. Eur J Ophthalmol. 2018;28:333–8.

    Article  Google Scholar 

  3. Chen K, Wang L, Wang Q, et al. Effects of pneumoperitoneum and steep Trendelenburg position on cerebral hemodynamics during robotic-assisted laparoscopic radical prostatectomy: a randomized controlled study. Medicine (Baltimore). 2019;98:e15794.

    Article  Google Scholar 

  4. Gibbison B, Angelini GD, Lightman SL. Dynamic output and control of the hypothalamic-pituitary-adrenal axis in critical illness and major surgery. Br J Anaesth. 2013;111:347–60.

    Article  CAS  Google Scholar 

  5. Porcaro AB, de Luyk N, Corsi P, et al. Robotic assisted radical prostatectomy accelerates postoperative stress recovery: final results of a contemporary prospective study assessing pathophysiology of cortisol peri-operative kinetics in prostate cancer surgery. Asian J Urol. 2016;3:88–95.

    Article  Google Scholar 

  6. Porcaro AB, Molinari A, Terrin A, et al. Robotic-assisted radical prostatectomy is less stressful than the open approach: results of a contemporary prospective study evaluating pathophysiology of cortisol stress-related kinetics in prostate cancer surgery. J Robot Surg. 2015;9:249–55.

    Article  Google Scholar 

  7. Queiroz Rangel Micuci AJ, Verçosa N, Filho PAG, de Boer HD, Barbosa DD, Cavalcanti IL. Effect of pretreatment with magnesium sulphate on the duration of intense and deep neuromuscular blockade with rocuronium: a randomised controlled trial. Eur J Anaesthesiol. 2019;36:502–8.

    Article  CAS  Google Scholar 

  8. Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis. Anaesthesia. 2013;68:79–90.

    Article  CAS  Google Scholar 

  9. Sohn HM, Jheon SH, Nam S, Do SH. Magnesium sulphate improves pulmonary function after video-assisted thoracoscopic surgery: a randomised double-blind placebo-controlled study. Eur J Anaesthesiol. 2017;34:508–14.

    Article  CAS  Google Scholar 

  10. Mesbah Kiaee M, Safari S, Movaseghi GR, et al. The effect of intravenous magnesium sulfate and lidocaine in hemodynamic responses to endotracheal intubation in elective coronary artery bypass grafting: a randomized controlled clinical trial. Anesth Pain Med. 2014;4:e15905.

    Article  Google Scholar 

  11. Honarmand A, Safavi M, Badiei S, Daftari-Fard N. Different doses of intravenous magnesium sulfate on cardiovascular changes following the laryngoscopy and tracheal intubation: a double-blind randomized controlled trial. J Res Pharm Pract. 2015;4:79–84.

    Article  CAS  Google Scholar 

  12. Kutlesic MS, Kutlesic RM, Mostic-Ilic T. Magnesium in obstetric anesthesia and intensive care. J Anesth. 2017;31:127–39.

    Article  Google Scholar 

  13. El Mourad MB, Arafa SK. Effect of intravenous versus intraperitoneal magnesium sulfate on hemodynamic parameters and postoperative analgesia during laparoscopic sleeve gastrectomy-A prospective randomized study. J Anaesthesiol Clin Pharmacol. 2019;35:242–7.

    Article  Google Scholar 

  14. Tan W, Qian DC, Zheng MM, Lu X, Han Y, Qi DY. Effects of different doses of magnesium sulfate on pneumoperitoneum-related hemodynamic changes in patients undergoing gastrointestinal laparoscopy: a randomized, double-blind, controlled trial. BMC Anesthesiol. 2019;19:237.

    Article  CAS  Google Scholar 

  15. Zhang J, Wang Y, Xu H, Yang J. Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy: a meta-analysis of randomized controlled studies. Medicine (Baltimore). 2018;97:e12747.

    Article  CAS  Google Scholar 

  16. Zarif P, Abdelaal Ahmed Mahmoud A, Abdelhaq MM, Mikhail HM, Farag A. Dexmedetomidine versus magnesium sulfate as adjunct during anesthesia for laparoscopic colectomy. Anesthesiol Res Pract. 2016. https://doi.org/10.1155/2016/7172920.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Del Giorno R, Lavorato Hadjeres S, Stefanelli K, et al. Consequences of supraphysiological dialysate magnesium on arterial stiffness, hemodynamic profile, and endothelial function in hemodialysis: a randomized crossover study followed by a non-controlled follow-up phase. Adv Ther. 2020;37:4848–65.

    Article  Google Scholar 

  18. Jahnen-Dechent W, Ketteler M. Magnesium basics. Clin Kidney J. 2012;5:i3–14.

    Article  CAS  Google Scholar 

  19. Kalmar AF, Foubert L, Hendrickx JF, et al. Influence of steep Trendelenburg position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth. 2010;104:433–9.

    Article  CAS  Google Scholar 

  20. Falabella A, Moore-Jeffries E, Sullivan MJ, Nelson R, Lew M. Cardiac function during steep Trendelenburg position and CO2 pneumoperitoneum for robotic-assisted prostatectomy: a trans-oesophageal Doppler probe study. Int J Med Robot. 2007;3:312–5.

    Article  Google Scholar 

  21. Haas S, Haese A, Goetz AE, Kubitz JC. Haemodynamics and cardiac function during robotic-assisted laparoscopic prostatectomy in steep Trendelenburg position. Int J Med Robot. 2011;7:408–13.

    Article  Google Scholar 

  22. Lestar M, Gunnarsson L, Lagerstrand L, Wiklund P, Odeberg-Wernerman S. Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45° Trendelenburg position. Anesth Analg. 2011;113:1069–75.

    Article  Google Scholar 

  23. Meininger D, Westphal K, Bremerich DH, et al. Effects of posture and prolonged pneumoperitoneum on hemodynamic parameters during laparoscopy. World J Surg. 2008;32:1400–5.

    Article  Google Scholar 

  24. Rosendal C, Markin S, Hien MD, Motsch J, Roggenbach J. Cardiac and hemodynamic consequences during capnoperitoneum and steep Trendelenburg positioning: lessons learned from robot-assisted laparoscopic prostatectomy. J Clin Anesth. 2014;26:383–9.

    Article  Google Scholar 

  25. D’Alonzo RC, Gan TJ, Moul JW, et al. A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy. J Clin Anesth. 2009;21:322–8.

    Article  Google Scholar 

  26. Alfonsi P, Vieillard-Baron A, Coggia M, et al. Cardiac function during intraperitoneal CO2 insufflation for aortic surgery: a transesophageal echocardiographic study. Anesth Analg. 2006;102:1304–10.

    Article  Google Scholar 

  27. Dubé L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth. 2003;50:732–46.

    Article  Google Scholar 

  28. Laurant P, Touyz RM. Physiological and pathophysiological role of magnesium in the cardiovascular system: implications in hypertension. J Hypertens. 2000;18:1177–91.

    Article  CAS  Google Scholar 

  29. Beers R, Camporesi E. Remifentanil update: clinical science and utility. CNS Drugs. 2004;18:1085–104.

    Article  CAS  Google Scholar 

  30. Albrecht S, Hering W, Schüttler J, Schwilden H. New intravenous anesthetics. Remifentanil, S(+)-ketamine, eltanolone and target controlled infusion. Anaesthesist. 1996;45:1129–41.

    Article  CAS  Google Scholar 

  31. Quinto D, Reis ST, Zampolli LJ, et al. Robotically assisted laparoscopic radical prostatectomy induces lower tissue trauma than radical retropubic prostatectomy. J Robot Surg. 2020. https://doi.org/10.1007/s11701-020-01150-y.

  32. De Oliveira GS Jr, Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2013;119:178–90.

    Article  Google Scholar 

  33. Lennon FE, Moss J, Singleto PA. The μ-opioid receptor in cancer progression: is there a direct effect? Anesthesiology. 2012;116:940–5.

    Article  Google Scholar 

  34. Gröber U, Schmidt J, Kisters K. Magnesium in prevention and therapy. Nutrients. 2015;7:8199–226.

    Article  Google Scholar 

  35. Blaszczyk U, Duda-Chodak A. Magnesium: its role in nutrition and carcinogenesis. Rocz Panstw Zakl Hig. 2013;64:165–71.

    CAS  PubMed  Google Scholar 

  36. Dai Q, Motley SS, Smith JA Jr, et al. Blood magnesium, and the interaction with calcium, on the risk of high-grade prostate cancer. PLoS One. 2011;6:e18237.

    Article  CAS  Google Scholar 

  37. Neeman E, Ben-Eliyahu S. Surgery and stress promote cancer metastasis: new outlooks on perioperative mediating mechanisms and immune involvement. Brain Behav Immun. 2013;30(Suppl):S32-40.

    Article  Google Scholar 

  38. Kumagai Y, Ohzawa H, Miyato H, et al. Surgical stress increases circulating low-density neutrophils which may promote tumor recurrence. J Surg Res. 2020;246:52–61.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors thank the participants and participating staff for their cooperation in the study.

Funding

This study and the Rapid Service Fee were sponsored by the new faculty research fund of Ajou University School of Medicine, Suwon, South Korea.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Ha Yeon Kim, Sook Young Lee, Hye Sun Lee, Bo Kyeong Jun, Jong Bum Choi, and Ji Eun Kim have nothing to disclose.

Compliance with Ethics Guidelines

The study protocol was approved by the Institutional Review Board of Ajou University School of Medicine. The study was performed in accordance with the Declaration of Helsinki of 1964 and its later amendments. Written informed consent was obtained from all study participants prior to participation.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. Jong Bum Choi and Ji Eun Kim contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea

    Ha Yeon Kim, Sook Young Lee, Bo Kyeong Jun, Jong Bum Choi & Ji Eun Kim

  2. Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea

    Hye Sun Lee

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  1. Ha Yeon Kim
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Correspondence to Ji Eun Kim.

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Kim, H.Y., Lee, S.Y., Lee, H.S. et al. Beneficial Effects of Intravenous Magnesium Administration During Robotic Radical Prostatectomy: A Randomized Controlled Trial. Adv Ther 38, 1701–1712 (2021). https://doi.org/10.1007/s12325-021-01643-8

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  • DOI: https://doi.org/10.1007/s12325-021-01643-8

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