EFFICACY OF INTRAVENOUS MAGNESIUM SULPHATE IN REDUCING INTRAOPERATIVE RESPIRATORY COMPLICATIONS AMONG SMOKERS VERSUS NON-SMOKERS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY
Keywords:
Magnesium sulphate; laparoscopic cholecystectomy; smokers; non-smokers; intraoperative respiratory complications; SpO₂; EtCO₂; bronchospasmAbstract
Background; Carbon dioxide pneumoperitoneum in general anesthesia laparoscopic cholecystectomy results to significant respiratory complications due to the following reasons. There is decreased lung compliance, increased airway pressures and change in carbon dioxide exhalation. Smoking increases susceptibility to respiratory complications.
Objective: The objective of the present study was to compare the intraoperative respiratory variables and complications in smokers and non-smokers who underwent elective laparoscopic cholecystectomy with intravenous magnesium sulphate administration.
Methods: This was a prospective, randomized, double-blind, placebo controlled comparative study conducted at the Department of Anaesthesiology, Allied Hospital, Faisalabad. A total of 124 patients undergoing elective laparoscopic cholecystectomy were enrolled in the study. Subjects were divided on the basis of smoking and magnesium sulphate/placebo administration. Magnesium sulphate was administered through intravenous route in a dose of 15 mg/kg in 100 mL of normal saline for 15 minutes prior to induction, whereas the placebo group was given an equal amount of normal saline. Respiratory variables intra-operatively such as SpO₂, EtCO₂, peak airway pressure and dynamic compliance were observed. Hypoxemia, hypercapnia, bronchospasm, laryngospasm and respiratory rescue measures were noted. Statistical analysis was done by SPSS software, with p≤0.05 significance level.
Results: The smoking patients exhibited intraoperative respiratory impairment relative to the non-smoking patients especially when in pneumoperitoneum and at pre-extubation times. The smoking patients under magnesium sulphate had lower SpO₂ but high EtCO₂ and high peak airway pressure relative to the non-smoking patients. There were statistically significant differences in hypoxemia, hypercapnia, bronchospasm and high airway pressure.
Conclusion: The respiratory system of smokers undergoing laparoscopic cholecystectomy surgery is more susceptible than that of nonsmokers. IV Magnesium Sulphate could be considered as an adjunct for respiratory management before and after the procedure; nevertheless, further research with a balanced sample group is needed.
