Effect of Intraoperative Magnesium Sulphate on the Occurrence of Postoperative Delirium
Status:
Recruiting
Trial end date:
2023-03-15
Target enrollment:
Participant gender:
Summary
Anaesthesia-related complications and mortality have been significantly reduced in the last
years.(1) Nevertheless, anaesthesia-related side effects, such as post-operative delirium and
sleep disturbances should not be underestimated. These side effects are economically
challenging because they may lead to prolonged hospital stay and change in lifestyle
condition. (2) After general anesthesia' sleep disturbances frequently occur. They are
featured by insomnia' hyperinsomnia' narcolepsy' and changed sleep structure. (3.4) There are
a lot of risk factors associated with post-operative sleep disturbance such as patient age,
preoperative comorbidity, severity of surgical trauma, postoperative pain, postoperative
complications and presence of pre-operative fatigue and depression. (5) Insomnia is one of
the most prevalent health problems during pre-operative period and after post-operative
recovery. It can lead to increase incidence of post-operative complications such as delayed
recovery , anxiety and delirium (6).
Post-operative delirium is also one of the most common complications following anaesthesia
with frequency estimates ranging from 10 to 50%. It is defined as delirium occurring 24 to 72
hours after surgery. (7) There are multiple risk factors for developing postoperative
delirium including pre-existing dementia, old age, medical co-morbidities, and
psycopathological symptoms. The recognition and treatment of Post-operative delirium is
critically important because postoperative delirium is associated with poor outcomes
including functional decline, dementia, cognitive impairment, increased hospital length of
stay , increased mortality ( 11% increasing in the risk of death at 3 months and up to a 17%
increased risk of death at 1 year. (8)
Animal studies have found that Magnesium can regulate melatonin production which is a hormone
that guide body sleep wake cycle (9) . Magnesium is an essential cofactor for many enzymatic
reactions' especially those that are involved in energy metabolism and neurotransmitter
synthesis. It is a cofactor involved in more than 300 enzyme systems' regulates diverse
biochemical reactions in the body (10.11) .
Magnesium supplements were used to improve insomnia symptom among older people in a double
blinded placebo controlled clinical trial(12). Low dietary Magnesium intake was found to be
significantly associated with depression which is a potential risk factor for insomnia(13).
Also using Magnesium sulphate as an adjuvant has been associated with significantly less
analgesic requirements and reducing postoperative pain which can improve quality of sleep and
decrease insomnia symptoms.(14)
AIM OF THE STUDY The aim of this work is to identify the potential predictors of
postoperative delirium and insomnia in patients undergoing lumbar fixation under general
anesthesia, and to evaluate the effect of intraoperative administration of Magnesium sulphate
on the occurrence of post-operative delirium and insomnia in those patients.