Haemodynamic and endocrine effects of deliberate hypotension with magnesium sulphate for cerebral-aneurysm surgery

Abstract

Deliberate hypotension is widely used during cerebral-artery aneurysm surgery to facilitate clipping and to prevent rupture. A large number of drugs are commonly employed to achieve hypotension, but all have their specific drawbacks. We investigated the effects of magnesium-sulphate-induced hypotension on haemodynamics, as well as on plasma catecholamine and renin concentrations in 11 patients undergoing cerebral-aneurysm surgery. Magnesium sulphate lowered blood pressure by reducing systemic vascular resistance. There was no reflex tachycardia or rebound hypertension, and cardiac output was not decreased. Plasma renin activity increased during hypotension but the inhibitory effects of magnesium on angiotensin converting enzyme prevented angiotensin-II-associated hypertension. Plasma catecholamine concentrations increased moderately during hypotension. Renal perfusion was not impaired since diuresis remained constant or even improved during and after hypotension. Magnesium sulphate in high doses has major drawbacks, however, among which are enhanced neuromuscular blockade and delayed return of consciousness. Although the haemodynamic effects of magnesium sulphate during hypotension appear to be beneficial, these side-effects might limits its usefulness, particularly in neurosurgery. More research must be conducted before magnesium sulphate can be considered a routine method.