Magnesium sulfate infusion for emergence agitation in adult patients after general anesthesia: a systematic review and meta-analysis of randomized controlled trials

Abstract

Introduction: Emergence agitation following general anesthesia poses significant risks to both patients and medical staff. While extensive research has explored the efficacy of magnesium sulfate (MgSO<inf>4</inf>) in managing pediatric emergence agitation, its effectiveness in adults remains uncertain. Therefore, this meta-analysis seeks to evaluate the efficacy of MgSO<inf>4</inf> in mitigating emergence agitation following general anesthesia in adult populations.

Evidence acquisition: A systematic search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases to identify randomized controlled trials (RCTs) comparing MgSO<inf>4</inf> or placebo infusion during surgical procedures involving adult patients under general anesthesia. Key outcomes assessed included the incidence of emergence agitation, agitation severity scores, extubation duration, and postoperative nausea and vomiting (PONV). Statistical analyses were conducted using Review Manager 5.4.1 (Cochrane, London, UK), with heterogeneity evaluated using I2 statistics. Significance was defined at P<0.05 for Odds Ratios (OR), mean differences (MD), and standard mean differences (SMD).

Evidence synthesis: Five RCTs encompassing 605 participants were included. MgSO<inf>4</inf> resulted in a lower emergence agitation incidence (OR=0.29 [95% CI: 0.12;0.72]; P=0.007). There were no significant differences between groups for patient's agitation severity scores (SMD=-0.69 [95% CI: -1.82; 0.44]; P=0.23), extubation time (MD=1.16 [95% CI: -1.06; 3.37]; P=0.30), or PONV incidence (OR=0.52 [95% CI: 0.15-1.76]; P=0.29).

Conclusions: Magnesium sulfate infusion during general anesthesia was associated with lower incidence of emergence agitation in adults. However, no significant differences were observed regarding emergence agitation severity scores, PONV, or extubation time.