Comparison of intravenous versus nebulized magnesium sulfate on attenuation of hemodynamic response to laryngoscopy in adult patients undergoing elective surgery: A randomized, double-blind study.

Background and aims: Intravenous magnesium sulfate is known to reduce hemodynamic response of laryngoscopy and intubation. However, it is associated with some systemic side effects. We compared the efficacy of nebulized and intravenous magnesium sulfate pretreatment on attenuation of hemodynamic response during tracheal intubation.

Material and methods: Sixty-six American Society of Anesthesiologists classification I-II patients aged 18-65 were randomly assigned to two groups: Group IV, which received 30 mg/kg of intravenous magnesium sulfate, and Group IN, which received the same dose via nebulization. Intubation was performed by an experienced anesthesiologist who was blinded to group allocation. The primary outcomes were heart rate (HR) and mean arterial pressure (MAP) during laryngoscopy and intubation. Secondary outcomes included propofol consumption for anesthesia induction, time to achieve a train-of-four (TOF) ratio of 0 after vecuronium administration, and any adverse effects.

Results: Both groups showed similar attenuation of hemodynamic responses during laryngoscopy and intubation (HR: P =0.139, MAP: P =0.40). Propofol consumption (mg) was comparable between the groups (113.64 in Group IN vs. 113.79 in Group IV, P = 0.629). However, the time (seconds) to achieve a TOF ratio of 0 was significantly shorter in Group IV compared to Group IN (228.33 vs. 247.09, P = 0.035).

Conclusion: Nebulized magnesium sulfate was as effective as intravenous magnesium sulfate in reducing hemodynamic changes during intubation, offering a noninvasive alternative for managing this response.