Authors: Kong, Hao et al.
Anesthesiology October 2025 | DOI: 10.1097/ALN.0000000000005778
This randomized, double-blind, placebo-controlled trial assessed whether preemptive magnesium sulfate infusion can improve intraoperative hemodynamic stability in patients undergoing pheochromocytoma or paraganglioma (PPGL) resection—procedures known for extreme fluctuations in blood pressure and heart rate due to catecholamine release.
Ninety-two patients scheduled for PPGL surgery were randomized to receive either magnesium sulfate (loading dose 50 mg/kg followed by 15 mg/kg/h infusion) or placebo beginning 30 minutes before incision and continuing until tumor removal. The primary endpoint was the percentage of total anesthesia time spent outside defined hemodynamic targets (systolic arterial pressure > 160 mmHg, mean arterial pressure < 60 mmHg, or heart rate > 100 bpm).
Among 88 evaluable patients, magnesium sulfate significantly reduced the cumulative time outside target hemodynamic ranges (median 4.3% vs. 8.3%; P = 0.003). Maximum intraoperative systolic pressure was lower (185 vs. 196 mmHg; P < 0.001), and both the proportion of patients requiring phentolamine (66% vs. 89%; P = 0.011) and total phentolamine dose (median 3 mg vs. 9 mg; P = 0.011) were reduced with magnesium treatment. Serum magnesium levels peaked at 1.82 mmol/L following the loading dose, and no significant differences in adverse events were observed between groups.
These findings demonstrate that preemptive magnesium sulfate provides a safe and effective method for attenuating hypertensive and tachycardic episodes during PPGL resection, likely by blunting catecholamine-driven vascular responses and reducing vasodilator requirements.
What You Should Know
-
Magnesium sulfate infusion before PPGL surgery significantly reduces intraoperative hemodynamic instability.
-
The regimen decreased peak blood pressures and the need for rescue α-blocker therapy.
-
No safety concerns or magnesium-related adverse effects were reported, supporting its potential use as a standard adjunct in PPGL anesthesia management.
Thank you for allowing us to use this article from Anesthesiology.