Authors: Kong H et al.
Journal: Anesthesiology, November 25, 2025. DOI: 10.1097/ALN.0000000000005778
Summary
This randomized, double-blind, placebo-controlled trial evaluated whether preemptive magnesium sulfate infusion improves intraoperative hemodynamic stability during pheochromocytoma and paraganglioma (PPGL) resection—procedures well known for extreme catecholamine-mediated blood pressure and heart rate fluctuations.
Ninety-two patients scheduled for PPGL resection were randomized to receive either magnesium sulfate or placebo, with infusion beginning 30 minutes before surgery and continuing until tumor removal. Magnesium dosing consisted of a weight-based loading dose followed by continuous infusion. The primary outcome was a clinically relevant composite measure reflecting the cumulative percentage of anesthesia time spent outside predefined hemodynamic targets for systolic blood pressure, mean arterial pressure, and heart rate.
Patients receiving magnesium sulfate experienced significantly less intraoperative hemodynamic instability than those receiving placebo, spending roughly half as much operative time outside target ranges. Magnesium sulfate also reduced peak systolic blood pressure, decreased the proportion of patients requiring rescue vasodilator therapy with phentolamine, and lowered total phentolamine dose requirements. Serum magnesium levels reached modest, controlled elevations after the loading dose, and no increase in adverse events was observed.
The study provides high-quality prospective evidence supporting magnesium sulfate as a safe and effective adjunct for controlling intraoperative hemodynamics in PPGL surgery, complementing standard alpha-adrenergic blockade strategies.
Key Points
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Preemptive magnesium sulfate significantly reduced intraoperative hemodynamic instability during PPGL resection.
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Patients receiving magnesium spent less time outside blood pressure and heart rate targets.
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Peak systolic pressures and need for phentolamine rescue were reduced.
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Magnesium levels remained within a safe therapeutic range.
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No increase in adverse events was observed.
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Magnesium sulfate is a useful adjunct for managing catecholamine-related instability in PPGL surgery.
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