Authors: Kong, Hao et al.
Anesthesiology, October 3, 2025. DOI: 10.1097/ALN.0000000000005778
This randomized, double-blind, single-center clinical trial investigated whether magnesium sulfate could improve intraoperative hemodynamic stability in patients undergoing pheochromocytoma and paraganglioma (PPGL) resection. A total of 92 patients were enrolled and randomized to magnesium sulfate (loading dose 50 mg/kg, followed by 15 mg/kg/h infusion) or placebo. The infusion began 30 minutes before surgery and was discontinued after tumor resection.
The primary endpoint, cumulative time spent outside defined hemodynamic target ranges (SAP >160 mmHg, MAP <60 mmHg, HR >100 bpm), was significantly reduced in the magnesium group (4.3% vs 8.3%, P=0.003). Secondary findings showed lower maximum systolic arterial pressure (185 vs 196 mmHg, P<0.001), fewer patients requiring phentolamine (66% vs 89%, P=0.011), and lower phentolamine doses (3 mg vs 9 mg, P=0.011) with magnesium. Peak serum magnesium concentration reached 1.82 mmol/L after the loading dose. Importantly, no differences in adverse safety outcomes were reported between the two groups.
This study provides prospective clinical evidence supporting the use of preemptive magnesium sulfate infusion as a safe and effective means to reduce intraoperative blood pressure and heart rate instability during PPGL resection.
What You Should Know:
Magnesium sulfate, when given before PPGL surgery, can decrease intraoperative blood pressure spikes, reduce the need for antihypertensives like phentolamine, and improve hemodynamic control without increasing safety risks. This could become a useful adjunct in anesthetic management of PPGL patients.
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