Deep tendon reflexes, magnesium, and calcium: assessments and implications.

School of Nursing, Loma Linda University, CA 92350, USA.
Journal of Obstetric Gynecologic & Neonatal Nursing (Impact Factor: 1.2). 01/2004; 33(2):221-30. DOI: 10.1177/0884217504263145
Source: PubMed

ABSTRACT The perinatal nurse, in collaboration with physicians, can use deep tendon reflexes as a powerful tool in determining the need to start, adjust, or stop magnesium infusion. Toxicity can be detected using physical manifestations as a guide. Clinical signs may be a better indicator than serum levels of tissue levels of magnesium. Whether magnesium is given to prevent seizures or for tocolysis, patients in both situations are at risk for developing toxicity and must be assessed regularly to ensure patient safety.

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    ABSTRACT: Magnesium enhances the effect of rocuronium. Sugammadex reverses rocuronium-induced neuromuscular block. The authors investigated whether magnesium decreased the efficacy of sugammadex for the reversal of rocuronium-induced neuromuscular block. Thirty-two male patients were randomized in a double-blinded manner to receive magnesium sulfate (MgSO4) 60 mg/kg or placebo intravenously before induction of anesthesia with propofol, sufentanil, and rocuronium 0.6 mg/kg. Neuromuscular transmission was monitored using TOF-Watch SX acceleromyography (Organon Ltd., Dublin, Ireland). In 16 patients, sugammadex 2 mg/kg was administered intravenously at reappearance of the second twitch of the train-of-four (moderate block). In 16 further patients, sugammadex 4 mg/kg was administered intravenously at posttetanic count 1 to 2 (deep block). Primary endpoint was recovery time from injection of sugammadex to normalized train-of-four ratio 0.9. Secondary endpoint was recovery time to final T1. Average time for reversal of moderate block was 1.69 min (SD, 0.81) in patients pretreated with MgSO4 and 1.76 min (1.13) in those pretreated with placebo (P = 0.897). Average time for reversal of deep block was 1.77 min (0.83) in patients pretreated with MgSO4 and 1.98 min (0.58) in those pretreated with placebo (P = 0.572). Times to final T1 were longer compared with times to normalized train-of-four ratio 0.9, without any difference between patients pretreated with MgSO4 or placebo. Pretreatment with a single intravenous dose of MgSO4 60 mg/kg does not decrease the efficacy of recommended doses of sugammadex for the reversal of a moderate and deep neuromuscular block induced by an intubation dose of rocuronium.
    Anesthesiology 03/2014; · 6.17 Impact Factor
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    ABSTRACT: Background Irukandji Syndrome is caused by a potentially lethal jellyfish envenomation. Despite the low incidence, the condition is associated with possible life-threatening cardiovascular complications that make it difficult to manage in emergency departments. Managing Irukandji Syndrome is important for many emergency departments across Australia, particularly in North Queensland, the Northern Territory, and Western Australia. Methods The aim of this quality project was to identify current management, practices and nursing knowledge in the only emergency department in the regional city of Townsville, Queensland. This was undertaken via chart audit of all presentations over a 2-year period and a survey of nursing staff. Results Fifteen cases of Irukandji Syndrome were identified. Medical treatment options included use of opioids and magnesium for symptom control. Magnesium as a treatment option was used in 80% of cases. Chart audit indicated that in 20% of cases nursing management did not follow approved clinical guidelines for treatment and monitoring. The survey of nursing staff indicated a knowledge deficit with respect to the signs and symptoms of Irukandji Syndrome, standards of clinical monitoring, clinical assessment, and overall care provided. Conclusions To improve care of Irukandji Syndrome in the emergency department, in-service education, implementation of tendon reflex assessment for patients receiving magnesium therapy, and the development of a specific clinical documentation are recommended.
    Australasian Emergency Nursing Journal 08/2010; 13(3):78–88.

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