Is HFJV a better alternative ventilation technique for percutaneous dilatational tracheostomy? A randomised trial

BACKGROUND

High-Frequency Jet Ventilation (HFJV) has been used for the treatment of tracheal lesions, airway surgery, and treatment of secondary lesions after tracheostomy for many years however, reports on the use of HFJV during PDT are limited. This study compares the use of traditional method, ventilation with LMA, and HFJV through ETT with respect to the duration of PDT procedure and complications.

METHODS

Seventy-five patients were randomized into one of the three groups with computergenerated random numbers: Group ETT (n_25), group LMA (n=25), and group HFJV (n=25). Demographic data, duration of PDT, complications such as ETT cuff puncture and tube transaction, accidental extubation, difficult cannula insertion, bleeding, desaturation during the procedure, arterial blood gases immediately before and after the procedure have been recorded.

RESULTS

Mean time for successful PDT in group ETT was 5.9±1.35 minutes, in group LMA 4.96±0.78 minutes, and 3.88±0.78 minutes in group HFJV. PDT duration was shorter in the LMA group than in the ETT group (p<0.05). In the HFJV group, the PDT duration was shorter than the LMA group (p<0.05) and the ETT group (p<0.001). In terms of the total number of complications, significantly fewer complications were observed in the HFJV group compared with group ETT and group LMA.

CONCLUSIONS

HFJV may be a more effective alternative method for airway management during PDT, facilitating and reducing the duration of the intervention.

The effects of hydroxyurea on proinflammatory cytokine and tissue histopathology in an experimental sepsis model

OBJECTIVE

The diagnosis and treatment of sepsis are costly to healthcare services, and it is an important disease with high mortality rates. In the pathogenesis of sepsis, for which we still cannot provide a complete cure, there is increased cytokine release and organ damage. Hydroxyurea has been shown to reduce leukocyte counts, decrease inflammatory cytokines, and limit organ inflammation in ischemia-reperfusion models. This study aimed to evaluate leukocyte counts, interleukin-1 beta (IL-1β), IL-6, and tumor necrosis factor-alpha (TNF-α) cytokine values and organ inflammatory processes in hydroxyurea-treated rats with an experimental sepsis model.

MATERIALS AND METHODS

After ethical approval, rats were randomly divided into three groups, control (n= 7), sepsis (n= 7), and hydroxyurea (n= 7). Sepsis was created using the cecal ligation and puncture (CLP) method in rats other than in the control group. Rats in the hydroxyurea group received hydroxyurea (200 mg/kg) intragastrically, and the control and sepsis groups received sterile distilled water. IL-1β, IL-6, and TNF-α levels were measured at 0, 8, and 24 hours after CLP in all rats. Blood samples were collected at the time of sacrification 24 hours after CLP and analyzed for the complete blood count. Tissue specimens were taken for histopathologic examination.

RESULTS

Cytokine levels (IL-1β, IL-6, TNF-α), white blood cell counts, and tissue damage were increased after the sepsis model in rats. It was found that the cytokine levels at the 8th hour, white blood cell count, and brain tissue damage in the hydroxyurea group were decreased significantly compared with the sepsis group.

CONCLUSIONS

Early hydroxyurea treatment in rats with sepsis decreases proinflammatory cytokine (IL-1β, IL-6, and TNF-α) levels and thus reduces brain damage.

Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units

Background:

There are limited data on the long-term outcomes of COVID-19 from different parts of the world.

Aims:

To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure.

Study design:

Retrospective, observational cohort.

Methods:

Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded.

Results:

A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO₂/FiO₂ ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050).

Conclusion:

Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

[The relation between preoperative anxiety and awareness during anesthesia: an observational study]

BACKGROUND

Anxiety is a state of worry caused by the anticipation of external or internal danger. Awareness During Anesthesia (ADA) is an unexpected memory recall during anesthesia. In this study, we aimed to determine the factors that affect preoperative anxiety and observe the incidence of ADA, as well as to determine the anxiety levels of these patients with a history of ADA.

METHODS

This study was planned to be prospective, observational, and cross-sectional. Patients in whom septoplasty was planned, who was admitted to the anesthesiology outpatients between March 2018 and September 2018, were ASA I-II, and aged 18-70 years were included in the study. The demographic characteristics of patients were recorded. The State-Trait Anxiety Inventory (STAI) was used to determine anxiety during a preoperative evaluation. The modified Brice awareness score was used simultaneously to determine previous ADA.

RESULTS

The anxiety scores of patients who were conscious during anesthesia were higher than other patients. The mean STAI score was 40.85±14.8 in the 799 patients who met the inclusion criteria of this study. When the anxiety scores were compared, the scores were higher in females than in males (p < 0.05). The mean STAI score was found as 40.3±13.8 in patients who dreamed during anesthesia.

CONCLUSION

It is important to determine the anxiety levels of patients in the preoperative period to prevent the associated complications. Preoperative anxiety, besides preventing ADA, should be dealt with in a multidisciplinary manner. ADA should be carefully questioned while evaluating previous anesthesia experiences.

Comparison of the standard and triple airway maneuvering techniques for i-gel™ placement in patients undergoing elective surgery: a randomized controlled study

PURPOSE

The i-gel is a supraglottic airway device with non-inflatable cuff which can suffer insertion failure if its standard placement technique is implemented. The aim of this study was to compare the placement technique proposed by the manufacturer of i-gel with the triple airway maneuver in terms of successful device insertion time and first-attempt success.

METHODS

After ethics committee approval, 103 ASA I-III patients were randomly allocated to the standard or triple airway maneuver groups. In the standard Group, the i-gel was inserted in the sniffing position while, in the triple group, it was inserted using the triple airway maneuver consisting of head tilt, jaw thrust, and open mouth. The time taken for successful insertion, first-attempt success rate, i-gel position, airway complications, and hemodynamic responses were assessed.

RESULTS

Between the two groups patient characteristics were similar. Time for successful insertion was significantly shorter in the triple group (20 ± 7 s) than with the standard technique (32 ± 11 s; p < 0.001). Successful insertion at the first attempt was 78% and 92% for the standard and triple group, respectively (p = 0.092). The i-gel position, airway complications, and hemodynamic responses were similar in both groups.

CONCLUSION

The triple airway maneuver required less i-gel insertion time as compared with the standard placement technique. First-attempt success rates were similar with both techniques, although the triple airway maneuver was superior to the standard method as a rescue technique in failed insertions. We therefore recommend use of the triple airway maneuver in i-gel insertion.

The effects of pregabalin and adductor canal block on postoperative pain in arthroscopic anterior cruciate ligament reconstruction

Background/aim

To determine the effectiveness of pregabalin and adductor canal block on opioid consumption, postoperative pain, and fast-tracking.

Materials and methods

A total of 51 American Society of Anaesthesiologists (ASA) classification I–II patients aged 18–70 years who were scheduled to undergo elective anterior cruciate ligament reconstruction were included in the study. Patients were randomized into groups P, A, and C. Patients in group P (n = 16), received 150 mg of preoperative oral pregabalin, patients in group A (n = 17) received postoperative adductor canal blockade, and patients in group C (n = 18) received neither adductor canal block nor pregabalin. Surgeries were performed under spinal anaesthesia with hyperbaric bupivacaine following monitorization. Demographic data along with block features, hemodynamic data, mean opioid consumption, numerical rating scale score, White’s fast-track score, and postoperative adverse effects were recorded.

Results

Fifty-seven patients were enrolled in the study, and 6 patients were excluded from the study; the data of 51 patients were included in the final analyses. Demographic characteristics and hemodynamic data were similar between the 3groups. Postoperative opioid consumption was significantly lower in groups A and P compared with group C (group P = 178.75 mg, group C = 318.61 mg, group A = 236.47 mg; P < 0.05). The regression of sensory block was significantly slower in group P (P < 0.05). The first analgesic requirement was earlier in group C than in groups P and A (P < 0.05). Patients in group P had higher fast-track scores at 8 h and 12 h compared with group C (P < 0.05); however, group A fast-track scores were similar to those of the other 2groups (P > 0.05). The rate of postoperative adverse effects was similar between the groups (P > 0.05).

Conclusion

Preoperative pregabalin (150 mg) reduced postoperative opioid consumption as much as adductor canal block in patients undergoing anterior cruciate ligament reconstruction. The first analgesic requirement was earlier in group C than in groups P and A. In addition, pregabalin can prolong the duration of spinal sensory block and shorten the time required to achieve high fast-tracking scores. We recommend the use of both methods as a part of multimodal analgesia.

Comparison of cervical spine motion during intubation with a C‑MAC D‑Blade® and an LMA Fastrach®

BACKGROUND

This prospective randomized study compared cervical motion during intubation with a C‑MAC D‑Blade® and with a laryngeal mask airway LMA Fastrach®.

MATERIAL AND METHODS

The participants in this study were 52 ASA I-III patients aged 18-70 years and assigned for elective cervical discectomy. The patients were randomly selected for intubation with a C‑MAC D‑Blade® (group V) or an LMA Fastrach® laryngeal airway (group F). Both groups received the same induction of anaesthesia. The first lateral view was X‑rayed while the head and neck were in a neutral supine position and the second exposure was taken during the passage of the endotracheal tube through the vocal cords for group V and during the advance of the endotracheal tube for group F. The occiput-C1 (C0-C1), C1-C2 and C2-5 angles were measured. The angle formed by the line between the occipital protuberance and anterior process of the foramen magnum and the line between the central point of C1 spinous process and the anterior process of the foramen magnum was defined as angle A. The differences between the angles were calculated. Overall intubation success and first-pass success (success at the first attempt) were recorded.

RESULTS

The change in angulations between C0-C1 during intubation was significantly lower in group F than in group V (2.78⁰ ± 2.1⁰ vs. 6.04⁰ ± 4.1⁰, p = 0.007). Before intubation, angle A was 14.4⁰ ± 3.9⁰ in group V and 13.8⁰ ± 3.7⁰ in group F (p = 0.627). During intubation, angle A was significantly smaller for group V than for group F (9.1⁰ ± 2.4⁰ vs. 10.7⁰ ± 2.9⁰, p = 0.04). The number of successful intubations were significantly higher in group V (100% of intubations were successful on the first attempt for group V, vs. 80% for group F, p = 0.023).

CONCLUSION

Intubation with both a C‑MAC D‑Blade and a Fastrach LMA resulted in cervical motion but within safe ranges. Intubation with a C-mac D blade might be preferred because the Fastrach LMA may result in more failed intubation attempts in patients with cervical spine disorders.

The effect of play distraction on anxiety before premedication administration: a randomized trial

STUDY OBJECTIVE

The majority of children scheduled to undergo surgery experience substantial anxiety in the preoperative holding area before induction of anesthesia. Pharmacological interventions aimed at reducing perioperative anxiety are paradoxically a source of stress for children themselves. Midazolam is frequently used as premedication, and the formula of this drug in Turkey is bitter. We aimed to assess the role of distraction in the form of playing with play dough (Play-Doh) on reducing premedication anxiety in children.

DESIGN

Prospective randomized clinical trial.

SETTING

Preoperative holding area.

PATIENTS

One hundred four healthy children aged 3 to 7 years scheduled to undergo elective surgery were enrolled into the study.

INTERVENTIONS

All children routinely receive sedative premedication (oral midazolam) before anesthesia. Children were randomized to 2 groups to receive either play dough (group PD) (n=52) or not (group C) (n=52) before administration of oral premedication.

MEASUREMENTS

Children's premedication anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS).

MAIN RESULTS

The difference in mYPAS scores between groups at T₀ (immediately after entering the preoperative holding area) was not significant (P=.876). Compared with group C, group PD was associated with lower mYPAS scores at T₁ and T₂ (P<.001). In group PD, mYPAS scores were significantly lower at both T₁ and T₂ as compared with the scores at T₀ (P<.001); they were similar between T₁ and T₂ (P>.001).

CONCLUSION

This study showed that distraction in the form of playing with play dough facilitated administration of oral midazolam in young children.

Vitamin D Levels of Anesthesia Personnel, Office Workers and Outdoor Workers in Ankara, Turkey

BACKGROUND

Vitamin D deficiency or insufficiency is a highly prevalent condition worldwide. Anesthesia providers or support personnel working in operating rooms might be considered at increased risk of vitamin D deficiency. There is a small amount of information about 25(OH)D levels in people who work mainly indoors as an operating room. This study aimed to investigate whether there was a higher vitamin D insufficiency or deficiency rate among anesthesia personnel working indoors when compared with personnel working in an office or outdoors in Ankara, Turkey (39 degrees North, 32 degrees East).

METHODS

This study consisted of 125 volunteer anesthesia personnel and 60 subjects as control groups (30 outdoor workers and 30 office workers). All of the individuals completed a questionnaire. Serum levels of total 25(OH)D were measured by a chemiluminescent immunoassay method.

RESULTS

74.4% of anesthesia personnel and 76.6% of control group 1 (outdoor workers) and 76.6% of control group 2 (office workers) had serum 25(OH)D concentrations < 10 ng/mL. 20.8% of anesthesia personnel and 23.4% of control group 1 and 23.4% of control group 2 had serum 25(OH)D concentrations levels 10 - 20 ng/mL. 4.8% of anesthesia personnel had serum 25(OH)D concentration levels 21 - 30 ng/mL. There was no significant difference in the mean serum 25(OH)D level between the groups (Anesthesia group: 8.98 ± 4.89 ng/mL, Control group 1: 8.18 ± 2.39 ng/mL, Control group 2: 8.37 ± 3.01 ng/mL) (p > 0.05).

CONCLUSIONS

To our knowledge the present study is the first study to investigate the comparison of vitamin D levels of anesthesia personnel with outdoor and office workers. Our findings alarmingly emphasize that vitamin D deficiency is very common at the end of winter in Ankara, regardless of being anesthesia personnel in operating room or a worker in office or an outdoor worker. Vitamin D supplementation may be suggested in all groups in Ankara.

Effect of two surgical circumcision procedures on postoperative pain: A prospective, randomized, double-blind study

BACKGROUND

Male circumcision (MC) is one of the most commonly used surgical procedures worldwide for medical and traditional reasons. No studies have compared the postoperative pain advantages of conventional techniques (i.e., sleeve and dorsal slit).

OBJECTIVE

In this prospective randomized double-blind study, we investigated the effect of two surgical techniques (i.e., sleeve and dorsal slit) on postoperative pain and emergence agitation.

STUDY DESIGN

This prospective study was conducted between January and July 2013. Approval was obtained from the local Ethical Committee on 17 December 2012, 06/23 (CLINICAL TRIALS IDENTIFIER: NCT 01909765). We compared two surgical techniques (i.e., the dorsal slit incision technique (Group A) and the double incision (i.e., sleeve) technique (Group B) in 60 children who were subjected to MC surgery under general anesthesia. All children received dorsal nerve blocks with bupivacaine. The modified objective pain scale (MOPS) was used for pain assessment, and the Ramsey Sedation Scale was used for the assessment of agitation during anesthesia emergence.

RESULTS

The MOPS scores were lower in Group B than in Group A in the post-anesthesia care unit and during the 4th hour post-surgery (p = 0.01 and p = 0.037, respectively). Twelve children (40%) in Group A and 23 children (76.6%) in Group B required no additional analgesia on postoperative day one (p = 0.004). The Ramsey sedation scores were lower in Group A (p = 0.018).

DISCUSSION

Dorsal slit is often the primary method in cases with paraphimosis; during this procedure, the frenulum frequently cannot be preserved at the 6-o'clock position of the mucosa, because of traction applied to skin and mucosa. As a result, the frenular artery is injured. In contrast, the sleeve technique protects the frenulum and the anatomic structures of the glans. In the sleeve technique, providing hemostasis and preventing partial ischemia by protecting the frenular artery reduces postoperative pain and complications. This present study demonstrated that the sleeve technique, which preserved the frenular artery, caused less bleeding, reduced electrocautery use and less ischemia than the dorsal slit technique. The sleeve technique effectively reduces early postoperative pain and agitation after circumcision, provided that adequate postoperative analgesia has been achieved. While all variables except the employed surgical techniques were similar, Group B had advantages with respect to analgesic requirement and pain control during the first 8 h after the operation.

CONCLUSION

The sleeve technique provides lower pain scores and a reduced incidence of agitation after elective MC.

Parkinson's Disease and Spinal Anaesthesia

Parkinson's is a neurodegenerative disease characterized by increased activity of GABA in basal ganglia and the loss of dopamine in nigrostriatum, associated with rigidity, resting tremor, gait with accelerating steps, and fixed inexpressive face. Being a neurological disease, spinal anaesthesia is often avoided in Parkinson's. Yet, in Parkinsons' patients, general anaesthesia may mask neurological symptoms in the intraoperative period and exacerbate them postoperatively. Moreover, the drugs administered in general anaesthesia more likely interact with anti-Parkinson drugs and may have side effects. With spinal anaesthesia, unlike general anaesthesia, because muscle relaxants and opioids are avoided, the exacerbation is not going to be masked due to muscle relaxation, and neurological symptoms may be distinguished clinically. In addition, the known effects of spinal anaesthesia, like suppression of surgical stress, postoperative pain relief, and early mobilization, may be advantageous in Parkinson's disease. Treated for Parkinson's disease for about 10 years at the age of 77 and with American Society of Anesthesiologists physical classification III (hyperlipidemia, hypertension, coronary artery disease, and chronic obstructive lung disease), a female patient was scheduled for elective surgery for fracture of the left distal tibia. In this case, we aimed to report a patient with Parkinson's disease who underwent spinal anaesthesia in order to avoid the disadvantages of general anaesthesia and reviewed the literature.

Effect of ultrasound-guided intercostal nerve block on postoperative pain after percutaneous nephrolithotomy : prospective randomized controlled study

BACKGROUND

The aim of the study was to investigate the effect of preoperative ultrasound-guided (US) intercostal nerve block (ICNB) in the 11th and 12th intercostal spaces on postoperative pain control and tramadol consumption in patients undergoing percutaneous nephrolithotomy (PCNL).

METHODS

After obtaining ethical committee approval and written informed patient consent, 40 patients were randomly allocated to the ICNB group or the control group. For the ICNB group US-guided ICNB was performed with 0.5 % bupivacaine and 1/200,000 epinephrine at the 11th and 12th intercostal spaces after premedication. A sham block was performed for the control group and postoperative pain and tramadol consumption were recorded by anesthesiologists blinded to the treatment.

RESULTS

Postoperative visual analog scale scores at all follow-up times were found to be significantly lower in the ICNB group than in the control group (p < 0.05). The mean 24 h intravenous tramadol consumption was 97.5 ± 39.5 mg for the ICNB group which was significantly lower than the 199.7 ± 77.6 mg recorded for the control group (p < 0.05).

CONCLUSION

In PCNL with nephrostomy tube placement US-guided ICNB performed at the 11th and 12th intercostal spaces provided effective analgesia.

The effects of tramadol infiltration on wound healing in rats

PURPOSE

Infiltration of a local anesthetic to provide postoperative analgesia is a frequently used method. However the infiltrated agents may have negative effects on wound healing. This study aimed to investigate the effects of tramadol, a weak opioid with a local anesthetic effect, on wound healing.

METHODS

Wistar albino rats were used in the study. Tramadol and saline infiltration was randomly performed on the left and right backs of rats. Following a linear incision, the site was sutured. A follow-up was conducted after seven days, and the tissue samples from both locations were extracted for histopathological examinations (fibrotic index : no fibrosis 0, mild 1, moderate 2, severe 3) and hydroxyproline measurements.

RESULTS

The hydroxyproline level found in the tramadol group was 0.060 +/- 0.04 ng/mg.protein. In the control group the hydroxyproline level was 0.012 +/-0.01 ng/mg.protein (p = 0.01). The fibrotic index levels in the tramadol group were higher than the control group (p < 0.001).

CONCLUSION

It was concluded that tramadol infiltration in a surgical incision site has no adverse effect on wound healing.

The effects of supplementation with a mixture of arginine, glutamine, and beta-hydroxy beta-methylbutyrate on the healing of colon anastomoses

BACKGROUND

Several researchers have investigated how wound healing is effected by supplementation with each of the following amino acids : arginine (Arg), glutamine (Glu), and beta-hydroxy beta-methylbutyrate (HMB). This research investigates how a combination of these amino acids improves the wound healing associated with anastomoses.

METHODS

We tested the effects of a combination of Arg, Glu, and HMB on the healing of colon anastomoses in 50 male rats. We randomly divided the animals into two equal groups. In each animal, the cecum was transected from its midpoint to create an end-to end anastomosis. During the first postoperative week, Group 1 (G1) animals were fed standard chow, and Group 2 (G2) animals were fed standard chow plus a ready-to-use supplement that contained a mixture of Arg, Glu, and HMB. At the end of the week, all of the rats were sacrificed, and a cecum segment containing the anastomosis line was resected. Bursting pressure and tissue hydroxyproline were measured for all animals.

RESULTS

The mean values for hydroxyproline were 0.0013 ng/mg protein/ml (SD +/-0.00075) and 0.034 ng/mg protein/ ml (SD +/- 0.022) for G1 and G2, respectively (p <0.0001). The mean values for bursting pressure measurements were 122.8 mmHg (SD +/- 9.4) and 192.8 mmHg (SD+/- 31) for G1 and G2, respectively (p <0.0001). Statistically significant differences between the groups in terms of both bursting pressure levels and tissue hydroxyproline levels were observed.

CONCLUSION

In an animal model of colon surgery, supplementation with a combination of three amino acids seemingly benefits anastomosis healing.

Assessment of the Ability of Anaesthetists to Locate the Internal Jugular Vein by the Anatomic Landmark Technique with Ultrasonography: Right or Left, Does it Make any Difference?

OBJECTIVE

To assess senior and junior anaesthetists' ability to locate the right and left jugular vein (IJV) using the anatomic landmark technique.

METHODS

A total of 45 anaesthetists were included in this study. Initially, a questionnaire assessing the experiences of the anaesthetists was completed. The anaesthetists were grouped into two groups, junior and senior. The anaesthetists, who were blind to the screen, were asked to point to the internal jugular vein bilaterally on the neck of a healthy volunteer using an ultrasound probe with the midpoint as an 'imaginary needle'. The success rates for locating the right and left IJV in both junior and senior groups were assessed separately.

RESULTS

The success rate for locating the right IJV was 88% (n=26, 23/26) in the senior and 68.4% (n=19, 13/19) in the junior group (p<0.001). The success rate for locating the left IJV was 69% (18/26) in the senior and 78% (15/19) in the junior group (p<0.001), while the difference in success rates for locating the right and left IJV in the senior group was found to be statistically significant (p<0.001).

CONCLUSION

Both use of the anatomic landmark technique and experience increased the success rate. Especially in the less preferred left IJV catheterization, use of the anatomic landmark technique independent of the experience factor could increase the success rate.

Effect of magnesium sulphate on bleeding during lumbar discectomy

We assessed the effect of magnesium on the amount of bleeding, coagulation profiles and surgical conditions during lumbar discectomy under general anaesthesia. Forty patients, of ASA physical status 1-2 and aged 18-65 years, undergoing single-level microscopic lumbar discectomy, were randomly assigned to magnesium sulphate (50 mg.kg(-1) in 100 ml saline over 10 min followed by a continuous infusion of 20 mg.kg.h(-1) ) or saline. The mean (SD) estimated blood loss was 190 (95) and 362 (170) ml in the magnesium and saline groups, respectively (mean difference = 172 ml; 95% CI 84-260 ml). The median (IQR [range]) Fromme's scale score for surgical conditions for the magnesium and saline groups were 2 (2-3 [2-3]) and 3 (2-3 [3-4]), respectively (p < 0.05). The bleeding time, haemoglobin, platelet count, prothrombin time, international normalised ratio and fibrinogen levels were similar in the two groups. The activated partial thromboplastin time was prolonged in the magnesium group immediately postoperatively and at 6 h after surgery. After the bolus of magnesium, the heart rate was higher and the mean arterial pressure lower in the magnesium group. The use of magnesium sulphate during lumbar discectomy decreases blood loss, and provides better surgical conditions without marked haemodynamic effects.