To assess the effectiveness of intravenously administered MgSO4 as an adjunct to nitroglycerine infusion in hypertensive encephalopathy.
18 patients with hypertensive encephalopathy(HE) admitted in the CCU over a period of 3 years. Randomly assigned to two groups viz.Group A(n = 10): patients with HE receiving MgSO4 as an adjunct to NTG infusionGroup B(n = 8): patients with HE receiving only NTG infusion for control of BPNTG infusion was started at a dose of 0.5ug/kg/min & gradually titrated up till desired level of BP control was acheived in both the groups. Patients in Group A were given MgSO4 as a 2g I/V bolus when the requirement of NTG infusion was greater than 2ug/kg/min.The end point of therapy was considered to be a 30% reduction in admission mean arterial pressure(MAP) values or to a BP of 160/90mm og Hg, whichever was higher.
Patients in Grp.A had a more rapid and smoother control of BP compared to Grp.B. The requirement of NTG infusion was lesser in Grp.A compared to Grp.B.One patient in Grp.B had intracerebral haemorrhage which was diagnosed at 24 hrs. after admission.Patients in Grp.A required lesser amount of sedation for restlessness than in Group B.
MgSO4 is a useful adjunct to NTG in the acute control of BP in patients with HE. Its use also results in a reduction of the dose of NTG needed.It proably also potentiates the action of sedatives & analgesics.
MgSO4 has documented cerebro-protective effectsalong with its potential to relax smooth muscle. It is also a physiological antagonist of Ca++. These properties makes its use in controlling the BP in HE, as an adjuvant to NTG,very useful.Its use in our study was not associated with any serious adverse effects other than to cause flushing & a feeling of warmth on injection.
A.K. Dam, None.