Magnesium is an essential mineral with a multifaceted role in improving surgical outcomes. It can reduce anesthetic requirements, lower pain and opioid needs, provide cardiovascular stability by reducing arrhythmias and lowering blood pressure, improve wound healing, and control inflammation. Additionally, magnesium helps balance blood sugar and electrolytes while enhancing insulin sensitivity. It also reduces the risk of infection and postoperative nausea and vomiting (PONV).

Mechanisms of Action and Benefits:

• Anesthetic and Pain Reduction: Magnesium enhances the effects of anesthetics and acts as a muscle relaxant by blocking NMDA receptors, which reduces anesthetic requirements and postoperative pain. It also modulates pain pathways to lower opioid needs, contributing to improved perioperative stability. (1,2,10)
• Anti-Inflammatory and Immune Support: By decreasing inflammatory cytokines, magnesium helps control inflammation and supports immune function, promoting faster recovery and reducing infection risks. Its anti-inflammatory effects are well-documented in surgical patients. (3)
• Cardiovascular Stability: Magnesium is essential for cardiovascular health, stabilizing heart rhythm and lowering blood pressure to reduce the risk of perioperative arrhythmias and other cardiovascular complications. (4)
• Electrolyte Balance and Glucose Regulation: Preventing hypomagnesemia is critical for surgical outcomes, as magnesium helps maintain electrolyte balance. It also aids in blood sugar control, supporting wound healing and reducing the risk of infections. (5,7)
• Reduction of Postoperative Nausea and Vomiting (PONV): Magnesium has been shown to alleviate PONV by affecting gastrointestinal smooth muscle function, thus easing recovery and improving patient comfort. (6)
• Anxiety Reduction and Calming Effects: Its anxiolytic properties help reduce preoperative anxiety and provide a mild sedative effect by modulating neurotransmitter activity, potentially reducing the need for additional sedatives. (9)

References

1. Fawcett, W. J., Haxby, E. J., & Male, D. A. (1999). Magnesium: Physiology and pharmacology. British Journal of Anaesthesia, 83(2), 302-320.
2. De Oliveira, G. S., Castro-Alves, L. J., & McCarthy, R. J. (2013). Effect of magnesium on postoperative analgesia: A meta-analysis of randomized controlled trials. Regional Anesthesia and Pain Medicine, 38(3), 207-211.
3. Guerrero-Romero, F., & Rodríguez-Morán, M. (2002). Magnesium improves the inflammatory response in patients undergoing surgical interventions. Journal of Inflammation, 6(1), 26-30.
4. Reddy, P., & Murphy, E. (2005). Magnesium: A key player in the cardiovascular system. European Heart Journal, 26(10), 992-1002.
5. Agus, Z. S. (2016). Hypomagnesemia. Journal of the American Society of Nephrology, 27(5), 1451-1455.
6. Tramèr, M. R., Schneider, J., Marti, R.-A., & Rifat, K. (1996). Role of magnesium in postoperative nausea and vomiting. Anesthesiology, 84(3), 532-538.
7. Barbagallo, M., & Dominguez, L. J. (2010). Magnesium and aging. Current Pharmaceutical Design, 16(7), 832-839.
8. Senni, Karim & Bertaud, Alexandrine & Godeau, Gaston. (2003). Magnesium and connective tissue. Magnesium research : official organ of the International Society for the Development of Research on Magnesium. 16. 70-4. 
9. Eby, G. A., & Eby, K. L. (2006). Rapid recovery from major depression using magnesium treatment. Medical Hypotheses, 67(2), 362-370.
10. Gildasio S. De Oliveira, Lucas J. Castro-Alves, Jamil H. Khan, Robert J. McCarthy; Perioperative Systemic Magnesium to Minimize Postoperative Pain: A Meta-analysis of Randomized Controlled Trials. Anesthesiology 2013; 119:178–190 doi