A loading dose of 70 mg/kg magnesium sulfate followed by an infusion of 1 to 4 g/h to keep serum levels between 2.5 and 4 mmol/l reduces systemic vascular resistance, pulse rate, and to a small extent cardiac output. The release of epinephrine (adrenaline) from the adrenal gland and norepinephrine (noradrenaline) from peripheral nerve terminals is inhibited and the sensitivity of receptors to these neurotransmitters is reduced. Magnesium also has a marked neuromuscular blocking effect, and may reduce the intensity of muscle spasms. However, it cannot be used without sedation and serum levels are difficult to maintain. Serum calcium needs to be monitored and occasionally requires supplementation.
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