Neuroprotective Effects of Magnesium Sulphate in Anesthesia and Neurocritical Care Settings: A Systematic Review

<ns3:p>Background Magnesium sulphate (MgSO₄) is increasingly recognized for its anti-inflammatory and neuroprotective properties, making it a promising adjunct in neuroanesthesia and neurocritical care. Its pharmacological actions—such as NMDA receptor antagonism, calcium channel blockade, and modulation of inflammatory pathways—may contribute to improved patient outcomes. This systematic review evaluates current evidence on the role of MgSO₄ in neuroanesthesia and neurocritical care settings. Methods A systematic search was conducted in PubMed, Scopus, Cochrane Library, ProQuest, and ScienceDirect, from inception until April 18, 2025 for studies evaluating the effects of MgSO₄ in adult patients undergoing neurosurgical procedures or treated in neurocritical care. Outcomes of interest included neurological recovery, cerebral vasospasm, delayed cerebral ischemia (DCI), postoperative opioid requirements, hemodynamic stability, and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool and the Newcastle-Ottawa Scale. Results Ten studies were included in this review. MgSO₄ administration was consistently associated with improved neurological recovery, as indicated by better modified Rankin Scale scores. Several trials reported a significant reduction in the incidence of cerebral vasospasm and DCI among MgSO₄-treated patients. Magnesium also demonstrated analgesic benefits, with reduced postoperative opioid requirements and pain scores. Hemodynamic stability was enhanced in the magnesium groups across multiple studies. Importantly, no significant increase in adverse events was reported, supporting the safety of MgSO₄ in this context. Conclusion This systematic review supports the potential of MgSO₄ as a safe and effective adjunct in neuroanesthesia and neurocritical care. Its anti-inflammatory and neuroprotective effects appear to translate into meaningful clinical benefits.</ns3:p>