{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:22:20Z","timestamp":1785435740387,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Indonesian Endowment Fund for Education","award":["4303\/B3\/DT.03.08\/2025"],"award-info":[{"award-number":["4303\/B3\/DT.03.08\/2025"]}]},{"name":"Indonesian Endowment Fund for Education","award":["3927\/UN6.RKT\/HK.07.00\/2025"],"award-info":[{"award-number":["3927\/UN6.RKT\/HK.07.00\/2025"]}]},{"award":["4303\/B3\/DT.03.08\/2025"],"award-info":[{"award-number":["4303\/B3\/DT.03.08\/2025"]}],"id":[{"id":"https:\/\/ror.org\/05p2xef58","id-type":"ROR","asserted-by":"publisher"}]},{"award":["3927\/UN6.RKT\/HK.07.00\/2025"],"award-info":[{"award-number":["3927\/UN6.RKT\/HK.07.00\/2025"]}],"id":[{"id":"https:\/\/ror.org\/05p2xef58","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Strict hemodynamic stability is critical during supratentorial craniotomy. This systematic review and meta-analysis aimed to evaluate the efficacy of magnesium sulfate (MgSO4) as a multimodal adjuvant on intraoperative hemodynamics, opioid consumption, and biomarker outcomes in this setting. Methods: We systematically searched PubMed, Scopus, EBSCO, and the Cochrane Library for randomized controlled trials (RCTs) comparing perioperative MgSO4 administration to placebo or standard care in adult patients undergoing elective supratentorial craniotomy. Results: Meta-analysis of nine included RCTs using a random-effects model demonstrated that MgSO4 significantly reduced intraoperative mean arterial pressure (mean difference [MD]: \u22124.65 mmHg; 95% confidence interval [CI]: \u22127.76 to \u22121.55; p = 0.0033; I2 = 73.6%). Furthermore, MgSO4 administration significantly lowered postoperative serum S100B levels (standardized MD [SMD]: \u22120.81; 95% CI: \u22121.24 to \u22120.38; p = 0.0002, I2 = 0.0%), indicating mitigated cellular neural damage, and decreased perioperative fentanyl consumption (standardized MD: \u22121.01; 95% CI: \u22121.45 to \u22120.57; p &lt; 0.0001; I2 = 0.0%). Intraoperative blood loss volume did not differ significantly between groups (MD: \u221285.03 mL; 95% CI: \u2212331.42 to 161.37; p = 0.4952; I2 = 92.5%). Conclusions: MgSO4 is a safe and effective multimodal adjuvant for supratentorial craniotomy, providing significant hemodynamic stability, opioid-sparing effects, and preliminary biochemical evidence suggestive of neuroprotection without compromising intraoperative hemostasis.<\/jats:p>","DOI":"10.3390\/jcm15124636","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:49:01Z","timestamp":1781570941000},"page":"4636","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Magnesium Sulfate as a Multimodal Anesthetic Adjuvant in Brain Tumor Surgery: A Systematic Review and Meta-Analysis of Hemodynamic, Analgesic, and Biomarker Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6354-2279","authenticated-orcid":false,"given":"Khairunnisai","family":"Tarimah","sequence":"first","affiliation":[{"name":"Doctoral Study Program in Medical Science, Faculty of Medicine, Universitas Padjadjaran, Ir. Soekarno Street Km. 21, Jatinangor, Sumedang 45363, Indonesia"},{"name":"Department of Anesthesia and Intensive Care, RSUD H.Muh Roeslan Mataram City, Faculty of Medicine, Universitas Islam Al Azhar Mataram, Lombok 83237, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0634-2134","authenticated-orcid":false,"given":"Iwan","family":"Fu\u2019adi","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Division of Neuroanesthesia and Critical Care, Faculty of Medicine, Universitas Padjadjaran, Ir. Soekarno Street Km. 21, Jatinangor, Sumedang 45363, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5676-7804","authenticated-orcid":false,"given":"Elvan","family":"Wiyarta","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jawa Barat 16424, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5676-0787","authenticated-orcid":false,"given":"Lisda","family":"Amalia","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Universitas Padjadjaran, Ir. Soekarno Street Km. 21, Jatinangor, Sumedang 45363, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatang","family":"Bisri","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitas Jendral Achmad Yani, Bandung 40525, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dewi Yulianti","family":"Bisri","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Division of Neuroanesthesia and Critical Care, Faculty of Medicine, Universitas Padjadjaran, Ir. Soekarno Street Km. 21, Jatinangor, Sumedang 45363, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Lizano-D\u00edez, I., Poteet, S., Burniol-Garc\u00eda, A., and Cerezales, M. (2022). The Burden of Perioperative Hypertension\/Hypotension: A Systematic Review. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0263737"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1213\/ANE.0000000000006789","article-title":"Perioperative Patients with Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation","volume":"138","author":"Scott","year":"2023","journal-title":"Anesth. Analg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2245","DOI":"10.1113\/JP285058","article-title":"Hypertension, Blood\u2013brain Barrier Disruption and Changes in Intracranial Pressure","volume":"603","author":"Colombari","year":"2025","journal-title":"J. Physiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e099864","DOI":"10.1136\/bmjopen-2025-099864","article-title":"Opioid-Free Anaesthesia and Postoperative Quality of Recovery in Patients Undergoing Supratentorial Tumour Resection: Protocol for A Randomised Controlled Trial","volume":"15","author":"Fu","year":"2025","journal-title":"BMJ Open"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Salom\u00e9, A., Harkouk, H., Fletcher, D., and Martinez, V. (2021). Opioid-Free Anesthesia Benefit\u2013Risk Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Clin. Med., 10.","DOI":"10.3390\/jcm10102069"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3120","DOI":"10.1007\/s11695-025-08008-y","article-title":"Effect of Opioid-Free Versus Opioid Anesthesia on the Quality of Postoperative Recovery in Patients Receiving Laparoscopic Sleeve Gastrectomy","volume":"35","author":"Song","year":"2025","journal-title":"Obes. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Campos, J., Bas, J., Campos, C., Mariscal, G., Bas, T., and Bas, P. (2024). Efficacy and Safety of Intravenous Magnesium Sulfate in Spinal Surgery: A Systematic Review and Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13113122"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Cazzaniga, A., Fedele, G., Castiglioni, S., and Maier, J. (2022). The Presence of Blood\u2013Brain Barrier Modulates the Response to Magnesium Salts in Human Brain Organoids. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23095133"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s10143-024-02291-6","article-title":"The Glymphatic System for Neurosurgeons: A Scoping Review","volume":"47","author":"Masri","year":"2024","journal-title":"Neurosurg. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kulik, K., \u017by\u017cy\u0144ska-Granica, B., Kowalczyk, A., Kurowski, P., Gajewska, M., and Bujalska-Zadro\u017cny, M. (2021). Magnesium and Morphine in the Treatment of Chronic Neuropathic Pain\u2013A Biomedical Mechanism of Action. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222413599"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sohn, H., Kim, B., Bae, Y., Seo, W., and Jeon, Y. (2021). Magnesium Sulfate Enables Patient Immobilization during Moderate Block and Ameliorates the Pain and Analgesic Requirements in Spine Surgery. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194289"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"znad101.068","DOI":"10.1093\/bjs\/znad101.068","article-title":"Magnesium, the Anaesthetists\u2019 Friend during Carotid Endarterectomy (CEA)","volume":"10","author":"Myers","year":"2023","journal-title":"BJS"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Fiorentini, D., Cappadone, C., Farruggia, G., and Prata, C. (2021). Magnesium: Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency. Nutrients, 13.","DOI":"10.3390\/nu13041136"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"111347","DOI":"10.1016\/j.jocn.2025.111347","article-title":"Comparative Evaluation of Analgesic Efficacy of Ketamine and Magnesium Sulfate as Adjuvants to Bupivacaine for Scalp Block in Supratentorial Craniotomy: A Randomized, Double-Blind Clinical Study","volume":"137","author":"Kadian","year":"2025","journal-title":"J. Clin. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e22379","DOI":"10.5812\/aapm.22379","article-title":"Evaluation of the Anti-Inflammatory Effects of Peri-Operative Infusion of Magnesium Sulfate on the Microsurgical Procedures for Intracranial Tumors","volume":"4","author":"Etezadi","year":"2014","journal-title":"Anesthesiol. Pain Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1007\/s00701-015-2376-x","article-title":"Effect of Magnesium on Functional Outcome and Paraclinical Parameters of Patients Undergoing Supratentorial Craniotomy for Brain Tumors: A Randomized Controlled Trial","volume":"157","author":"Mirrahimi","year":"2015","journal-title":"Acta Neurochir."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"299","DOI":"10.4103\/sja.SJA_837_18","article-title":"Effect of Magnesium and Lignocaine on Post-Craniotomy Pain: A Comparative, Randomized, Double Blind, Placebo-Controlled Study","volume":"13","author":"Mahajan","year":"2019","journal-title":"Saudi J. Anaesth."},{"key":"ref_18","first-page":"76","article-title":"Effect of Intravenous Magnesium Sulfate on Patients Undergoing Craniotomy for Meningioma Excision","volume":"9","author":"Premkumar","year":"2020","journal-title":"Glob. J. Res. Anal."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1055\/s-0042-1750692","article-title":"Effects of Magnesium Sulfate on Intraoperative Blood Loss and Anesthetic Requirement in Meningioma Patients Undergoing Craniotomy with Tumor Removal: A Prospective Randomized Study","volume":"9","author":"Jitsinthunun","year":"2022","journal-title":"J. Neuroanaesth. Crit. Care"},{"key":"ref_20","first-page":"108","article-title":"Lidocaine versus Magnesium Sulfate Infusion during Isoflurane Anesthesia for Brain Tumor Resection, Effect on Minimum Alveolar Concentration Reduction Guided by Bispectral Index: A Prospective Randomized Controlled Trial","volume":"18","author":"Aboelela","year":"2022","journal-title":"Signa Vitae"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e149422","DOI":"10.5812\/jcma-149422","article-title":"A Comparison of Dexmedetomidine and Magnesium Sulfate as an Anesthetic Adjuvant in Trans-Sphenoidal Pituitary Surgery","volume":"9","author":"Nashibi","year":"2024","journal-title":"J. Cell. Mol. Anesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"45","DOI":"10.23736\/S0375-9393.24.18401-5","article-title":"Effect of Perioperative Magnesium Sulfate on Neurological Outcome in Neurosurgical Patients: A Randomized Double-Blind Controlled Trial","volume":"91","author":"Gracia","year":"2025","journal-title":"Minerva Anestesiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Sohn, H., Ahn, H., Seo, W., Yi, I., and Park, J. (2022). Magnesium Sulfate and Cerebral Oxygen Saturation in Mild Traumatic Brain Injury: A Randomized, Double-Blind, Controlled Trial. J. Clin. Med., 11.","DOI":"10.3390\/jcm11123388"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lang, B., Zhang, L., Lin, Y., Zhang, W., Li, F., and Chen, S. (2020). Comparison of Effects and Safety in Providing Controlled Hypotension during Surgery between Dexmedetomidine and Magnesium Sulphate: A Meta-Analysis of Randomized Controlled Trials. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227410"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.bja.2023.08.026","article-title":"Intraoperative Hypotension and Postoperative Outcomes: A Meta-Analysis of Randomised Trials","volume":"131","author":"Fominskiy","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Gan, L., Qian, K., Yang, J., Cai, Q., Ye, Q., Dai, M., Jia, Z., Jiang, T., Ma, C., and Lin, X. (2025). Intraoperative Transcutaneous Electrical Acupoint Stimulation Combined with Anesthesia to Prevent Postoperative Cognitive Dysfunction: A Systematic Review and Meta-Analysis. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0313622"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Wang, X., Chen, X., Wu, F., Liu, Y., Yang, Y., Chen, W., Pan, Z., Hu, W., Zheng, F., and He, H. (2023). Relationship between Postoperative Biomarkers of Neuronal Injury and Postoperative Cognitive Dysfunction: A Meta-Analysis. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0284728"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1896","DOI":"10.7150\/thno.104879","article-title":"MgSO4 as a Novel Hypothermia Infusion Solution Promotes Ischemic Stroke Recovery through Ca2+ Regulation of Neurovascular Units","volume":"15","author":"Zhang","year":"2025","journal-title":"Theranostics"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lee, Y., Kim, B., Park, J., Kim, S., and Park, H. (2020). The Effect of Intraoperative Magnesium Sulphate Infusion on Emergence Agitation after Ambulatory Ophthalmic Surgery in Children. J. Clin. Med., 9.","DOI":"10.3390\/jcm9124126"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4636\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T01:16:17Z","timestamp":1781572577000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4636"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124636"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124636","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]}}}