Effect of Nebulized Magnesium Sulfate on Post-intubation Stress Response in Patients Undergoing Laparoscopic Cholecystectomy

This randomized controlled double blinded study will be carried out on 140 patients underwent elective fit laparoscopic cholecystectomy at El-Rajhi Assiut University Hospital.

Inclusion criteria:

* 20-50 years old. * Both sexes. * American society of anesthesiologists (ASA) physical status I-II. * Elective fit laparoscopic cholecystectomy

Exclusion criteria:

* Patient refusal. * Patients with history of hypersensitivity to magnesium sulfate. * Patients with coronary ischemic disease, atrioventricular block of any degree, known cardiac arrhythmias, heart failure on beta blockers or calcium channel blockers expected difficult intubation (Mallampati 4). * Body mass index (BMI) \> 40 kg/m2.

An online randomization program (http://www.randomizer.org) will be used to generate a random list and each patients' code will be kept in an opaque sealed envelope. Patients will be randomly allocated with 1:1 allocation ratio into two equal groups in a parallel manner:

* Group A: (N=70) Patients will receive nebulized magnesium sulfate in 5 ml (250 mg) over 15 min. * Group B: (N=70) Patients received nebulized normal saline in 5 ml over 15 min, ending 5 min before the induction of anesthesia.

A. Preoperative assessment:

All patients will be subjected to the followings:

1. Demographic data collection (age, weight, height, BMI, and ASA). 2. Complete clinical examination. 3. Routine Laboratory investigations:

* Random blood sugar. * Blood sample withdrawal for cortisol level at baseline 2ml intravenously. The sample will be sent to be centrifugated within 30 minutes and the serum will be separated and stored in -20°C till time of cortisol level by ELIZA technique.