Magnesium substitution in elective coronary artery surgery: A double-blind clinical study

Autor: Aimo Ruokonen, Martti Lepojärvi, Juhani Koistinen, Lauri S. Nuutinen, Juha Nissinen, Jouko J Laurila, Risto Pokela, Esa Salmela, Jan-Ola M. Wistbacka, Risto Hanhela, Kai E. V. Karlqvist
Rok vydání: 1995
Předmět:
Male
Cardiac Complexes
Premature
Pacemaker
Artificial
medicine.medical_specialty
Magnesium Chloride
chemistry.chemical_element
law.invention
Magnesium Sulfate
Bolus (medicine)
Double-Blind Method
law
medicine.artery
Internal medicine
Atrial Fibrillation
Tachycardia
Supraventricular
Cardiopulmonary bypass
medicine
Humans
Magnesium
Prospective Studies
Derivation
Coronary Artery Bypass
Infusions
Intravenous
Creatine Kinase
Morning
Aorta
business.industry
Arrhythmias
Cardiac
Atrial fibrillation
Middle Aged
medicine.disease
Isoenzymes
medicine.anatomical_structure
Anesthesiology and Pain Medicine
chemistry
Elective Surgical Procedures
Anesthesia
Ventricular Fibrillation
Ventricular fibrillation
Cardiology
Calcium
Female
Bolus (digestion)
Cardiology and Cardiovascular Medicine
business
Complication
Artery
Zdroj: Journal of Cardiothoracic and Vascular Anesthesia. 9:140-146
ISSN: 1053-0770
DOI: 10.1016/s1053-0770(05)80184-3
Popis: Magnesium may be beneficial in the control of ventricular ectopy and supraventricular tachyarrhythmias after coronary artery bypass graft (CABG) surgery, but it is not known whether a high-dose magnesium regimen is superior to a regimen keeping the patient normomagnesemic. A prospective randomized and double-blind clinical comparison was performed in 81 elective CABG patients in order to assess the effects of two different magnesium infusion regimens on electrolyte balance and postoperative arrhythmias. Forty-one patients (high-dose group, H) received 4.2 ± 0.7 g (mean ± SD), of magnesium sulfate before cardiopulmonary bypass, followed by an infusion of 11.9 ± 2.8 g of magnesium chloride until the first postoperative (PO) morning, and a further 5.5 ± 1.0 g until the second PO morning. Forty patients (low-dose group, L) received magnesium sulfate only after bypass to a total of 2.9 ± 0.5 g at the first, and 1.4 ± 0.1 g at the second PO morning. A blood cardioplegia technique was used in both groups, including bolus doses of magnesium chloride to a total of 2.4 ± 0.6 g and 2.3 ± 0.6 g to H and L patients, respectively. Continuous Holter tape-recording was used for 12 to 15 hours preoperatively, and for 48 hours postoperatively. Serum magnesium peaked in H patients on the first PO morning at 1.60 ± 0.25 mmol/L, whereafter it declined to the normal level on the third PO morning. Patients in the L group were normomagnesemic, except after the start of bypass. Recovery to spontaneous rhythm after declamping of the aorta was better in the H patients; only one patient had ventricular fibrillation (VF), whereas in the L group, four patients had VF and five patients needed a temporary pacemaker ( p = 0.016). Atrial fibrillation (AF) was detected in 3 H (7.3%), and 10 L patients (25%) within the first 48 PO hours ( p = 0.037). Ten H (24.3%) and 18 L patients (45.0%) had a total of 19 and 41 episodes of AF during the first PO week ( p p = 0.013).
Databáze: OpenAIRE
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