Portal de Periódicos da CAPES

Intraoperative Magnesium Administration Does Not Improve Neurocognitive Function After Cardiac Surgery

2013; Lippincott Williams & Wilkins; Volume: 44; Issue: 12 Linguagem: Inglês

10.1161/strokeaha.113.002703

1524-4628

Joseph P. Mathew, William D. White, David B. Schinderle, Mihai V. Podgoreanu, Miles Berger, Carmelo A. Milano, Daniel T. Laskowitz, Mark Stafford‐Smith, James A. Blumenthal, Mark F. Newman, Joseph P. Mathew, James A. Blumenthal, Manuel A. Fontes, Miklós D. Kertai, Frederick W. Lombard, Joseph P. Mathew, David L. McDonagh, Terri G. Monk, Mark F. Newman, Mihai V. Podgoreanu, Mark Stafford‐Smith, Madhav Swaminathan, David S. Warner, Bonita L. Funk, Narai Balajonda, Roger L. Hall, Tiffany Bisanar, Karen Clemmons, Yi‐Ju Li, Greg Pecora, Yi‐Ju Li, Yanne Toulgoat-Dubois, Peter Waweru, William D. White, Michael A. Babyak, James A. Blumenthal, Jeffrey N. Browndyke, Kathleen A. Welsh‐Bohmer, Daniel B. Mark, Michael H. Sketch, Ellen Bennett, Carmelo Graffagnino, Daniel T. Laskowitz, Warren J. Strittmatter, Stanlin Alexander, Kevin Collins, Greg Smigla, Ian Shearer, Mark F. Berry, Thomas A. D’Amico, Mani A. Daneshmand, R. Duane Davis, Jeffrey G. Gaca, Donald D. Glower, R. David Harpole, G. Chad Hughes, Robert D.B. Jaquiss, Shu S. Lin, Andrew J. Lodge, Carmelo A. Milano, Mark W. Onaitis, J. Schroeder, Peter K. Smith, Betty C. Tong,

Cardiac, Anesthesia and Surgical Outcomes

Background and Purpose— Neurocognitive decline occurs frequently after cardiac surgery and persists in a significant number of patients. Magnesium is thought to provide neuroprotection by preservation of cellular energy metabolism, blockade of the N-methyl-D-aspartate receptor, diminution of the inflammatory response, and inhibition of platelet activation. We therefore hypothesized that intraoperative magnesium administration would decrease postoperative cognitive impairment. Methods— After approval by the Duke University Health System Institutional Review Board, 389 patients undergoing cardiac surgery were enrolled in this prospective, randomized, double-blind, placebo-controlled clinical trial. Subjects were randomized to receive magnesium as a 50 mg/kg bolus followed by another 50 mg/kg infusion for 3 hours or placebo bolus and infusion. Cognitive function was assessed preoperatively and again at 6 weeks postoperatively using a standardized test battery. Mean CD11b fluorescence and percentage of platelets expressing CD62P, which are markers of leukocyte and platelet activation, respectively, were assessed by flow cytometry as a secondary outcome. The effect of magnesium on postoperative cognition was tested using multivariable regression modeling, adjusting for age, years of education, baseline cognition, sex, race, and weight. Results— Among the 389 allocated subjects (magnesium: n=198; placebo: n=191), the incidence of cognitive deficit in the magnesium group was 44.4% compared with 44.9% in the placebo group ( P =0.93). The cognitive change score and platelet and leukocyte activation were also not different between the groups. Multivariable analysis revealed a marginal interaction between treatment group and weight such that heavier subjects receiving magnesium were less likely to have cognitive deficit ( P =0.06). Conclusions— Magnesium administered intravenously during cardiac surgery does not reduce postoperative cognitive dysfunction. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00041392.