Magnesium Group Research Articles

Preparation and characterization of carboxylated cellulose nanofibrils with dual metal counterions

Surface C6-carboxylated cellulose nanofibrils (TCNF-COONa) were prepared from wood cellulose by TEMPO/NaBr/NaClO oxidation in water at pH 10 and successive mechanical disintegration of the oxidized cellulose in water. Aqueous TCNF dispersions with magnesium and calcium carboxylate groups, TCNF-COOMg and TCNF-COOCa, respectively, were prepared in high yields of 85–90% from aqueous TCNF-COONa dispersion by addition of aqueous MgCl2 and CaCl2 solutions, respectively, to the aqueous TCNF-COONa dispersion, washing the gels with water by filtration without drying, and successive mechanical disintegration of the gels in water. The cast-dried TCNF-COONa, TCNF-COOMg, and TCNF-COOMg films had no significant differences in density and water content at 23 °C and 50% relative humidity. Consequently, they had similar mechanical properties. Aqueous TCNF-COONa/Mg and TCNF-COONa/Ca dispersions were prepared by mixing TCNF-COONa and either TCNF-COOMg or TCNF-COOCa dispersion at a weight ratio of 1:1. Oxygen permeabilities of the TCNF-COONa/Mg and TCNF-COOCa films had the lowest and highest values at 50% RH, respectively, while those of the TCNF-COOMg and TCNF-COONa/Ca films had the lowest and highest values at 80%, respectively. The Na and Mg counterions in the aqueous TCNF-COONa/Mg dispersion were homogeneously distributed in each TCNF element without separately keeping individual TCNF-COONa and TCNF-COOMg elements.

Oral Magnesium Supplementation Improved Lipid Profile but Increased Insulin Resistance in Patients with Diabetic Nephropathy: a Double-Blind Randomized Controlled Clinical Trial.

Low serum magnesium concentrations were associated with development of renal failure. We aimed to determine whether magnesium supplementation improves renal function, insulin resistance, and metabolic profiles in patients with diabetic nephropathy. A total of 80 hypomagnesemic patients diagnosed with type 2 diabetes and early-stage nephropathy were recruited. Subjects received either daily magnesium oxide or placebo for 12weeks. Biochemical and anthropometric variables were measured. Physical activity and dietary intakes were also recorded. This study was approved by the ethics committee of Isfahan University of Medical Sciences and was registered on the Iranian Registry of Clinical Trials website (IRCT registration no. IRCT201404271485N12). Serum magnesium levels were not changed significantly. Although the supplementation did not influence glycemic indices, patients in the magnesium group had greater insulin resistance compared with the placebo group after intervention (0.3 ± 2.3μIU/mL vs. - 0.04 ± 2.05, P = 0.04). No significant changes were observed in serum total cholesterol, triglycerides, HDL, LDL, and total cholesterol/HDL cholesterol ratio. Furthermore, magnesium did not affect inflammation, serum levels of creatinine, and blood urine nitrogen. However, a marginal decrease in microalbuminuria (- 3.1 ± 2.2mg/L vs. - 14 ± 9.9, P = 0.09) was observed. Oral magnesium supplementation slightly improved microalbuminuria but resulted in increased insulin resistance in patients with diabetic nephropathy.

A Study on Effects of Magnesium Sulphate Infusion in Preventing Cardiac Arrhythmia During Off Pump Beating Heart Coronary Artery Bypass Grafting (CABG) Surgery

Objective: The objective of the present study was to see the effect of magnesium in preventing cardiac arrhythmias in patients undergoing coronary artery bypass grafting (CABG) surgery.
 Methods: This study was carried out in the Department of Anesthesia, Analgesia and Intensive Care Medicine (Cardiac Anesthesia Wing) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka who underwent CABG surgery under general anaesthesia. A total of 60 patients scheduled for CABG were consecutively selected and were randomly divided into study group and control group. Patients aged 35-70 years irrespective of sex, ASA grade I & II, NYHA functional class I & II and ejection fraction 35-65% were included in the study. The study group was treated by vecuronium, fentanyl and magnesium sulphate infusion, while the control group was treated by vecuronium and fentanyl infusion. The demographic variables, preoperative clinical characteristics, peroperative variables and haemodynamic findings were observed at different time intervals.
 Results: The mean ages of the study and control groups were 51.0 ± 6.9 years and 53.8 ± 6.2 years respectively. Males demonstrated their predominance in both magnesium (83.3%) and control (76.7%) groups. The distribution of preoperative confounding factors like diabetes, previous MI, hypertension and ejection fraction were not statistically different between the study groups. Two-thirds (67.7%) of the patients in magnesium group and 53.3% in the control group required 3 grafts. Number of 4 grafts in magnesium and control groups was 20% and 30% respectively and that of 2 grafts was 13.3% and 16.7% respectively. In the study group, out of 30 patients, 3(10%) developed arrhythmia, while in the control group out of 30 patients, 5(16.7%) developed arrhythmia (p = 0.353).The haemodynamic parameters in patients receiving magnesium were more stable during the whole period of observation.
 Conclusion: The findings of the study suggest that magnesium could reduce the development of arrhythmia to an acceptable level in patients undergoing beating heart CABG surgery. However, further study with large sample is recommended to achieve a conclusive remark.
 Ibrahim Card Med J 2017; 7 (1&2): 37-43

The efficacy of magnesium oxide and sodium valproate in prevention of migraine headache: a randomized, controlled, double-blind, crossover study.

Migraine is a disabling disorder that affects the quality of life of patients. Different medications have been used in prevention of migraine headache. In this study, we evaluated the effectiveness of magnesium oxide in comparison with valproate sodium in preventing migraine headache attacks. This is a single-center, randomized, controlled, crossover trial which is double-blind, 24-week, 2-sequence, 2-period, 2-treatment. After patient randomization into two sequences, the intervention group received magnesium oxide 500mg and the control group received valproate sodium 400mg two tablets each day (every 12h) for 8 weeks. The primary efficacy variable was reduction in the number of migraine attacks and number of days with moderate or severe headache and hours with headache (duration) per month in the final of 8 weeks in comparison with baseline. Seventy patients were randomized and seven dropped out, leaving 63 for analysis. In an intention-to-treat analysis, 31 patients were in group 1 (magnesium oxide-valproate) and 32 patients were in group 2 (valproate-magnesium oxide). The mean number of migraine attacks and days per month was 1.72 ± 1.18 and 2.09 ± 1.70, with a mean duration of 15.50 ± 21.80h in magnesium group and 1.27 ± 1.27 and 2.22 ± 1.96, with a mean duration 13.38 ± 14.10 in valproate group. This study has shown that 500mg magnesium oxide appears to be effective in migraine prophylaxis similar to valproate sodium without significant adverse effect.

Magnesium based materials for hydrogen based energy storage: Past, present and future

Magnesium hydride owns the largest share of publications on solid materials for hydrogen storage. The “Magnesium group” of international experts contributing to IEA Task 32 “Hydrogen Based Energy Storage” recently published two review papers presenting the activities of the group focused on magnesium hydride based materials and on Mg based compounds for hydrogen and energy storage. This review article not only overviews the latest activities on both fundamental aspects of Mg-based hydrides and their applications, but also presents a historic overview on the topic and outlines projected future developments. Particular attention is paid to the theoretical and experimental studies of Mg-H system at extreme pressures, kinetics and thermodynamics of the systems based on MgH2, nanostructuring, new Mg-based compounds and novel composites, and catalysis in the Mg based H storage systems. Finally, thermal energy storage and upscaled H storage systems accommodating MgH2 are presented.

Analysis of Calcium Levels in Groundwater and Dental Caries in the Coastal Population of an Archipelago Country.

BACKGROUND:The coastal region is the largest region in Indonesia as a country of the archipelago. Characteristics of groundwater content in coastal areas are very influential on dental health, especially dental caries. The main elements contained in 1-1000 mg/litre groundwater are calcium, magnesium, sodium, potassium, chlorine, bicarbonate, and sulfate groups. Calcium is an essential ingredient for living organisms that play a role in the formation of bone and tooth along with permeability of cell walls.AIM:This study aimed to analyse the relationship between calcium in groundwater with dental caries.METHOD:Analytical observational study with cross-sectional approach was implemented was coastal communities in Watu Ulo Jember Regency in February 2018 (3,686 inhabitants), with sample criteria of the minimum age of 12 years and consumed groundwater as drinking water at least 2 years by purposive side. The variables in this study were calcium levels as the independent variable and dental caries as the dependent variable. Calcium was measured using the spectrophotometric method. Caries measurements were performed using the DMF-T index. Data were presented descriptively in the table and analysed by Spearman Correlation test to analyze the relationship between groundwater calcium with dental caries.RESULTS:Average groundwater calcium content was 126.75 mg/litre (high category), and average dental caries was 2.2 (low category). Spearman correlation analysis showed p = 0.029 (p < 0.000), which means there was a correlation between groundwater calcium level with dental caries.CONCLUSION:There is a positive relationship between the calcium content of groundwater with dental caries.

Dexmedetomidine versus Magnesium as Adjuvants to Bupivacaine-Induced Caudal Block in Children: A Randomized, Double-Blinded, Placebo-Controlled, Trial.

BACKGROUND:Caudal block remains fundamental in pediatric anaesthetic practice. It is very useful in a wide range of surgical procedures and has proved to have a remarkable safety record, But one of the major limitations of the single-injection technique is the relatively short duration of postoperative analgesia. Prolongation of caudal analgesia using single-shot technique has been achieved by the addition of various adjuvant.AIM:This work aims to compare magnesium and dexmedetomidine as adjuvants to bupivacaine-induced caudal block in children undergoing lower limb orthopaedic surgery.STUDY DESIGN:Randomized, double-blind trial.SETTINGS:Pediatric or of a tertiary care centre.METHODS:A double-blinded, randomised controlled trial included 36 children, aged between 1 and 7 years, scheduled for lower limb orthopaedic surgery. Patients received general anaesthesia in addition to the caudal block. Patients were divided into three groups: Dexmedetomidine group (n = 12): received 0.5 mL/Kg bupivacaine + 2 mcg/Kg dexmedetomidine, Magnesium group (n = 12): received 0.5 mL/Kg bupivacaine + 50 mg magnesium, and control group (n = 12): received 0.5 mL/Kg bupivacaine + normal saline. Patients were compared according to the duration of analgesia, pain scores, sedation scores, mean arterial pressure, and heart rate.RESULTS:Both magnesium group and dexmedetomidine group showed better analgesic profile (duration of analgesia and pain scores) compared to the control group without significant difference between the two former groups. Dexmedetomidine group showed higher sedation score, lower mean arterial pressure and lower heart rate compared to other groups.CONCLUSIONS:Both magnesium (50 mg) and dexmedetomidine (2 mcg/Kg) improved the analgesic profile of bupivacaine-induced caudal block in children. Dexmedetomidine administration was accompanied with higher sedation score and negative hemodynamic profile.

Effect of Intervenous Magnesium Sulfate on Decreasing Opioid Requirement after Surgery of the Lower Limb Fracture by Spinal Anesthesia.

Background:Magnesium is the calcium natural physiological antagonist; it also antagonizes N-Methyl-D-aspartate receptors, therefore, providing antinociceptive properties. The reason for effective role of treatment with magnesium on decreasing opioid usage, less dissatisfaction, and good sleep quality is proposed theoretically yet. This study aimed to evaluate the effect of magnesium sulfate on decreasing opioids requirement after surgery of the lower limbs fracture by spinal anesthesia.Methods:A total of 60 patients aged from 45 to 75 years with the lower limb fractures (femur and hip) candidate for surgery by spinal anesthesia. In a randomized double-blind method, patients were divided into two groups as Magnesium Group (M) and Control Group (C). Group M received a bolus of 5 mg/kg magnesium sulfate plus (250 CC) normal saline and Group C received (250 CC) normal saline in the same condition.Results:Pain score and the physical dissatisfaction were reduced at 12, 24, and 48 h after surgery in Group M as compared with Group C (P = 0.000). Total opioid requirement at the end of 48 h and at the first 24 h after surgery were reduced in Group M as compared with Group C (P = 0.001). The endurance of spinal block was increased in Group M as compared with Group C (P = 0.000).Conclusions:A low dose of magnesium sulfate reduced the pain score, opioid requirement, and physical dissatisfaction while increased endurance of spinal block.

The Use of Magnesium Sulphate and Morphine Vs. Morphine-Only in Irukandji Syndrome: A Retrospective Review of Ambulance Data

Introduction In 2006, the Queensland Ambulance Service (QAS) approved the use of magnesium sulphate for the management of patients with Irukandji syndrome (IS). The aim of this study was to compare pain scores and hypertensive (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg) patients who received intravenous morphine as their treatment (morphine group) over those who received a combination of intravenous morphine and magnesium (magnesium group). Methods A retrospective case review of all IS patients attended by the QAS between 2007 and 2014. A search of the QAS electronic data base found 112 patients had IS. Analyses in IBM SPSS v.22 was undertaken to determine the outcome in final pain scores and blood pressure between the two groups. Results Pain reduction was statistically different (F=29.18; p&lt;.01), between the morphine group and the magnesium group with mean numerical pain scores post-treatment of 4.91 (95% CI: 4.02–5.81) and 2.21 (95% CI: 1.66–2.76) respectively. There was a lower frequency of patients in the magnesium group who remained hypertensive on arrival at a medical facility, with a significant difference between mean arterial BP of 101 mmHg (95% CI: 96–105; p=.028) and diastolic BP of 84 mmHg (95% CI: 80–88; p=.029) post-treatment. Of the 54 cases in the magnesium group, 32 were normotensive post-treatment compared to only six from the morphine group (n=17). Conclusion There has been considerable difference of opinion as to the utility of magnesium in IS and a marked difference in the results of case series versus a small randomised control trial. This study suggests that the combination of morphine and magnesium is more effective in treating patients with IS than morphine alone.

Effects of Bispectral Index-controlled Use of Magnesium on Propofol Consumption and Sedation Level in Patients Undergoing Colonoscopy.

Objective:The aim of this study is to investigate the effects of bispectral index-controlled use of magnesium on propofol consumption, periprocedural hemodynamic response and patient comfort.Material:A total of 60 patients were enrolled in the study. In Group 1 (magnesium), a single dose 50 mg/kg magnesium sulfate diluted with 100 mL 0.9% NaCl was administered 10 minutes before the beginning of the procedure. Initially bolus dose of 0.5 mg/kg propofol was applied. The maintenance dose of propofol was 60 mcg/kg/min. During the procedure, the propofol infusion was increased by titration until the bispectral index (BIS) value of 70 was achieved. In Group 2 (saline), 100 ml 0.9% NaCl was administered 10 minutes before the beginning of the procedure. The bolus and maintenance doses of propofol, and target BIS values were the same as those in Group 1.Results:When BIS values were compared between the groups, the initial BIS values in the magnesium group (Group 1) were significantly higher than those of the saline group (Group 2) (p<0.05). The time to reach BIS 70 was significantly shorter in the magnesium group (p<0.05). Propofol consumption was greater in Group 2 than in Group 1 (p<0.05). The time to reach BIS 70 was significantly shorter in Group 1 (p<0.05). No significant difference was found between the groups in terms of patient- and endoscopist-satisfaction (p<0.05).Conclusion:The use of magnesium in addition to propofol may be an efficient and reliable option to reduce the drug consumption during colonoscopic interventions.

Comparative study between magnesium sulfate and ketamine added to lidocaine in ultrasound-guided supraclavicular brachial plexus block in upper limb surgery

Introduction Supraclavicular brachial plexus (SBP) block is an excellent substitute for general anesthesia during upper limb operations. It prevents undesirable effects of using general anesthesia and upper airway instruments. Moreover, it reduces the duration of hospitalization and costs and provides complete muscle relaxation. The ultrasound-guided technique requires a lower anesthetic volume to provide an efficient block and decreases the risk associated with intravascular injections and trauma to the surrounding tissues. Aim We conducted this study to compare the effect of ketamine versus magnesium sulfate as additives to lidocaine on onset and duration of sensory and motor block and duration of analgesia time, postoperative visual analog scale (VAS), total analgesic need, stress response (cortisol and blood glucose), and adverse effects in ultrasound-guided supraclavicular brachial plexus (SBP) block for patients who electively underwent upper limb surgeries. Patients and methods A total of 90 patients aged 21–65 years, with American Society of Anesthesiologists status I, II, and III, scheduled for elective upper limb surgeries under SBP block, were divided into three equal groups in a randomized controlled fashion: group C (n=30) received 25 ml 2% lidocaine plus 5 cm saline, group K (n=30) received 25 ml 2% lidocaine plus 2 mg/kg ketamine, and group M (n=30) received 25 ml 2% lidocaine plus 250 mg magnesium sulfate (total volume in all groups 30 ml). Hemodynamic variables such as mean arterial blood pressure and heart rate, onset and duration of sensory and motor block, postoperative VAS, time to first analgesic request, total analgesic need, stress response (cortisol and blood glucose), and adverse effects were recorded for each patient. Results The sensory block duration was 438.0±80.4 min in group K, 280.2±42.6 min in group M, and 132.0±24.6 min in group C, with a P value less than 0.001, which was statistically significant, whereas the motor block duration was 500±79 min in the group K, 342±50 min in group M, and 200±35 min in group C, with a P value less than 0.001, which was statistically significant, indicating a prolongation in block duration in the ketamine group followed by magnesium group and then control group. The most significant and highest VAS pain scores were found in the control group at all time points (P&lt;0.001), whereas the K group had the lowest VAS. Postoperative analgesic requirement was less in K group when compared with other groups (P&lt;0.001). Conclusion Both ketamine and magnesium sulfate prolong the duration of analgesia without any major adverse effects. Ketamine is a better adjuvant to lidocaine for SBP than magnesium sulfate, as it has lower VAS and less postoperative analgesic requirement in upper limb surgeries.

Role of topical magnesium in post-operative sore throat: A systematic review and meta-analysis of randomised controlled trials.

Background and Aims:Post-operative sore throat (POST) is a common undesirable consequence of tracheal intubation. Magnesium, an N-methyl-D-aspartate receptor antagonist, has anti-nociceptive and anti-inflammatory properties, and has been found to be useful in POST prevention in various trials. We conducted this systematic review and meta-analysis to study the efficacy of topical magnesium in preventing POST in adult patients undergoing surgery under general anaesthesia with single lumen tracheal tube.Methods:Comprehensive literature search was performed in PubMed, Google Scholar, EMBASE, Scopus and the Cochrane central registers of controlled trial databases through July, 2018 and data were pooled using fixed effect modelling followed by random-effect methods (after assessing heterogeneity with fixed modelling). The primary outcome was the incidence of POST at 24 h after surgery/extubation. Comparative results were deliberated as pooled mean difference for continuous variables and Mantel–Haenszel (MH) odds ratio for dichotomous variables. Statistical analysis was done using Comprehensive Meta-Analysis-Version 3 (Biostat Inc., USA).Results:Seven trials involving 726 study participants were included in the final analysis. Incidence of POST at 24 hours was significantly lower in magnesium group (26/363) in comparison to active and non-active control group (89/363); P = 0.00- RR 0.22 (95%CI = 0.12-0.39, I2 = 0%). No significant adverse events were reported with the use of topical magnesium.Conclusion:Prophylactic use of topical magnesium before the induction of general anaesthesia seems to be an effective measure to decrease the incidence of POST.

Randomised Control Trial of Dexmedetomidine and Magnesium Sulfate as an Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block

Background Several adjuvants potentiate peripheral nerve block. We studied effects of adding magnesium sulfate or dexmedetomidine to 20 ml 0.75% ropivacaine for supraclavicular brachial plexus block. Materials and Method 80 patients were divided in four groups, which, in addition to ropivacaine, received: Group A- 1 ml normal saline, Group B- 125 mg magnesium sulfate, Group C- 250 mg magnesium sulfate, Group D- 1 μg/kg dexmedetomidine. Results Duration of analgesia was significantly prolonged, onset of sensory and motor blockade was hastened and analgesic requirement was reduced in a dose responsive manner (for magnesium group), without causing clinically significant and unmanageable side effects. Intensity of potentiation was higher with dexmedetomidine than magnesium sulfate. Conclusion Magnesium sulfate potentiates supraclavicular block in a dose dependent manner. Potentiation by dexmedetomidine is greater than that by magnesium sulfate.

Effect of intravenous versus intraperitoneal magnesium sulfate on hemodynamic parameters and postoperative analgesia during laparoscopic sleeve gastrectomy-A prospective randomized study.

Background and Aims:Hemodynamic changes to pneumoperitoneum and postoperative pain can be detrimental in obese patients; we investigated whether intravenous (IV) or intraperitoneal (IP) magnesium sulphate (MgSo4) administration could attenuate the hemodynamic stress response to pneumoperitoneum and improve postoperative pain control after laparoscopic sleeve gastrectomy (LSG).Material and Methods:In total, 120 patients scheduled for LSG were randomized to either, control group (Group C, IV and IP saline), Group I (IV 30 mg/kg MgSo4), or Group P (IP 30 mg/kg MgSo4). Outcome variables were mean arterial pressure (MAP), heart rate (HR), postoperative pain score, total analgesic consumption, and incidence of adverse events.Results:MAP and HR were significantly lower in Groups I and P than that in control group. Pain score was better in Groups I and P than in control group up to 2 h postoperative (P = 0.023, 0.010, respectively); it was significantly lower in Group P than other two groups at 4 h postoperative (P <0.001). Significantly, reduced postoperative analgesic consumption with delayed onset to first analgesic request were observed in magnesium groups compared to control (P = 0.001, respectively). Moreover, onset to first analgesic request was longer in Group P than Group I (P = 0.001). No serious side effects were noticed.Conclusion:The IV and IP administration of MgSo4 significantly attenuated the circulatory response to pneumoperitoneum and reduced postoperative pain as well as opioid consumption as compared to controls in obese patients undergoing LSG with no serious adverse effects.

Efeitos do sulfato de magnésio e da milrinona sobre o vasoespasmo cerebral após hemorragia subaracnoidea por aneurisma: estudo randômico

BackgroundAneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. MethodsThe study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500mg.day−1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5μg.kg−1.min−1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity≥120cm.s−1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%). ResultsThe mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p<0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p=0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p=0.036, p=0.012, p=0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p=0.012). ConclusionsThe incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.

Association between intraoperative magnesium sulfate infusion and mortality after non-cardiac surgery: a retrospective propensity score matched analysis.

The short-term effects of magnesium sulfate infusion during surgery are well known. However, the long-term outcomes of intraoperative magnesium sulfate infusion remain unknown. Medical records of patients aged ≥20 years who underwent non-cardiac surgical procedures at Seoul National University Bundang Hospital between January, 2010 and October, 2016 were analyzed. After propensity score matching, 12,652 patients were included in the final analysis, 6326 each in the magnesium and non-magnesium groups. There were no significant differences in 30-day or 1-year mortality between subjects [30-day mortality, hazard ratio (HR): 1.31, 95% CI: 0.64-2.69, P = 0.465; 1-year mortality, HR: 1.20, 95%CI: 0.94-1.53, P = 0.136]. Intraoperative magnesium sulfate infusion was not significantly associated with postoperative 30-day or 1-year mortality.

Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study

BackgroundAneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. MethodsThe study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500mg.day−1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5μg.kg−1.min−1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow velocity≥120cm.s−1), neurological deterioration by Glasgow coma scale, or angiography (the decrease in diameter of the involved cerebral artery >25%). ResultsThe mean cerebral blood flow velocity decreased significantly in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p<0.001). The incidence of cerebral vasospasm decreased significantly with magnesium compared to milrinone (p=0.007). The Glasgow coma scale significantly improved in the magnesium group compared to milrinone group through Day 7, Day 14 and Day 21 (p=0.036, p=0.012, p=0.016, respectively). The incidence of hypotension was higher with milrinone than magnesium (p=0.012). ConclusionsThe incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage was significantly lower and Glasgow coma scale significantly better with magnesium when compared to milrinone. Milrinone was associated with a higher incidence of hypotension and requirement for dopamine and norepinephrine when compared to magnesium.

Administration of Magnesium and its Association with Prevention of Ventricular Arrhythmias Following Cardiopulmonary Bypass in Open Heart Surgery

Background: The development of cardiac arrhythmias following open- heart surgery is fairly common. Hypomagnesemia appear to be a significant element in the genesis of postoperative ventricular arrhythmias. Purpose of this study is to evaluate the effects of postoperative use of magnesium following cardiopulmonary bypass and minimize the risk of dreadful ventricular arrhythmia.Methods: Total 80 (Eighty) patients were enrolled for this study divided in 2 groups, Group A (n=40): patients who were given Magnesium Sulphate and Group B (n=40): patients who were not given Magnesium. Monitoring of the patient in ICU was done for incidence of ventricular arrhythmias.Results: From this study the incidence of postoperative ventricular arrhythmia was less in the magnesium treated group than the control group. Mean serum magnesium concentration decreased to subnormal value, immediately after surgery in both magnesium-treated and untreated groups.Conclusions: Routine intravenous magnesium administration can reduce the incidence of ventricular arrhythmias after cardiac surgery following cardiopulmonary bypass.Cardiovasc. j. 2018; 11(1): 23-30

Effect of magnesium on cognition after aneurysmal subarachnoid haemorrhage in a randomized trial.

Background and purposeIn randomized trials magnesium supplementation did not improve clinical outcome after aneurysmal subarachnoid haemorrhage (aSAH) on handicap scales. After aSAH, many patients have cognitive problems that may not translate into handicap. The effect of magnesium on cognitive outcome after aSAH was studied.MethodsIn total, 209 patients who had been included in the Magnesium for Aneurysmal Subarachnoid Haemorrhage (MASH‐2) trial in the University Medical Centre of Utrecht were studied. Patients had been randomized to 64 mmol magnesium sulfate daily or placebo during hospitalization. Three months after aSAH patients underwent a neuropsychological examination (NPE) consisting of six neuropsychological tests or a brief cognitive assessment. Poisson and linear regression analyses were used to analyse the effect of magnesium on cognition.ResultsIn the magnesium group 53 (49.5%) of the 107 patients and in the placebo group 51 (50.0%) of the 102 patients scored lower than the median cognitive score [relative risk 0.99, 95% confidence interval (CI) 0.76–1.30]. Linear regression analyses showed no significant relationship between intervention and cognition (B = 0.05, 95% CI −0.15 to 0.33).ConclusionsTreatment with magnesium has no effect on cognitive outcome after aSAH.

Magnesium Protects in Episodes of Critical Perfusion after Aneurysmal SAH.

BackgroundTo analyze whether magnesium has a neuroprotective effect during episodes that indicate a critical brain perfusion after aneurysmal subarachnoid hemorrhage (SAH).Methods107 patients with aSAH were randomized to continuously receive intravenous magnesium sulfate with target serum levels of 2.0 – 2.5 mmol/l (n = 54) or isotonic saline (n = 53). Neurological examination and transcranial Doppler sonography (TCD) were performed daily, Perfusion-CT (PCT) was acquired in 3-day intervals, angiography in case of suspected vasospasm. The primary endpoint was the development of secondary infarction following episodes of delayed ischemic neurological deficit (DIND), elevated mean flow velocity (MFV) in TCD or pathological findings in PCT.ResultsIn the magnesium group, 9 episodes of DIND were registered, none was followed by secondary infarction. In the control group, 23 episodes of DIND were registered, 9 were followed by secondary infarction (p < 0.05). In the magnesium group, 114 TCD-measurements showed an elevated MFV(> 140 cm/s). 7 were followed by new infarction. In control patients, 135 measurements showed elevated MFV, 32 were followed by new infarction (p < 0.05). 10 of 117 abnormal PCT-findings were followed by new infarction, compared to 30 of 122 in the control-group (p < 0.05).ConclusionDIND, elevated MFV in TCD and abnormal PCT are findings which are associated with an increased risk to develop delayed secondary infarction. The results of this analysis suggest that magnesium-treatment may reduce the risk to develop infarction in a state of critical brain perfusion.