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Liu B, Li M, Wang J, Zhang F, Wang F, Jin C, Li J, Wang Y, Sanderson TH, Zhang R. The role of magnesium in cardiac arrest. Front Nutr 2024; 11:1387268. [PMID: 38812935 PMCID: PMC11133868 DOI: 10.3389/fnut.2024.1387268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiac arrest is a leading cause of death globally. Only 25.8% of in-hospital and 33.5% of out-of-hospital individuals who achieve spontaneous circulation following cardiac arrest survive to leave the hospital. Respiratory failure and acute coronary syndrome are the two most common etiologies of cardiac arrest. Effort has been made to improve the outcomes of individuals resuscitated from cardiac arrest. Magnesium is an ion that is critical to the function of all cells and organs. It is often overlooked in everyday clinical practice. At present, there have only been a small number of reviews discussing the role of magnesium in cardiac arrest. In this review, for the first time, we provide a comprehensive overview of magnesium research in cardiac arrest focusing on the effects of magnesium on the occurrence and prognosis of cardiac arrest, as well as in the two main diseases causing cardiac arrest, respiratory failure and acute coronary syndrome. The current findings support the view that magnesium disorder is associated with increased risk of cardiac arrest as well as respiratory failure and acute coronary syndrome.
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Affiliation(s)
- Baoshan Liu
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Muyuan Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Jian Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Fengli Zhang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Fangze Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Caicai Jin
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Jiayi Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
| | - Yanran Wang
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- School of Anesthesiology, Shandong Second Medical University, Weifang, China
| | - Thomas Hudson Sanderson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Rui Zhang
- School of Clinical Medicine, Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
- Department of Cardiology, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Weifang, The First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, China
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Halonen J, Kärkkäinen J, Jäntti H, Martikainen T, Valtola A, Ellam S, Väliaho E, Santala E, Räsänen J, Juutilainen A, Mahlamäki V, Vasankari S, Vasankari T, Hartikainen J. Prevention of Atrial Fibrillation After Cardiac Surgery: A Review of Literature and Comparison of Different Treatment Modalities. Cardiol Rev 2024; 32:248-256. [PMID: 36729126 DOI: 10.1097/crd.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Atrial fibrillation is the most common arrhythmia to occur after cardiac surgery, with an incidence of 10% to 50%. It is associated with postoperative complications including increased risk of stroke, prolonged hospital stays and increased costs. Despite new insights into the mechanisms of atrial fibrillation, no specific etiologic factor has been identified as the sole perpetrator of the arrhythmia. Current evidence suggests that the pathophysiology of atrial fibrillation in general, as well as after cardiac surgery, is multifactorial. Studies have also shown that new-onset postoperative atrial fibrillation following cardiac surgery is associated with a higher risk of short-term and long-term mortality. Furthermore, it has been demonstrated that prophylactic medical therapy decreases the incidence of postoperative atrial fibrillation after cardiac surgery. Of note, the incidence of postoperative atrial fibrillation has not changed during the last decades despite the numerous preventive strategies and operative techniques proposed, although the perioperative and postoperative care of cardiac patients as such has improved.
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Affiliation(s)
- Jari Halonen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jussi Kärkkäinen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Tero Martikainen
- Department of Anesthesiology and Operative Services, Kuopio University Hospital, Kuopio, Finland
| | - Antti Valtola
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Sten Ellam
- Department of Anesthesiology and Operative Services, Kuopio University Hospital, Kuopio, Finland
| | - Eemu Väliaho
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Elmeri Santala
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jenni Räsänen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Auni Juutilainen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Visa Mahlamäki
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sini Vasankari
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland
- The Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Hartikainen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
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3
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Curran J, Ross-White A, Sibley S. Magnesium prophylaxis of new-onset atrial fibrillation: A systematic review and meta-analysis. PLoS One 2023; 18:e0292974. [PMID: 37883337 PMCID: PMC10602269 DOI: 10.1371/journal.pone.0292974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Atrial fibrillation (AF) is the most common cardiac arrhythmia in intensive care units (ICU) and is associated with increased morbidity and mortality. Magnesium prophylaxis has been shown to reduce incidence of AF in cardiac surgery patients, however, evidence outside this population is limited. The objective of this study is to summarize studies examining magnesium versus placebo in the prevention of NOAF outside the setting of cardiac surgery. SOURCE We performed a comprehensive search of MEDLINE, EMBASE, and Cochrane Library (CENTRAL) from inception until January 3rd, 2023. We included all interventional research studies that compared magnesium to placebo and excluded case reports and post cardiac surgery patients. We conducted meta-analysis using the inverse variance method with random effects modelling. PRINCIPAL FINDINGS Of the 1493 studies imported for screening, 87 full texts were assessed for eligibility and six citations, representing five randomized controlled trials (n = 4713), were included in the review, with four studies (n = 4654) included in the pooled analysis. Administration of magnesium did not significantly reduce the incidence of NOAF compared to placebo (OR 0.72, [95% CI 0.48 to 1.09]). CONCLUSION Use of magnesium did not reduce the incidence of NOAF, however these studies represent diverse groups and are hindered by significant bias. Further studies are necessary to determine if there is benefit to magnesium prophylaxis for NOAF in non-cardiac surgery patients.
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Affiliation(s)
- Jeffrey Curran
- Department of Critical Care Medicine, Queen’s University, Kingston, Canada
| | - Amanda Ross-White
- Bracken Health Sciences Library, Queen’s University, Kingston, Canada
| | - Stephanie Sibley
- Department of Critical Care Medicine, Queen’s University, Kingston, Canada
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Saglietti F, Girombelli A, Marelli S, Vetrone F, Balzanelli MG, Tabaee Damavandi P. Role of Magnesium in the Intensive Care Unit and Immunomodulation: A Literature Review. Vaccines (Basel) 2023; 11:1122. [PMID: 37376511 PMCID: PMC10304084 DOI: 10.3390/vaccines11061122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Both the role and the importance of magnesium in clinical practice have grown considerably in recent years. Emerging evidence suggests an association between loss of magnesium homeostasis and increased mortality in the critical care setting. The underlying mechanism is still unclear, but an increasing number of in vivo and in vitro studies on magnesium's immunomodulating capabilities may shed some light on the matter. This review aims to discuss the evidence behind magnesium homeostasis in critically ill patients, and its link with intensive care unit mortality via a likely magnesium-induced dysregulation of the immune response. The underlying pathogenetic mechanisms, and their implications for clinical outcomes, are discussed. The available evidence strongly supports the crucial role of magnesium in immune system regulation and inflammatory response. The loss of magnesium homeostasis has been associated with an elevated risk of bacterial infections, exacerbated sepsis progression, and detrimental effects on the cardiac, respiratory, neurological, and renal systems, ultimately leading to increased mortality. However, magnesium supplementation has been shown to be beneficial in these conditions, highlighting the importance of maintaining adequate magnesium levels in the intensive care setting.
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Affiliation(s)
- Francesco Saglietti
- Santa Croce and Carle Hospital, Department of Emergency and Critical Care, 12100 Cuneo, Italy
| | - Alessandro Girombelli
- Division of Anesthesiology, Department of Anesthesiology, Intensive care and Emergency Medicine, Ospedale Regionale di Lugano, 69000 Lugano, Switzerland;
| | - Stefano Marelli
- Department of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy; (S.M.); (F.V.)
| | - Francesco Vetrone
- Department of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy; (S.M.); (F.V.)
| | - Mario G. Balzanelli
- Department of Prehospital Emergency Medicine, ASL TA, Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy;
| | - Payam Tabaee Damavandi
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, School of Medicine and Surgery, Milan Center for Neuroscience, University of Milano-Bicocca, 20900 Monza, Italy;
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Li L, Lutsey PL, Chen LY, Soliman EZ, Rooney MR, Alonso A. Circulating Magnesium and Risk of Major Adverse Cardiac Events among Patients with Atrial Fibrillation in the ARIC Cohort. Nutrients 2023; 15:1211. [PMID: 36904210 PMCID: PMC10005106 DOI: 10.3390/nu15051211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Background: Serum magnesium (Mg) has been reported to be inversely associated with the risk of atrial fibrillation (AF), coronary artery disease (CAD), and major adverse cardiovascular events (MACE). The association between serum Mg and the risk of MACE, heart failure (HF), stroke, and all-cause mortality among patients with AF has not been evaluated. Objective: We aim to examine whether higher serum Mg is associated with a lower risk of MACE, heart failure (HF), stroke, and all-cause mortality among patients with AF. Methods: We evaluated prospectively 413 participants of the Atherosclerosis Risk in Communities (ARIC) Study with a diagnosis of AF at the time of Mg measurement participating in visit 5 (2011-2013). Serum Mg was modeled in tertiles and as a continuous variable in standard deviation units. Endpoints (HF, MI, stroke, cardiovascular (CV) death, all-cause mortality, and MACE) were identified and modeled separately using Cox proportional hazard regression adjusting for potential confounders. Results: During a mean follow-up of 5.8 years, there were 79 HFs, 34 MIs, 24 strokes, 80 CV deaths, 110 MACEs, and 198 total deaths. After adjustment for demographic and clinical variables, participants in the second and third tertiles of serum Mg had lower rates of most endpoints, with the strongest inverse association for the incidence of MI (HR 0.20, 95% CI 0.07, 0.61) comparing top to bottom tertile. Serum Mg modeled linearly as a continuous variable did not show clear associations with endpoints except MI (HR 0.50, 95% CI 0.31, 0.80). Due to the limited number of events, the precision of most estimates of association was relatively low. Conclusions: Among patients with AF, higher serum Mg was associated with a lower risk of developing incident MI and, to a lesser extent, other CV endpoints. Further studies in larger patients with AF cohorts are needed to evaluate the role of serum Mg in preventing adverse CV outcomes in these patients.
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Affiliation(s)
- Linzi Li
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin City, Minneapolis, MN 55455, USA
| | - Lin Yee Chen
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Mary R. Rooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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Peden CJ, Aggarwal G, Aitken RJ, Anderson ID, Bang Foss N, Cooper Z, Dhesi JK, French WB, Grant MC, Hammarqvist F, Hare SP, Havens JM, Holena DN, Hübner M, Kim JS, Lees NP, Ljungqvist O, Lobo DN, Mohseni S, Ordoñez CA, Quiney N, Urman RD, Wick E, Wu CL, Young-Fadok T, Scott M. Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization. World J Surg 2021; 45:1272-1290. [PMID: 33677649 PMCID: PMC8026421 DOI: 10.1007/s00268-021-05994-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach. METHODS Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1-Preoperative Care and Part 2-Intraoperative and Postoperative management. This paper provides guidelines for Part 1. RESULTS Twelve components of preoperative care were considered. Consensus was reached after three rounds. CONCLUSIONS These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.
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Affiliation(s)
- Carol J. Peden
- Department of Anesthesiology and Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA 90033 USA
- Department of Anesthesiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
| | - Geeta Aggarwal
- Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - Robert J. Aitken
- Sir Charles Gardiner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
| | - Iain D. Anderson
- Salford Royal NHS Foundation Trust, Stott La, Salford, M6 8HD UK
- University of Manchester, Manchester, UK
| | | | - Zara Cooper
- Harvard Medical School, Kessler Director, Center for Surgery and Public Health, Brigham and Women’s Hospital and Division of Trauma, Burns, Surgical Critical Care, and Emergency Surgery, Brigham and Women’s Hospital, 1620, Tremont Street, Boston, MA 02120 USA
| | - Jugdeep K. Dhesi
- Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, Division of Surgery & Interventional Science, University College London, London, UK
| | - W. Brenton French
- Department of Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street, Richmond, VA 23298 USA
| | - Michael C. Grant
- Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Folke Hammarqvist
- Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Huddinge Hälsovägen 3. B85, S 141 86, Stockholm, Sweden
| | - Sarah P. Hare
- Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY UK
| | - Joaquim M. Havens
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Daniel N. Holena
- Department of Surgery and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Jeniffer S. Kim
- Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA 90033 USA
| | - Nicholas P. Lees
- Department of General & Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, M6 8HD UK
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Dileep N. Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital & School of Medical Sciences, Örebro University, 701 85 Örebro, Sweden
| | - Carlos A. Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 – 49, 760032 Cali, Colombia
- Sección de Cirugía de Trauma Y Emergencias, Universidad del Valle – Hospital Universitario del Valle, Cl 5 No. 36-08, 760032 Cali, Colombia
| | - Nial Quiney
- Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX UK
| | - Richard D. Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital / Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Elizabeth Wick
- Department of Surgery, University of California San Francisco, 513 Parnassus Ave HSW1601, San Francisco, CA 94143 USA
| | - Christopher L. Wu
- Department of Anesthesiology, Critical Care and Pain Medicine-Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Department of Anesthesiology, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021 USA
| | - Tonia Young-Fadok
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054 USA
| | - Michael Scott
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
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Mathew AA, Panonnummal R. 'Magnesium'-the master cation-as a drug-possibilities and evidences. Biometals 2021; 34:955-986. [PMID: 34213669 PMCID: PMC8249833 DOI: 10.1007/s10534-021-00328-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
Magnesium (Mg2+) is the 2nd most abundant intracellular cation, which participates in various enzymatic reactions; there by regulating vital biological functions. Magnesium (Mg2+) can regulate several cations, including sodium, potassium, and calcium; it consequently maintains physiological functions like impulse conduction, blood pressure, heart rhythm, and muscle contraction. But, it doesn't get much attention in account with its functions, making it a "Forgotten cation". Like other cations, maintenance of the normal physiological level of Mg2+ is important. Its deficiency is associated with various diseases, which point out to the importance of Mg2+ as a drug. The roles of Mg2+ such as natural calcium antagonist, glutamate NMDA receptor blocker, vasodilator, antioxidant and anti-inflammatory agent are responsible for its therapeutic benefits. Various salts of Mg2+ are currently in clinical use, but their application is limited. This review collates all the possible mechanisms behind the behavior of magnesium as a drug at different disease conditions with clinical shreds of evidence.
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Affiliation(s)
- Aparna Ann Mathew
- Amrita School of Pharmacy, Amrita Institute of Medical Science & Research Centre, Amrita VishwaVidyapeetham, Kochi, 682041, India
| | - Rajitha Panonnummal
- Amrita School of Pharmacy, Amrita Institute of Medical Science & Research Centre, Amrita VishwaVidyapeetham, Kochi, 682041, India.
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Sharma S, Angral R, Saini H. Effect of Prophylaxis of Amiodarone and Magnesium to Prevent Atrial Fibrillation in Patients with Rheumatic Valve Disease Undergoing Mitral Valve Replacement Surgery. Anesth Essays Res 2020; 14:189-193. [PMID: 33487813 PMCID: PMC7819424 DOI: 10.4103/aer.aer_63_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/04/2020] [Accepted: 07/18/2020] [Indexed: 11/05/2022] Open
Abstract
CONTEXT Maintenance of sinus rhythm is superior to the incidence of atrial fibrillation (AF) in patients with rheumatic valve disease undergoing mitral valve replacement (MVR) surgery. AIM To evaluate the effect of prophylactic combination of intravenous (i.v.) amiodarone and magnesium sulfate (MgSO4) in patients undergoing MVR surgery. MATERIALS AND METHODS One hundred and twenty patients with valvular heart disease with or without AF were randomly divided into two groups. Group I (n = 60) received amiodarone (3 mg.kg -1 in 20 mL saline) + MgSO4 (30 mg.kg - 1 in 20 mL saline), and Group II (n = 60) received 40 mL of normal saline. The standardized protocol for cardiopulmonary bypass was maintained for all the patients. STATISTICAL ANALYSIS Continuous variables were expressed as mean ± standard deviation and categorical variables were summarized as frequencies and percentages. Student's independent t-test was employed for comparing continuous variables. Chi-square test was applied for comparing categorical variables. RESULTS Before surgery, AF was observed in 58.3% of patients in Group I and in 53.3% of patients in Group II (P = 0.581). Postoperatively, in the intensive care unit, 26.7% of the patients in Group I and 71.7% in Group II had AF (P < 0.001). At the time of discharge, 30% of patients in Group I and 73.3% of patients in Group II had AF (P < 0.001). CONCLUSION A single combined prophylactic intraoperative dose of i.v. amiodarone and MgSO4 decreased postbypass arrhythmia in comparison to the placebo group in patients of MVR surgery.
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Affiliation(s)
- Shruti Sharma
- Department of Cardiothoracic Anaesthesia, GMC, SSH, Jammu, Jammu and Kashmir, India
- Department of Anaesthesia, GMC, Doda, Jammu and Kashmir, India
| | - Rajesh Angral
- Department of Cardiothoracic Anaesthesia, GMC, SSH, Jammu, Jammu and Kashmir, India
- Department of Anaesthesia, GMC, Kathua, Jammu and Kashmir, India
| | - Heena Saini
- Department of Cardiothoracic Anaesthesia, GMC, SSH, Jammu, Jammu and Kashmir, India
- Department of Anaesthesia, GMC, Kathua, Jammu and Kashmir, India
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9
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Chaudhary R, Garg J, Turagam M, Chaudhary R, Gupta R, Nazir T, Bozorgnia B, Albert C, Lakkireddy D. Role of Prophylactic Magnesium Supplementation in Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials. J Atr Fibrillation 2019; 12:2154. [PMID: 31687067 DOI: 10.4022/jafib.2154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/14/2018] [Accepted: 12/20/2018] [Indexed: 01/22/2023]
Abstract
Background Several randomized trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aimed to determine the role of prophylactic Mg in 3 different settings (intraoperative, postoperative, intraoperative plus postoperative) in prevention of POAF. Methods A systemic literature search was performed (until January 19, 2019) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in POAF post CABG. Results We included a total of 2,430 participants (1,196 in the Mg group and 1,234 in the placebo group) enrolled in 20 randomized controlled trials. Pooled analysis demonstrated no reduction in POAF between the two groups (RR 0.90; 95% CI, 0.79-1.03; p=0.13; I2=42.9%). In subgroup analysis, significant reduction in POAF was observed with postoperative Mg supplementation (RR 0.76; 95% CI, 0.58-0.99; p=0.04; I2=17.6%) but not with intraoperative or intraoperative plus postoperative Mg supplementation (RR 0.77; 95% CI, 0.49-1.22; p = 0.27; I2=49% and RR 0.92; 95% CI, 0.68-1.24; p = 0.58; I2=51.8%, respectively). Conclusions Magnesium supplementation, especially in the postoperative period, is an effective strategy in reducing POAF following CABG.
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Affiliation(s)
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Medical College of Wisconsin Milwaukee, WI
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | | | - Rahul Gupta
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Talha Nazir
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Babak Bozorgnia
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Christine Albert
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
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Prevention of Cardiovascular Disease: Screening for Magnesium Deficiency. Cardiol Res Pract 2019; 2019:4874921. [PMID: 31192005 PMCID: PMC6525869 DOI: 10.1155/2019/4874921] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/17/2019] [Indexed: 12/15/2022] Open
Abstract
Magnesium is an essential mineral naturally present in the human body, where it acts as cofactor in several enzymatic reactions. Magnesium is a key cardiovascular regulator, which maintains electrical, metabolic, and vascular homeostasis. Moreover, magnesium participates in inflammation and oxidative processes. In fact, magnesium deficiency is involved in the pathophysiology of arterial hypertension, diabetes mellitus, dyslipidemia, metabolic syndrome, endothelial dysfunction, coronary artery disease, cardiac arrhythmias, and sudden cardiac death. In consideration of the great public-health impact of cardiovascular disease, the recognition of the negative effects of magnesium deficiency suggests the possible role of hypomagnesaemia as cardiovascular risk factor and the use of serum magnesium level for the screening and prevention of cardiovascular risk factors and cardiovascular diseases. Moreover, it might help with the identification of new therapeutical strategies for the management of cardiovascular disease through magnesium supplementation.
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Jannati M, Shahbazi S, Eshaghi L. Comparison of the Efficacy of Oral versus Intravascular Magnesium in the Prevention of Hypomagnesemia and Arrhythmia after CABG. Braz J Cardiovasc Surg 2019; 33:448-453. [PMID: 30517252 PMCID: PMC6257533 DOI: 10.21470/1678-9741-2018-0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/19/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Cardiac arrhythmias are a common challenge following open-heart surgeries.
Hypomagnesemia is believed to be correlated with this condition.
Prophylactic intravenous magnesium supplementation has been practiced for a
long time in patients undergoing CABG. This study was designed in an attempt
to compare the efficacy of oral versus intravenous routes
in the prevention of hypomagnesemia and arrhythmia. Methods In this interventional clinical study, 82 patients were randomly assigned to
2 groups. All patients were evaluated for baseline serum magnesium level and
arrhythmias. One group received 1,600 mg of oral magnesium hydroxide through
nasogastric (NG) tube prior to surgery, while the other group received 2 g
of magnesium sulfate during the induction of anesthesia. The serum magnesium
level was monitored for 48 hours after the operation. The difference in
preoperative hypomagnesemia was non-significant (Sig: 0.576). Results During the operation, the serum magnesium level peaked around 4 mg/dL, and no
hypomagnesemia was detected in any patient. Although the curve of oral group
declined parallel and below that of intravenous (IV) group, no significant
differences were detected during postoperative monitoring. In addition, a
prevalence of arrhythmia of 13.9% and 6.5% was noticed in IV and oral
groups, respectively (OR: 0.428). Conclusion Providing 1,600 mg of oral magnesium supplement to patients is as effective
as 2,000 mg of magnesium sulfate IV in preventing hypomagnesemia and
arrhythmia after CABG. Thus, the authors introduce this treatment regimen as
a promising and cost-effective method.
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Affiliation(s)
- Mansour Jannati
- Cardiovascular Surgery Ward, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrbanoo Shahbazi
- Department of Anesthesiology, Shiraz Anesthesiology and Critical and Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Eshaghi
- Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran
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Jedwab RM, Hutchinson AM, Redley B. Magnesium sulphate replacement therapy in cardiac surgery patients: A systematic review. Aust Crit Care 2018; 32:421-433. [PMID: 30501993 DOI: 10.1016/j.aucc.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 09/06/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this review was to identify evidence to inform clinical practice guidelines for magnesium sulphate (MgSO4) replacement therapy for postoperative cardiac surgery patients. DATA SOURCES Three databases were systematically searched: CINAHL Complete, MEDLINE Complete, and EmBase. REVIEW METHOD USED A systematic literature review method was used to locate, appraise, and synthesise available evidence for each step of the medication management cycle (indication, prescription, preparation, administration, and monitoring) for MgSO4 replacement therapy. Database searches used combinations of synonyms for postoperation or surgery, cardiac, heart, arrhythmia, atrial fibrillation, and magnesium sulphate. Search results were independently screened for inclusion by two researchers at title, abstract, and full-text stages with good statistical agreement (kappa scores of 0.99, 0.87, and 1.00, respectively). RESULTS Twenty-four included studies reported varying methodologies, data collected, and medication management practices. Of these, 23 studies (95.8%) excluded patients with comorbidities commonly observed in clinical practice. This review identified low-level evidence for two practice recommendations: (i) concurrent administration of MgSO4 with medications recommended as the best practice for prevention of postoperative atrial fibrillation and (ii) clinical and laboratory monitoring of magnesium blood serum levels, vital signs, and electrocardiography should be performed during MgSO4 replacement therapy. Evidence to inform MgSO4 replacement therapy for each medication management cycle step was limited; therefore, a guideline could not be developed. CONCLUSIONS Although MgSO4 is routinely administered to prevent hypomagnesaemia in postoperative cardiac surgery patients, there was insufficient evidence to guide critical care nurses in each medication management cycle step for MgSO4 replacement therapy. These findings precluded the development of comprehensive recommendations to standardise this practice. Poor standardisation can increase the risk for patient harm related to variation in clinical processes and procedural errors. In light of this evidence gap, consensus of expert opinion should be used as a strategy to guide MgSO4 medication management.
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Affiliation(s)
- Rebecca M Jedwab
- Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
| | - Alison M Hutchinson
- Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Deakin University, School of Nursing and Midwifery, Geelong, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Bernice Redley
- Centre for Quality and Patient Safety Research - Monash Health Partnership, 246 Clayton Road, Clayton, Victoria, 3168, Australia; Deakin University, School of Nursing and Midwifery, Geelong, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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13
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Salaminia S, Sayehmiri F, Angha P, Sayehmiri K, Motedayen M. Evaluating the effect of magnesium supplementation and cardiac arrhythmias after acute coronary syndrome: a systematic review and meta-analysis. BMC Cardiovasc Disord 2018; 18:129. [PMID: 29954320 PMCID: PMC6025730 DOI: 10.1186/s12872-018-0857-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 06/07/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Atrial and ventricular cardiac arrhythmias are one of the most common early complications after cardiac surgery and these serve as a major cause of mortality and morbidity after cardiac revascularization. We want to evaluate the effect of magnesium sulfate administration on the incidence of cardiac arrhythmias after cardiac revascularization by doing this systematic review and meta-analysis. METHODS The search performed in several databases (SID, Magiran, IranDoc, IranMedex, MedLib, PubMed, EmBase, Web of Science, Scopus, the Cochrane Library and Google Scholar) for published Randomized controlled trials before December 2017 that have reported the association between Magnesium consumption and the incidence of cardiac arrhythmias. This relationship measured using odds ratios (ORs) with a confidence interval of 95% (CIs). Funnel plots and Egger test used to examine publication bias. STATA (version 11.1) used for all analyses. RESULTS Twenty-two studies selected as eligible for this research and included in the final analysis. The total rate of ventricular arrhythmia was lower in the group receiving magnesium sulfate than placebo (11.88% versus 24.24%). The same trend obtained for the total incidence of supraventricular arrhythmia (10.36% in the magnesium versus 23.91% in the placebo group). In general the present meta-analysis showed that magnesium could decrease ventricular and supraventricular arrhythmias compared with placebo (OR = 0.32, 95% CI 0.16-0.49; p < 0.001 and OR = 0.42, 95% CI 0.22-0.65; p < 0.001, respectively). Subgroup analysis showed that the effect of magnesium on the incidence of cardiac arrhythmias was not affected by clinical settings and dosage of magnesium. Meta-regression analysis also showed that there was no significant association between the reduction of ventricular arrhythmias and sample size. CONCLUSION The results of this meta-analysis study suggest that magnesium sulfate can be used safely and effectively and is a cost-effective way in the prevention of many of ventricular and supraventricular arrhythmias.
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Affiliation(s)
- Shirvan Salaminia
- Department of Cardiac Surgery, Yasuj University of Medical Science, Yasuj, Iran
| | - Fatemeh Sayehmiri
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Angha
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Koroush Sayehmiri
- Department of Social Medicine, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Morteza Motedayen
- Department of Cardiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
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Baker WL. Treating arrhythmias with adjunctive magnesium: identifying future research directions. EUROPEAN HEART JOURNAL - CARDIOVASCULAR PHARMACOTHERAPY 2016:pvw028. [DOI: 10.1093/ehjcvp/pvw028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Rodríguez-Rubio L, Solis Garcia Del Pozo J, Nava E, Jordán J. Interaction between magnesium sulfate and neuromuscular blockers during the perioperative period. A systematic review and meta-analysis. J Clin Anesth 2016; 34:524-34. [PMID: 27687446 DOI: 10.1016/j.jclinane.2016.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/19/2016] [Accepted: 06/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Laura Rodríguez-Rubio
- Grupo de Neurofarmacología, Instituto de Investigación en Discapacidades Neurológicas-UCLM, Albacete, España; Servicio de Anestesia y Reanimación, Hospital de Almansa, Albacete, España.
| | - Julian Solis Garcia Del Pozo
- Grupo de Neurofarmacología, Instituto de Investigación en Discapacidades Neurológicas-UCLM, Albacete, España; Servicio de Medicina Interna, Hospital General de Villarrobledo, Albacete, España
| | - Eduardo Nava
- Departamento de Ciencias Médicas, Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, España
| | - Joaquín Jordán
- Grupo de Neurofarmacología, Instituto de Investigación en Discapacidades Neurológicas-UCLM, Albacete, España; Departamento de Ciencias Médicas, Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, España
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Rosanoff A, Dai Q, Shapses SA. Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Status Interact with Vitamin D and/or Calcium Status? Adv Nutr 2016; 7:25-43. [PMID: 26773013 PMCID: PMC4717874 DOI: 10.3945/an.115.008631] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Although much is known about magnesium, its interactions with calcium and vitamin D are less well studied. Magnesium intake is low in populations who consume modern processed-food diets. Low magnesium intake is associated with chronic diseases of global concern [e.g., cardiovascular disease (CVD), type 2 diabetes, metabolic syndrome, and skeletal disorders], as is low vitamin D status. No simple, reliable biomarker for whole-body magnesium status is currently available, which makes clinical assessment and interpretation of human magnesium research difficult. Between 1977 and 2012, US calcium intakes increased at a rate 2-2.5 times that of magnesium intakes, resulting in a dietary calcium to magnesium intake ratio of >3.0. Calcium to magnesium ratios <1.7 and >2.8 can be detrimental, and optimal ratios may be ∼2.0. Background calcium to magnesium ratios can affect studies of either mineral alone. For example, US studies (background Ca:Mg >3.0) showed benefits of high dietary or supplemental magnesium for CVD, whereas similar Chinese studies (background Ca:Mg <1.7) showed increased risks of CVD. Oral vitamin D is widely recommended in US age-sex groups with low dietary magnesium. Magnesium is a cofactor for vitamin D biosynthesis, transport, and activation; and vitamin D and magnesium studies both showed associations with several of the same chronic diseases. Research on possible magnesium and vitamin D interactions in these human diseases is currently rare. Increasing calcium to magnesium intake ratios, coupled with calcium and vitamin D supplementation coincident with suboptimal magnesium intakes, may have unknown health implications. Interactions of low magnesium status with calcium and vitamin D, especially during supplementation, require further study.
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Affiliation(s)
| | - Qi Dai
- Vanderbilt Epidemiology Center, Department of Medicine, School of Medicine, Vanderbilt University, Nashville, TN; and
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Lomivorotov VV, Efremov SM, Pokushalov EA, Karaskov AM. New-Onset Atrial Fibrillation After Cardiac Surgery: Pathophysiology, Prophylaxis, and Treatment. J Cardiothorac Vasc Anesth 2016; 30:200-16. [DOI: 10.1053/j.jvca.2015.08.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Indexed: 01/13/2023]
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18
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Klinger RY, Thunberg CA, White WD, Fontes M, Waldron NH, Piccini JP, Hughes GC, Podgoreanu MV, Stafford-Smith M, Newman MF, Mathew JP. Intraoperative Magnesium Administration Does Not Reduce Postoperative Atrial Fibrillation After Cardiac Surgery. Anesth Analg 2015; 121:861-867. [PMID: 26237622 DOI: 10.1213/ane.0000000000000873] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hypomagnesemia has been associated with an increased risk of postoperative atrial fibrillation (POAF). Although previous studies have suggested a beneficial effect of magnesium (Mg) therapy, almost all of these are limited by small sample size and relatively low Mg dose. We hypothesized that high-dose Mg decreases the occurrence of new-onset POAF, and we tested this hypothesis by using data from a prospective trial that assessed the effect of Mg on cognitive outcomes in patients undergoing cardiac surgery. METHODS A total of 389 patients undergoing cardiac surgery were enrolled in this double-blind, placebo-controlled trial. Subjects were randomized to receive Mg as a 50-mg/kg bolus immediately after induction of anesthesia followed by another 50 mg/kg as an infusion given over 3 hours (total dose, 100 mg/kg) or placebo. We tested the effect of Mg therapy on POAF with logistic regression, adjusting for the risk of atrial fibrillation (AF) by using the Multicenter Study of Perioperative Ischemia risk index for Atrial Fibrillation after Cardiac Surgery. RESULTS Among the 363 patients analyzed, after we excluded patients with chronic or acute preoperative AF (placebo: n = 177; Mg: n = 186), the incidence of new-onset POAF was 42.5% (95% confidence interval [CI], 35%-50%) in the Mg group compared with 37.9% (95% CI, 31%-45%) in the placebo group (P = 0.40). The 95% CI for this absolute risk difference of 4.6% is -5.5% to 14.7%. The time to onset of POAF also was identical between the groups, and no significant effect of Mg was found in logistic regression analysis after we adjusted for AF risk (odds ratio, 1.09; 95% CI, 0.69-1.72; P = 0.73). CONCLUSIONS High-dose intraoperative Mg therapy did not decrease the incidence of new-onset POAF after cardiac surgery.
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Affiliation(s)
- Rebecca Y Klinger
- From the Departments of Anesthesiology, Medicine-Cardiology, and Surgery, Duke University Medical Center, Durham, North Carolina
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Duan L, Zhang CF, Luo WJ, Gao Y, Chen R, Hu GH. Does magnesium-supplemented cardioplegia reduce cardiac injury? A meta-analysis of randomized controlled trials. J Card Surg 2015; 30:338-45. [PMID: 25652312 DOI: 10.1111/jocs.12518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Magnesium is often used to supplement cardioplegic solutions during cardiopulmonary bypass due to its cardioprotective effect during ischemia and reperfusion. The aim of this meta-analysis was to evaluate the effects of magnesium-supplemented cardioplegia versus an inactive (placebo) control cardioplegia on reducing cardiac injury after cardiac arrest surgery, as found by randomized, controlled trials. METHODS The Medline, Cochrane Library, and Chinese literature databases (CJFD, CBM, CSJD, Wanfang) were comprehensively searched for reports of randomized, controlled trials (RCTs) evaluating magnesium-supplemented cardioplegic solutions. The clinical parameters and outcomes of interest were the incidence of postoperative low cardiac output, auto-rebeating rate, ICU stay length, new onset postoperative atrial fibrillation, peak value of CK-MB (and/or cTnI), incidence of myocardial infarction, and in-hospital mortality. RESULTS Ten trials, with a total of 1214 patients, were included. The frequency of low cardiac output, inotropic utilization, and myocardial infarction, as well as auto-rebeating rate, length of ICU stay and in-hospital mortality, were similar between the two groups. There was a marginal reduction in the incidence of new-onset postoperative atrial fibrillation in the magnesium-supplemented cardioplegia group. CONCLUSIONS The advantage of magnesium-supplemented cardioplegia, compared with cardioplegia without magnesium, remains unconvincing based on the current evidence. The decision to add magnesium to the cardioplegic solution to a patient undergoing cardiac arrest surgery should be carefully considered.
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Affiliation(s)
- Lian Duan
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, China
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20
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Maaroos M, Tuomainen R, Price J, Rubens FD, Jideus RL, Halonen J, Hartikainen J, Hakala T. Preventive strategies for atrial fibrillation after cardiac surgery in Nordic countries. Scand J Surg 2015; 102:178-81. [PMID: 23963032 DOI: 10.1177/1457496913492671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Atrial fibrillation is a common arrhythmia after cardiac surgery. It increases morbidity, length of hospital stay, and costs of operative treatment. Beta-blockers, sotalol, amiodarone, corticosteroids, and biatrial pacing have been shown to be efficient in the prevention of postoperative atrial fibrillation. The aim of this study was to find out how widely different prophylactic strategies for postoperative atrial fibrillation are used in Scandinavian countries. MATERIAL AND METHODS An online link for a questionnaire was emailed to (214) cardiac surgeons in Finland, Sweden, Norway, Denmark, and Estonia to assess the use of prophylactic methods for postoperative atrial fibrillation. RESULTS A total of 97 surgeons responded to the survey. Oral beta-blockers were routinely used for atrial fibrillation prophylaxis by 62% of responders. The main reasons for nonuse of beta-blockers were that responders were unconvinced of the evidence of benefit or they preferred some alternative prophylaxis. Intravenous beta-blockers were used frequently by 6% of responders. Amiodarone was used for prophylaxis by 18% of responders. Nonusers were unconvinced of its efficacy, were afraid of its complications, or found its use too cumbersome. Other prophylactic atrial fibrillation strategies that were used are as follows: sotalol by 2%, magnesium by 17%, corticosteroids by 1%, and atrial pacing by 11% of respondents. CONCLUSIONS There is still widely varying implementation of strategies for atrial fibrillation prophylaxis among Scandinavian cardiac surgeons. Lack of confidence in the efficacy of these approaches is the main rationale for nonimplementation.
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Affiliation(s)
- M Maaroos
- Heart Center, Kuopio University Hospital, Kuopio, Finland
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Lee HY, Ghimire S, Kim EY. Magnesium supplementation reduces postoperative arrhythmias after cardiopulmonary bypass in pediatrics: a metaanalysis of randomized controlled trials. Pediatr Cardiol 2013; 34:1396-403. [PMID: 23443885 DOI: 10.1007/s00246-013-0658-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/06/2013] [Indexed: 11/30/2022]
Abstract
Postoperative arrhythmia (POA) is the most common complication encountered after cardiopulmonary bypass (CPB). The preventive effect of magnesium in POA has been confirmed by metaanalyses in adults, but less is known in pediatric patients. A metaanalysis of published trials was conducted to examine the efficacy of magnesium supplementation in POA prevention among pediatric patients undergoing CPB. Relevant trials were identified from electronic databases (Medline, Embase, Web of Science, and Cochrane library). Pooled relative risk (RR) and 95 % confidence intervals (CI) were calculated using Mantel-Haenszel random-effects models, and heterogeneity was determined qualitatively according to I (2) and chi-squared statistical analyses. Among 121 potentially relevant studies, five randomized controlled trials met the inclusion criteria, resulting in a pooled total of 348 participants. Compared with placebo, magnesium supplementation decreased the incidence of arrhythmia after CPB in pediatric patients by 66 % (RR, 0.34; 95 % CI, 0.18-0.65; P = 0.001), with no heterogeneity between trials (heterogeneity P = 0.68; I (2) = 0 %). Magnesium supplementation significantly reduces the incidence of postoperative arrhythmias in pediatric patients undergoing CPB. Although the findings encourage the use of magnesium as an alternative to postoperative arrhythmias after CPB in pediatric patients, higher-quality randomized clinical trials are necessary before the findings can be generalized.
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Affiliation(s)
- Hee Young Lee
- College of Pharmacy, Chungnam National University, 99, Dehak-ro, Yuseong-gu, Daejeon 305-764, South Korea
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Wong GKC, Chan MTV, Poon WS, Boet R, Gin T. Magnesium therapy within 48 hours of an aneurysmal subarachnoid hemorrhage: neuro-panacea. Neurol Res 2013; 28:431-5. [PMID: 16759446 DOI: 10.1179/016164106x115035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Whereas advances in neurosurgical treatment and intensive care management improve the results from many of the devastating complications associated with aneurysmal subarachnoid hemorrhage, cerebral vasospasm remains a major cause of neurological morbidity and mortality. Experimental studies suggested that MgSO(4) inhibits excitatory amino acid release, blocks N-methyl-D-aspartate (NMDA) receptors and prevents calcium entry into the cell. Magnesium also increases red blood cell deformability. These changes may reduce the occurrence of cerebral vasospasm and minimize neuronal injury during episodes of cerebral vasospasm. Our group is currently hosting the intravenous magnesium sulfate to improve outcome after aneurysmal subarachnoid hemorrhage (IMASH) trial, which is a randomized, placebo-controlled, double-blinded, multicentered trial to evaluate the effect of magnesium sulfate infusion on the clinical outcome of patients with aneurysmal subarachnoid hemorrhage since 2002. The pilot result showed a trend towards decreased clinical vasospasm and better patient outcome. Magnesium sulfate infusion may prove to be an effective and inexpensive way to reduce the morbidity and mortality associated with aneurysmal subarachnoid hemorrhage, which is a major breakthrough in the current management.
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Affiliation(s)
- George K C Wong
- Division of Neurosurgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
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Ganga HV, Noyes A, White CM, Kluger J. Magnesium adjunctive therapy in atrial arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1308-18. [PMID: 23731344 DOI: 10.1111/pace.12189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/02/2013] [Accepted: 04/10/2013] [Indexed: 11/30/2022]
Abstract
Magnesium (Mg) is an important intracellular ion with cardiac metabolism and electrophysiologic properties. A large percentage of patients with arrhythmias have an intracellular Mg deficiency, which is out of line with serum Mg concentrations, and this may explain the rationale for Mg's benefits as an atrial antiarrhythmic agent. A current limitation of antiarrhythmic therapy is that the potential for cardiac risk offsets some of the benefits of therapy. Mg enhances the balance of benefits to harms by enhancing atrial antiarrhythmic efficacy and reducing antiarrhythmic proarrhythmia potential as well as providing direct antiarrhythmic efficacy when used as monotherapy in patients undergoing cardiothoracic surgery.
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Affiliation(s)
- Harsha V Ganga
- The Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut
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Prophylactic Magnesium Does Not Prevent Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis. Ann Thorac Surg 2013; 95:533-41. [DOI: 10.1016/j.athoracsur.2012.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/28/2012] [Accepted: 09/04/2012] [Indexed: 11/15/2022]
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Khan AM, Lubitz SA, Sullivan LM, Sun JX, Levy D, Vasan RS, Magnani JW, Ellinor PT, Benjamin EJ, Wang TJ. Low serum magnesium and the development of atrial fibrillation in the community: the Framingham Heart Study. Circulation 2012; 127:33-8. [PMID: 23172839 DOI: 10.1161/circulationaha.111.082511] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Low serum magnesium has been linked to increased risk of atrial fibrillation (AF) after cardiac surgery. It is unknown whether hypomagnesemia predisposes to AF in the community. METHODS AND RESULTS We studied 3530 participants (mean age, 44 years; 52% women) from the Framingham Offspring Study who attended a routine examination and were free of AF and cardiovascular disease. We used Cox proportional hazard regression analysis to examine the association between serum magnesium at baseline and risk of incident AF. Analyses were adjusted for conventional AF risk factors, use of antihypertensive medications, and serum potassium. During up to 20 years of follow-up, 228 participants developed AF. Mean serum magnesium was 1.88 mg/dL. The age- and sex-adjusted incidence rate of AF was 9.4 per 1000 person-years (95% confidence interval, 6.7-11.9) in the lowest quartile of serum magnesium (≤1.77 mg/dL) compared with 6.3 per 1000 person-years (95% confidence interval, 4.1-8.4) in the highest quartile (≥1.99 mg/dL). In multivariable-adjusted models, individuals in the lowest quartile of serum magnesium were ~50% more likely to develop AF (adjusted hazard ratio, 1.52; 95% confidence interval, 1.00-2.31; P=0.05) compared with those in the upper quartiles. Results were similar after the exclusion of individuals on diuretics. CONCLUSIONS Low serum magnesium is moderately associated with the development of AF in individuals without cardiovascular disease. Because hypomagnesemia is common in the general population, a link with AF may have potential clinical implications. Further studies are warranted to confirm our findings and to elucidate the underlying mechanisms.
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Affiliation(s)
- Abigail May Khan
- Division of Cardiology, University of Pennsylvania, Philadelphia, USA
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Dabrowski W, Rzecki Z, Czajkowski M, Pilat J. Magnesium reduces matrix metalloproteinase-9, but not glial fibrillary acidic protein, in cardiac surgery patients. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Magnesium (Mg) is one of the most important ions in the brain. Its supplementation decreases intracellular disorders and improves final outcomes following traumatic brain injury. Aim: The aim of the study was to analyze the effects of magnesium supplementation on arteriovenous differences in plasma magnesium concentration in brain circulation (a–vMg), plasma matrix metalloproteinase-9 (MMP-9) and glial fibrillary acidic protein (GFAP) concentrations in cardiac surgery patients. Methods: A total of 92 adult patients were enrolled. Patients were allocated into three groups: A, receiving 6.66 mg of MgSO4 per min intravenously; B, receiving 10 mg of MgSO4; and C, receiving 13.33 mg of MgSO4. Results: In all groups, GFAP and MMP-9 increased after extracorporeal circulation and immediately after surgery. Sequentially higher concentrations of MMP-9 and a–vMg were noted in groups A, B and C. Plasma GFAP concentrations were similar in all groups. Conclusion: Magnesium supplementation reduces plasma MMP-9 and a-vMg in brain circulation but does not affect plasma GFAP.
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Affiliation(s)
- Wojciech Dabrowski
- Department of Anaesthesiology & Intensive Therapy, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Ziemowit Rzecki
- Department of Anaesthesiology & Intensive Therapy, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Marek Czajkowski
- Department of Anaesthesiology & Intensive Therapy, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Jacek Pilat
- Department of Anaesthesiology & Intensive Therapy, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
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Intravenous magnesium prevents atrial fibrillation after coronary artery bypass grafting: a meta-analysis of 7 double-blind, placebo-controlled, randomized clinical trials. Trials 2012; 13:41. [PMID: 22520937 PMCID: PMC3359243 DOI: 10.1186/1745-6215-13-41] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 04/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative atrial fibrillation (POAF) is the most common complication after coronary artery bypass grafting (CABG). The preventive effect of magnesium on POAF is not well known. This meta-analysis was undertaken to assess the efficacy of intravenous magnesium on the prevention of POAF after CABG. Methods Eligible studies were identified from electronic databases (Medline, Embase, and the Cochrane Library). The primary outcome measure was the incidence of POAF. The meta-analysis was performed with the fixed-effect model or random-effect model according to heterogeneity. Results Seven double-blind, placebo-controlled, randomized clinical trials met the inclusion criteria including 1,028 participants. The pooled results showed that intravenous magnesium reduced the incidence of POAF by 36% (RR 0.64; 95% confidence interval (CI) 0.50-0.83; P = 0.001; with no heterogeneity between trials (heterogeneity P = 0.8, I2 = 0%)). Conclusions This meta-analysis indicates that intravenous magnesium significantly reduces the incidence of POAF after CABG. This finding encourages the use of intravenous magnesium as an alternative to prevent POAF after CABG. But more high quality randomized clinical trials are still need to confirm the safety.
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Maeda T, Otsuka T, Irie S, Zukeran T, Yoshida H, Oshiro K. [Case report; Magnesium sulfate could induce ventricular fibrillation in specific type of wide QRS tachycardia]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2012; 101:1082-1084. [PMID: 22730739 DOI: 10.2169/naika.101.1082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Cardiac dysfunction in the CABG patient. Curr Opin Pharmacol 2012; 12:166-71. [DOI: 10.1016/j.coph.2012.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 01/09/2012] [Accepted: 01/21/2012] [Indexed: 12/15/2022]
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Kerin NZ, Jacob S. The efficacy of sotalol in preventing postoperative atrial fibrillation: a meta-analysis. Am J Med 2011; 124:875.e1-9. [PMID: 21854895 DOI: 10.1016/j.amjmed.2011.04.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/28/2011] [Accepted: 04/29/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Supraventricular tachyarrhythmias including atrial fibrillation are common and troubling complications after cardiac surgery, and thus considerable interest in pharmacologic prophylaxis has developed. The aim of this study was to evaluate the efficacy of sotalol in the prevention of postoperative supraventricular tachyarrhythmias. METHODS Standard methods of meta-analysis were used. Randomized clinical trials published in English language were eligible for the meta-analysis. RESULTS A systematic review revealed 15 eligible publications that provided 20 comparisons of sotalol with a control group. The incidence and relative risk (RR) with 95% confidence interval (CI) of developing postoperative supraventricular tachyarrhythmias while taking sotalol were sotalol (n=489) versus placebo (n=499): 22.5% versus 41.5%, RR=0.55 (CI, 0.454-0.667, P<.001); sotalol (n=304) versus no treatment (n=311): 12% versus 39%, RR=0.329 (CI, 0.236-0.459, P<.001); sotalol (n=488) versus beta-blocker (n=555): 14% versus 23%, RR=0.644 (CI, 0.495-0.838, P<.001); sotalol (n=139) versus amiodarone (n=146): no significant differences in supraventricular tachyarrhythmia prevention; and sotalol (n=51) versus magnesium (n=54): no significant differences in supraventricular tachyarrhythmia prevention. Initiating sotalol orally or intravenously had no significant effect on efficacy. Initiating sotalol after surgery showed a trend toward less adverse events (before: RR=1.700 [CI, 0.903-3.200] and after: RR=0.767 [CI, 0.391-1.505]). CONCLUSION Sotalol is more effective in the prevention of supraventricular tachyarrhythmia than placebo or beta-blockers. Initiating sotalol before cardiac surgery has no advantage compared with initiating sotalol shortly after surgery. Starting sotalol intravenously after surgery may be a more reliable method than administering via a nasogastric tube or delaying treatment until the patient can take oral medication.
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Affiliation(s)
- Nicholas Z Kerin
- Department of Medicine, Section of Cardiology, Wayne State University Medical School, Detroit, MI, USA.
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Sultan A, Steven D, Rostock T, Hoffmann B, Müllerleile K, Servatius H, Drewitz I, Lüker J, Meyer P, Salukhe T, Willems S. Intravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation. J Cardiovasc Electrophysiol 2011; 23:54-9. [PMID: 21815963 DOI: 10.1111/j.1540-8167.2011.02146.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND External biphasic electrical cardioversion (CV) is a standard treatment option for patients suffering from acute symptoms of atrial fibrillation (AF). Nevertheless, CV is not always successful, and thus strategies to increase the success rate are desirable. OBJECTIVE The purpose of this study was to evaluate the effect of intravenously administered K/Mg solution on the biphasic CV energy threshold and success rate to restore sinus rhythm (SR) in patients with AF. METHODS The study consisted of 170 patients with persistent AF. The patients were randomly assigned to undergo biphasic CV either with (n = 84) or without (n = 86) pretreatment with K/Mg solution. An energy step-up protocol of 75, 100, and 150 W (J) was used. RESULTS Biphasic CV of AF was effective in 81 (96.4%) patients in the pretreatment and 74 (86.0%) patients in the control group (P = 0.005). The effective energy level required to achieve SR was significantly lower in the pretreated group (140.8 ± 26.9 J vs 182.5 ± 52.2 J, P = 0.02). No K/Mg-solution-associated side effects such as hypotension or bradycardia were observed. CONCLUSION Administration of K/Mg solution positively influences the success rate of CV in patients with persistent AF. Furthermore, significantly less energy is required to successfully restore SR and therefore K/Mg pretreatment may facilitate SR restoration in patients undergoing CV for AF.
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Affiliation(s)
- Arian Sultan
- Cardiac Electrophysiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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Koniari I, Apostolakis E, Rogkakou C, Baikoussis NG, Dougenis D. Pharmacologic prophylaxis for atrial fibrillation following cardiac surgery: a systematic review. J Cardiothorac Surg 2010; 5:121. [PMID: 21118555 PMCID: PMC3006380 DOI: 10.1186/1749-8090-5-121] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 11/30/2010] [Indexed: 01/22/2023] Open
Abstract
Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery. Its incidence varies depending on type of surgery. Postoperative AF may cause hemodynamic deterioration, predispose to stroke and increase mortality. Effective treatment for prophylaxis of postoperative AF is vital as reduces hospitalization and overall morbidity. Beta-blockers, have been proved to prevent effectively atrial fibrillation following cardiac surgery and should be routinely used if there are no contraindications. Sotalol may be more effective than standard b-blockers for the prevention of AF without causing an excess of side effects. Amiodarone is useful when beta-blocker therapy is not possible or as additional prophylaxis in high risk patients. Other agents such as magnesium, calcium channels blocker or non-antiarrhythmic drugs as glycose-insulin--potassium, non-steroidal anti-inflammatory drugs, corticosteroids, N-acetylcysteine and statins have been studied as alternative treatment for postoperative AF prophylaxis.
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Affiliation(s)
- Ioanna Koniari
- Cardiothoracic Surgery Department. Patras University, School of Medicine. Rion Patras, Greece
| | - Efstratios Apostolakis
- Cardiothoracic Surgery Department. Patras University, School of Medicine. Rion Patras, Greece
| | - Christina Rogkakou
- Cardiothoracic Surgery Department. Patras University, School of Medicine. Rion Patras, Greece
| | - Nikolaos G Baikoussis
- Cardiothoracic Surgery Department. Patras University, School of Medicine. Rion Patras, Greece
| | - Dimitrios Dougenis
- Cardiothoracic Surgery Department. Patras University, School of Medicine. Rion Patras, Greece
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Enríquez F, Jiménez A. Taquiarritmias postoperatorias en la cirugía cardíaca del adulto. Profilaxis. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70100-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Atrial fibrillation is the most common arrhythmia occurring after heart surgery. Its prevalence after coronary artery bypass surgery is 17-33%. Atrial fibrillation requires additional treatment, lengthens hospitalization and increases the overall expenses of cardiac surgery. Atrial fibrillation can cause hemodynamic problems, predispose to congestive heart failure and increase the risk of stroke. Beta-blockers have been shown to effectively prevent atrial fibrillation, and beta-blockers should be a part of the medication of every patient undergoing cardiac surgery, if there are no contraindications. Amiodarone therapy can also be considered for especially high-risk patients.
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Affiliation(s)
- Hakala Tapio
- Department of Surgery, Knorth Karelia Central Hospital, Tikkamäentie 16, Joensuu, 80210, and Kuopio University Hospital, Finland
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Dunning J, Treasure T, Versteegh M, Nashef SAM. Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery. Eur J Cardiothorac Surg 2006; 30:852-72. [PMID: 17070065 DOI: 10.1016/j.ejcts.2006.09.003] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 07/28/2006] [Accepted: 09/04/2006] [Indexed: 11/29/2022] Open
Affiliation(s)
- Joel Dunning
- James Cook University Hospital, Middlesbrough, UK
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Cagli K, Ozeke O, Ergun K, Budak B, Demirtas E, Birincioglu CL, Pac M. Effect of Low-Dose Amiodarone and Magnesium Combination on Atrial Fibrillation After Coronary Artery Surgery. J Card Surg 2006; 21:458-64. [PMID: 16948756 DOI: 10.1111/j.1540-8191.2006.00277.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND To evaluate whether postoperative administration of intravenous low-dose amiodarone and magnesium sulfate (MgSO(4)) combination would reduce the incidence of atrial fibrillation following coronary artery bypass grafting (CABG) in normomagnesemic high-risk patients for postoperative atrial fibrillation (POAF). METHODS A total of 136 patients undergoing elective CABG and had > or =3 risk factors for POAF were prospectively randomized to one of three groups, to receive a single dose of amiodarone (5 mg/kg) and MgSO(4) (1.5 g) (combination group, n = 44), or an equal dose of amiodarone (amiodarone group, n = 44) or equal volumes of saline (control group, n = 48) at early postoperative period. Continuous electrocardiographic (ECG) monitoring was performed for the first 48 hours and an ECG was recorded every 8 hours later. POAF longer than 30 minutes or for any length requiring treatment, and the drug-related side effects were recorded. RESULTS The study population showed a homogeneous distribution regarding risk factors for POAF and there was no significant difference in patient characteristics, echocardiographic variables, or operative variables among three groups. POAF developed in 4 patients in combination group, in 16 patients in amiodarone group and in 16 patients in control group, representing a 24% relative risk reduction between the combination group and control group (p = 0.023). No statistically significant difference regarding incidence of POAF was observed between amiodarone and control groups. CONCLUSIONS Combined prophylactic therapy with amiodarone and MgSO(4) at the early postoperative period without a maintenance phase is an effective, simple, well-tolerated, and possibly cost-effective regimen to prevent POAF in normomagnesemic, high-risk patients.
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Affiliation(s)
- Kerim Cagli
- Department of Cardiovascular Surgery, Türkiye Yuksek Ihtisas Hospital, Anakara, Turkey.
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Abstract
Perioperative atrial fibrillation (AF) is one of the most frequent complications of cardiac surgery. Its development is associated with an increased morbidity and mortality, for example from perioperative stroke, as well as ventricular arrhythmias, postoperative myocardial infarction, congestive cardiac failure, renal failure, increased use of inotropic medications and the need for intra-aortic balloon pump. Furthermore, AF after cardiac surgery results in prolonged hospitalization after the procedure, as well as an excess utilization of hospital resources and increased hospital costs. Given the importance of AF for patient outcome, a wide variety of prophylactic pharmacologic strategies have been evaluated. The risk of post-operative AF should be reduced by the administration of amiodarone, a beta-blocker, sotalol or rate-limiting calcium antagonists. In addition, in patients undergoing cardiac surgery on pre-existing beta-blocker therapy, this treatment should be continued unless contraindications develop (such as post-operative bradycardia or hypotension). Unless contraindicated, a rhythm control strategy is recommended as the initial option for the treatment of post-operative AF following cardiothoracic surgery. More recently, some data regarding magnesium, statins and n-3 polyunsaturated fatty acids in reducing post-op AF are available. Clearly, perspectives are changing in our management of this common arrhythmia.
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Affiliation(s)
- Eduard Shantsila
- University Department of Medicine, City Hospital, Birmingham B18 7QH, UK
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Behmanesh S, Tossios P, Homedan H, Hekmat K, Hellmich M, Müller-Ehmsen J, Schwinger RHG, Mehlhorn U. Effect of prophylactic bisoprolol plus magnesium on the incidence of atrial fibrillation after coronary bypass surgery: results of a randomized controlled trial. Curr Med Res Opin 2006; 22:1443-50. [PMID: 16870070 DOI: 10.1185/030079906x115649] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Bisoprolol, a highly cardioselective beta(1)-blocker, is widely used to treat elderly patients with hypertension, coronary artery disease and heart failure. The current literature lacks evidence regarding its potency to prevent atrial fibrillation (AF) following cardiac surgery. Therefore the aim of this study was to evaluate the efficacy of bisoprolol plus magnesium (Mg) in the prophylaxis of AF after coronary artery bypass graft (CABG) surgery. RESEARCH DESIGN AND METHODS A total of 100 consecutive patients subjected to elective on-pump CABG (84 men, age 65 +/- 8 [SD] years), with no prior AF history, were randomly assigned to the prophylaxis group (n = 50) receiving after surgery bisoprolol (5 mg/day) plus Mg (intravenous infusion of 2 g of Mg on arrival in the intensive care unit, followed by oral Mg at 1800 mg/day for 1 week), or to the control group (n = 50), receiving no combined study medication but remaining on their preoperative drugs, including beta-blockers. All patients were continuously monitored to identify the onset of AF. RESULTS In the prophylaxis group the incidence of postoperative AF was significantly lower, with 20% (10 / 50) compared to 42% (21 / 50) among controls (p = 0.030, 95% confidence interval [CI] for absolute risk reduction [ARR], 2-42%). Particularly in the elderly, bisoprolol plus Mg was effective in preventing AF; in the prophylaxis group only six of 36 (17%) patients > or = 65 years of age developed AF, compared to 13 of 20 (65%) in the control group (p < 0.001, 95% CI for ARR, 17-65%). This was associated with significantly (p = 0.022) shorter hospital stays in the prophylaxis group (median of 7 vs. 9 days, 95% CI for difference in medians, 0-3 days). CONCLUSIONS The combination of bisoprolol plus Mg effectively reduces the incidence of postoperative AF following on-pump CABG, particularly in elderly patients, and is associated with a shorter hospital length of stay.
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Affiliation(s)
- Saeid Behmanesh
- Department of Cardiothoracic Surgery, University of Cologne, Joseph-Stelzman-Strasse 9, 50924 Cologne, Germany
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Dunning J. Are the American College of Chest Physicians guidelines for the prevention and management of atrial fibrillation after cardiac surgery already obsolete? Chest 2006; 129:1112; author reply 1112-3. [PMID: 16608965 DOI: 10.1378/chest.129.4.1112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Aerra V, Kuduvalli M, Moloto AN, Srinivasan AK, Grayson AD, Fabri BM, Oo AY. Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis. J Cardiothorac Surg 2006; 1:6. [PMID: 16722587 PMCID: PMC1440299 DOI: 10.1186/1749-8090-1-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 03/03/2006] [Indexed: 11/30/2022] Open
Abstract
Background Atrial fibrillation can occur in up to 40% of patients undergoing coronary surgery. Methods We retrospectively analysed 103 consecutive coronary surgery patients under the care of one surgeon between April 2003 and September 2003. These patients received 40 mg of sotalol orally twice daily from the first post-operative day for 6 weeks and 2 g of magnesium intravenously immediately post surgery and on the first post-operative day. We developed a propensity score for the probability of receiving sotalol and magnesium after coronary surgery. 89 patients from the sotalol and magnesium group were successfully matched with 89 unique coronary surgery patients who did not receive either sotalol or magnesium with an identical propensity score. Results Preoperative characteristics were well matched between groups. There was no significant difference with respect to in-hospital mortality between groups (sotalol and magnesium 1.1% versus control 4.5%; p = 0.17). The incidence of atrial fibrillation in the sotalol and magnesium group was 13.5% compared to 27.0% in the controls (p = 0.025). Conclusion The combination of sotalol and magnesium can significantly reduce the incidence of post-operative atrial fibrillation following coronary surgery.
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Affiliation(s)
- V Aerra
- Department of Cardiothoracic Surgery. The Cardiothoracic Centre Liverpool, UK
| | - M Kuduvalli
- Department of Cardiothoracic Surgery. The Cardiothoracic Centre Liverpool, UK
| | - AN Moloto
- Department of Cardiothoracic Surgery. The Cardiothoracic Centre Liverpool, UK
| | - AK Srinivasan
- Department of Cardiothoracic Surgery. The Cardiothoracic Centre Liverpool, UK
| | - AD Grayson
- Department of Research and Development. The Cardiothoracic Centre Liverpool, UK
- Senior Clinical Information Analyst, Clinical Governance Department. The Cardiothoracic Centre-Liverpool, Thomas Drive, Liverpool, L14 3PE, UK
| | - BM Fabri
- Department of Cardiothoracic Surgery. The Cardiothoracic Centre Liverpool, UK
| | - AY Oo
- Department of Cardiothoracic Surgery. The Cardiothoracic Centre Liverpool, UK
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