Intraoperative magnesium infusion during carotid endarterectomy: a double-blind placebo-controlled trial
Document Type
Article
Abstract
OBJECT: Recent data from both experimental and clinical studies have supported the use of intravenous magnesium as a potential therapy in the setting of cerebral ischemia. This study assessed whether intraoperative magnesium therapy improves neuropsychometric testing (NPT) following carotid endarterectomy (CEA). METHODS: One hundred eight patients undergoing CEA were randomly assigned to receive placebo infusion or 1 of 3 magnesium-dosing protocols. Neuropsychometric testing was performed 1 day after surgery and compared with baseline performance. Assessment was also performed on a set of 35 patients concurrently undergoing lumbar laminectomy to serve as a control group for NPT. A forward stepwise logistic regression analysis was performed to evaluate the impact of magnesium therapy on NPT. A subgroup analysis was then performed, analyzing the impact of each intraoperative dose on NPT. RESULTS: Patients treated with intravenous magnesium infusion demonstrated less postoperative neurocognitive impairment than those treated with placebo (OR 0.27, 95% CI 0.10-0.74, p = 0.01). When stratified according to dosing bolus and intraoperative magnesium level, those who were treated with low-dose magnesium had less cognitive decline than those treated with placebo (OR 0.09, 95% CI 0.02-0.50, p < 0.01). Those in the high-dose magnesium group demonstrated no difference from the placebo-treated group. CONCLUSIONS: Low-dose intraoperative magnesium therapy protects against neurocognitive decline following CEA.
Medical Subject Headings
Aged; Brain Ischemia (therapy); Cognition Disorders (prevention & control); Endarterectomy, Carotid; Female; Humans; Infusions, Intravenous; Laminectomy; Magnesium (adverse effects, blood); Male; Neuropsychological Tests; Postoperative Complications; Prospective Studies
Publication Date
5-1-2009
Publication Title
Journal of neurosurgery
ISSN
0022-3085
Volume
110
Issue
5
First Page
961
Last Page
7
PubMed ID
19199498
Digital Object Identifier (DOI)
10.3171/2008.9.17671
Recommended Citation
Mack, William J.; Kellner, Christopher P.; Sahlein, Daniel H.; Ducruet, Andrew F.; Kim, Grace H.; Mocco, J; Zurica, Joseph; Komotar, Ricardo J.; Haque, Raqeeb; Sciacca, Robert; Quest, Donald O.; Solomon, Robert A.; Connolly, E Sander; and Heyer, Eric J., "Intraoperative magnesium infusion during carotid endarterectomy: a double-blind placebo-controlled trial" (2009). Translational Neuroscience. 2116.
https://scholar.barrowneuro.org/neurobiology/2116