TY - JOUR
T1 - Intraoperative magnesium administration does not improve neurocognitive function after cardiac surgery
AU - Mathew, Joseph P.
AU - White, William D.
AU - Schinderle, David B.
AU - Podgoreanu, Mihai V.
AU - Berger, Miles
AU - Milano, Carmelo A.
AU - Laskowitz, Daniel T.
AU - Stafford-Smith, Mark
AU - Blumenthal, James A.
AU - Newman, Mark F.
PY - 2013/12
Y1 - 2013/12
N2 - BACKGROUND AND PURPOSE - Neurocognitive decline occurs frequently after cardiac surgery and persists in a significant number of patients. Magnesium is thought to provide neuroprotection by preservation of cellular energy metabolism, blockade of the N-methyl-D-aspartate receptor, diminution of the inflammatory response, and inhibition of platelet activation. We therefore hypothesized that intraoperative magnesium administration would decrease postoperative cognitive impairment. METHODS - After approval by the Duke University Health System Institutional Review Board, 389 patients undergoing cardiac surgery were enrolled in this prospective, randomized, double-blind, placebo-controlled clinical trial. Subjects were randomized to receive magnesium as a 50 mg/kg bolus followed by another 50 mg/kg infusion for 3 hours or placebo bolus and infusion. Cognitive function was assessed preoperatively and again at 6 weeks postoperatively using a standardized test battery. Mean CD11b fluorescence and percentage of platelets expressing CD62P, which are markers of leukocyte and platelet activation, respectively, were assessed by flow cytometry as a secondary outcome. The effect of magnesium on postoperative cognition was tested using multivariable regression modeling, adjusting for age, years of education, baseline cognition, sex, race, and weight. RESULTS - Among the 389 allocated subjects (magnesium: n=198; placebo: n=191), the incidence of cognitive deficit in the magnesium group was 44.4% compared with 44.9% in the placebo group (P=0.93). The cognitive change score and platelet and leukocyte activation were also not different between the groups. Multivariable analysis revealed a marginal interaction between treatment group and weight such that heavier subjects receiving magnesium were less likely to have cognitive deficit (P=0.06). CONCLUSIONS - Magnesium administered intravenously during cardiac surgery does not reduce postoperative cognitive dysfunction. CLINICAL TRIAL REGISTRATION - : URL: http://www.clinicaltrials.gov. Unique identifier: NCT00041392.
AB - BACKGROUND AND PURPOSE - Neurocognitive decline occurs frequently after cardiac surgery and persists in a significant number of patients. Magnesium is thought to provide neuroprotection by preservation of cellular energy metabolism, blockade of the N-methyl-D-aspartate receptor, diminution of the inflammatory response, and inhibition of platelet activation. We therefore hypothesized that intraoperative magnesium administration would decrease postoperative cognitive impairment. METHODS - After approval by the Duke University Health System Institutional Review Board, 389 patients undergoing cardiac surgery were enrolled in this prospective, randomized, double-blind, placebo-controlled clinical trial. Subjects were randomized to receive magnesium as a 50 mg/kg bolus followed by another 50 mg/kg infusion for 3 hours or placebo bolus and infusion. Cognitive function was assessed preoperatively and again at 6 weeks postoperatively using a standardized test battery. Mean CD11b fluorescence and percentage of platelets expressing CD62P, which are markers of leukocyte and platelet activation, respectively, were assessed by flow cytometry as a secondary outcome. The effect of magnesium on postoperative cognition was tested using multivariable regression modeling, adjusting for age, years of education, baseline cognition, sex, race, and weight. RESULTS - Among the 389 allocated subjects (magnesium: n=198; placebo: n=191), the incidence of cognitive deficit in the magnesium group was 44.4% compared with 44.9% in the placebo group (P=0.93). The cognitive change score and platelet and leukocyte activation were also not different between the groups. Multivariable analysis revealed a marginal interaction between treatment group and weight such that heavier subjects receiving magnesium were less likely to have cognitive deficit (P=0.06). CONCLUSIONS - Magnesium administered intravenously during cardiac surgery does not reduce postoperative cognitive dysfunction. CLINICAL TRIAL REGISTRATION - : URL: http://www.clinicaltrials.gov. Unique identifier: NCT00041392.
KW - Blood platelets
KW - Cardiopulmonary bypass
KW - Cognition
UR - https://www.scopus.com/pages/publications/84889246044
UR - https://www.scopus.com/pages/publications/84889246044#tab=citedBy
U2 - 10.1161/STROKEAHA.113.002703
DO - 10.1161/STROKEAHA.113.002703
M3 - Article
C2 - 24105697
AN - SCOPUS:84889246044
SN - 0039-2499
VL - 44
SP - 3407
EP - 3413
JO - Stroke
JF - Stroke
IS - 12
ER -