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The perioperative effect of magnesium sulfate in patients with concentric left ventricular hypertrophy undergoing
Rabie Soliman1, Walid Abukhudair2
1Department of Anesthesia, Cairo University, Cairo, Egypt; Department of Cardiac Anesthesia, Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
Insights
Magnesium sulfate offers cardioprotection in cardiac surgery patients with left ventricular hypertrophy. This treatment reduced myocardial infarction and arrhythmia incidence, along with the need for circulatory support.
Area of Science:
- Cardiology
- Anesthesiology
- Cardiovascular Surgery
Background:
- Left ventricular concentric hypertrophy presents unique challenges during cardiac surgery.
- Perioperative myocardial injury and arrhythmias are significant concerns in these patients.
- Magnesium sulfate is explored for its potential cardioprotective properties.
Purpose of the Study:
- To evaluate the cardioprotective effect of magnesium sulfate in patients with left ventricular concentric hypertrophy undergoing cardiac surgery.
- To assess the impact of magnesium sulfate on myocardial injury markers and hemodynamic parameters.
Main Methods:
- A double-blinded randomized controlled trial was conducted with 250 patients.
- Patients were divided into two groups: one receiving magnesium sulfate infusion and the other receiving normal saline.
- Key measurements included cardiac biomarkers (troponin I, CK-MB), ECG, echocardiographic parameters, and hemodynamic variables.
Main Results:
- Magnesium sulfate group showed significantly lower troponin I, CK-MB levels, and ECG changes compared to the control group.
- Improvements in diastolic function (E/A peak ratio) and end-diastolic volume were observed with magnesium sulfate.
- Enhanced cardiac index and reduced heart rate, pulmonary artery pressure, and need for circulatory support were noted.
Conclusions:
- Magnesium sulfate demonstrates a significant cardioprotective effect in patients with concentric ventricular hypertrophy undergoing cardiac surgery.
- It effectively decreases the incidence of perioperative myocardial infarction and arrhythmias.
- The use of magnesium sulfate reduces the requirement for pharmacological and mechanical circulatory support.
Objective:
The objective of this study was to assess the cardioprotective effect of magnesium sulfate in patients with left ventricular concentric hypertrophy undergoing cardiac surgery.
Design:
The study was a double-blinded randomized study.
Setting:
This study was conducted at a cardiac center.
Patients:
The study included 250 patients.
Intervention:
The study included two groups (each = 125): Group M - the patients who received magnesium sulfate infusion (15 mg/kg/h). The infusion was started 20 min before induction, during surgery, and the first postoperative 24 h. Group C - the patients who received an equal amount of normal saline.
Measurements:
The variables included troponin I level, creatinine kinase-MB (CK-MB) level, electrocardiograph (ECG) with automatic ST-segment analysis (leads II and V), E/A peak ratio, end-diastolic volume, cardiac index (CI), heart rate, mean arterial blood pressure (MAP), mean arterial pulmonary pressure (mPAP), pulmonary and systemic vascular resistances, and pharmacological and mechanical support.
Main Results:
The troponin I level, CK-MB, and ECG changes were lower in Group M than Group C (P < 0.05). The E/A peak ratio and end-diastolic volume increased in Group M than Group C (P < 0.05). There was a significant increase in the CI and a decrease in the heart rate, mPAP, pulmonary vascular resistances, and pharmacological and mechanical support in Group M compared to Group C (P < 0.05). There were minimal changes in the MAP and systemic vascular resistance in Group M compared to Group C (P < 0.05).
Conclusion:
The magnesium sulfate provides a cardioprotective effect in patients with concentric ventricular hypertrophy undergoing cardiac surgery. It decreases the incidence of perioperative myocardial infarction and arrhythmia. Furthermore, it decreases the requirement of pharmacological and mechanical support.
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