Intraoperative Magnesium Administration Does Not Improve Neurocognitive Function After Cardiac Surgery

被引:57
作者
Mathew, Joseph P. [1 ]
White, William D. [1 ]
Schinderle, David B. [5 ]
Podgoreanu, Mihai V. [1 ]
Berger, Miles [1 ]
Milano, Carmelo A. [4 ]
Laskowitz, Daniel T. [2 ]
Stafford-Smith, Mark [1 ]
Blumenthal, James A. [3 ]
Newman, Mark F. [1 ]
机构
[1] Duke Univ, Med Ctr, Dept Anesthesiol, Durham, NC 27710 USA
[2] Duke Univ, Med Ctr, Dept Neurol, Durham, NC 27710 USA
[3] Duke Univ, Med Ctr, Dept Psychiat, Durham, NC 27710 USA
[4] Duke Univ, Med Ctr, Dept Surg, Durham, NC 27710 USA
[5] Sentara Cardiovasc Res Inst, Dept Anesthesiol, Norfolk, VA USA
基金
美国国家卫生研究院;
关键词
blood platelets; cardiopulmonary bypass; cognition; CORONARY-ARTERY-BYPASS; PLATELET ACTIVATION; CARDIOPULMONARY BYPASS; COGNITIVE DECLINE; BRAIN-INJURY; SULFATE; NEUROPROTECTION; LEUKOCYTE; DYSFUNCTION; GRANULES;
D O I
10.1161/STROKEAHA.113.002703
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:3407 / 3413
页数:7
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