Intraoperative magnesium infusion during carotid endarterectomy: A double-blind placebo-controlled trial: Clinical article

William J. Mack, Christopher P. Kellner, Daniel H. Sahlein, Andrew F. Ducruet, Grace H. Kim, J. Mocco, Joseph Zurica, Ricardo J. Komotar, Raqeeb Haque, Robert Sciacca, Donald O. Quest, Robert A. Solomon, E. Sander Connolly, Eric J. Heyer

Research output: Contribution to journalArticle

24 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)961-967
Number of pages7
JournalJournal of neurosurgery
Volume110
Issue number5
DOIs
StatePublished - May 1 2009
Externally publishedYes

Keywords

  • Carotid endarterectomy
  • Magnesium
  • Neuroprotectant
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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    Mack, W. J., Kellner, C. P., Sahlein, D. H., Ducruet, A. F., Kim, G. H., Mocco, J., Zurica, J., Komotar, R. J., Haque, R., Sciacca, R., Quest, D. O., Solomon, R. A., Connolly, E. S., & Heyer, E. J. (2009). Intraoperative magnesium infusion during carotid endarterectomy: A double-blind placebo-controlled trial: Clinical article. Journal of neurosurgery, 110(5), 961-967. https://doi.org/10.3171/2008.9.17671