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Ann Thorac Surg 1995;59:502-507
© 1995 The Society of Thoracic Surgeons
Divisions of Cardiac and Thoracic Surgery, Cardiology, and Cardiac Anaesthesia, University of Alberta, Edmonton, Alberta, Canada
Accepted for publication October 27, 1994.
One hundred patients undergoing elective cardiac operations were randomized into placebo (n = 54) and magnesium (n = 46) groups. The magnesium group received six doses of 2.4 g (19.2 mEq) magnesium sulfate intravenously in the first 24 hours after the cardiac operation. The magnesium group had higher serum magnesium concentrations postoperatively (1.09 ± 0.20 versus 0.75 ± 0.13 mmol/L; p < 0.0001), postoperative day 1 (1.49 ± 0.34 versus 0.70 ± 0.12 mmol/L; p < 0.0001) and postoperative day 2 (0.96 ± 0.19 versus 0.76 ± 0.07 mmol/L; p < 0.0001). Patients in the magnesium group had a lower incidence of ventricular tachyarrythmias (VTs) (17.3% versus 51.9%; p = 0.0006), less need for treatment (6.5% versus 20.3%; p < 0.0001), fewer VT episodes/patient (0.3 ± 0.8 versus 1.39 ± 1.9; p < 0.0001), and a reduction in the severity of VTs as measured by the modified Lown grade (p = 0.0002). No differences were demonstrated with respect to supraventricular tachyarrythmias. The magnesium group had reduced absolute creatine kinase-MB levels (5.3 ± 4.2 versus 28.4 ± 28 IU/L; p = 0.001) as well as creatine kinase-MB fraction (0.01 ± 0.02 versus 0.05 ± 0.04; p = 0.001) on postoperative day 1. Serum magnesium concentrations were lower during VTs than during periods of sinus rhythm (0.75 ± 0.75 versus 1.02 ± 0.35 mmol/L; p < 0.001). Patients with VTs had higher serum creatine kinase-MB levels than those that did not both postoperatively (32.7 ± 26 versus 23.0 ± 14.7 IU/L; p = 0.04) and on postoperative day 1 (29.7 ± 32 versus 10.3 ± 11.7 IU/L; p = 0.019). Magnesium sulfate prophylaxis prevents hypomagnesemia and reduces the incidence and severity of VTs postoperatively, possibly by enhancing myocardial protection.
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