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Title: Magnesium sulfate therapy after cardiac surgery: a before-and-after study comparing strategies involving bolus and continuous infusion.
Austin Authors: Osawa, Eduardo A;Biesenbach, Peter;Cutuli, Salvatore L ;Eastwood, Glenn M ;Mårtensson, Johan;Matalanis, George ;Fairley, Jessica;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
Department of Cardiac Surgery, Austin Health, Heidelberg, Victoria, Australia
School of Public Health and Preventive Medicine, Monash University, Prahran, VIC 3004, Australia
Issue Date: Sep-2018
Publication information: Critical Care and Resuscitation 2018; 20(3): 209-216
Abstract: Magnesium therapy may reduce the risk of atrial fibrillation after cardiac surgery. However, studies are heterogeneous in relation to dosage and method of delivery and no studies have directly compared the biochemical effect of different delivery strategies. We conducted a before-and-after study to compare the effects of two strategies of magnesium delivery after cardiac surgery. We conducted a prospective interventional before-and-after study. We enrolled patients admitted to the intensive care unit (ICU) after cardiac surgery and with no history of renal failure. The before period consisted of a single 20 mmol of magnesium sulfate bolus administered over one hour. The after period comprised a 10 mmol magnesium loading dose over one hour followed by a continuous infusion at 3 mmol/h for 12 hours. We measured serum and urine magnesium levels at baseline (T0), at the end of loading dose (T1), 6 (T2) and 12 hours after the intervention (T3). We enrolled 60 patients (30 in each group) with similar baseline characteristics. In the before period, patients had a higher peak serum magnesium level at T1 (1.88 ± 0.06 v 1.59 ± 0.04 mmo/L; P < 0.001) compared with the after period. However, at 6 hours, patients in the after period had a significantly higher magnesium level (1.61 ± 0.04 v 1.29 ± 0.26 mmol/L; P < 0.001) and this level remained higher at 12 hours (1.70 ± 0.05 v 1.17 ± 0.02; P < 0.001), leading to increased time-weighted magnesaemia (P < 0.001). These changes occurred despite a significantly increased urinary magnesium concentration, fractional excretion of magnesium, and magnesium clearance, which paralleled changes in magnesaemia (P < 0.001). The strategy of a 10 mmol magnesium bolus followed by a continuous infusion over 12 hours achieved a more sustained and moderately elevated magnesium concentration in comparison to a single 20 mmol bolus, despite increased urinary losses of magnesium. Further studies are required to assess a more extended continuous infusion.
ORCID: 0000-0002-1650-8939
Journal: Critical Care and Resuscitation
PubMed URL: 30153783
ISSN: 1441-2772
Type: Journal Article
Subjects: Postoperative Care
Anti-Arrhythmia Agents
Cardiac Surgical Procedures
Magnesium Sulfate
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