Intraoperative magnesium infusion during carotid endarterectomy: a double-blind placebo-controlled trial.
OBJECTIVE
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.
Mack
William J
WJ
Departments of Neurological Surgery, Columbia University Medical Center, New York, USA. wjm32@columbia.edu
Kellner
Christopher P
CP
Sahlein
Daniel H
DH
Ducruet
Andrew F
AF
Kim
Grace H
GH
Mocco
J
J
Zurica
Joseph
J
Komotar
Ricardo J
RJ
Haque
Raqeeb
R
Sciacca
Robert
R
Quest
Donald O
DO
Solomon
Robert A
RA
Connolly
E Sander
ES
Heyer
Eric J
EJ
D000368:Aged; D002545:Brain Ischemia / Q000628:therapy; D003072:Cognition Disorders / Q000517:prevention & control; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007796:Laminectomy; D008274:Magnesium / Q000009:adverse effects / Q000097:blood; D008297:Male; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D011446:Prospective Studies
D008274:Magnesium