Abstract
Kardiyopulmoner Bypass’ ta Magnezyumun Önemi
Öz
Amaç: Magnezyum sülfat majör aritmilerin engellenmesinde kullanılan önemli bir elektrolittir. Potasyum desteğine cevabı artırmak ve atriyal fibrilasyonun oluşumunu engelleyebilmek için magnezyum desteği kalp cerrahisinde genellikle tercih edilen bir uygulamadır. Bu çalışmamızda, kardiyopulmoner bypass ameliyatı geçiren hastalarda postoperatif aritmiler üzerine magnezyumun etkisi araştırıldı.
Materyal ve Metod: Kardiyopulmoner bypass cerrahisi uygulanan otuz hasta çalışmaya dahil edildi ve rastgele iki gruba ayrıldı. Çalışma grubundaki hastaların (n=15) prime solüsyonu içerisine 10 cc magnezyum sülfat eklendi. Kontrol grubundaki hastaların (n=15) prime solüsyonu içerisine ise 5 cc magnezyum sülfat ilave edildi. Magnezyum sülfat uygulanmadan önce preoperatif dönemde, prime solüsyonuna magnezyum sülfat eklendikten sonra intraoperatif dönemde ve postoperatif ilk 4 saat içerisinde kan örnekleri alındı.
Bulgular: Hastaların demografik verilerinde çalışma ve kontrol grubu arasındaki fark istatistiksel olarak anlamlı bulunmadı. (p>0,05). Gruplar postoperatif dönemde atriyal fibrilasyon açısından karşılaştırıldığında, çalışma grubunda atriyal fibrilasyon dahil majör aritmi izlenmedi (P>0,05). Kontrol grubundaki hastaların %33,3'ünde atriyal fibrilasyon görüldü (P<0,05) ve istatistiksel olarak anlamlı bulundu.
Sonuç: Benzer demografik verileri olan ve kardiyopulmoner bypass ameliyatı olacak hastalarda, kardiyopulmoner bypass uygulamalarında uygulanan ve prime solüsyonuna eklenen magnezyum sülfat değerlerinin arttırılması ve hastaya daha yüksek doz verilmesinin postoperatif atriyal fibrilasyon ve aritmiler üzerine etkili olduğunu düşünmekteyiz.
Importance of Magnesium During Cardiopulmonary Bypass Operation
Abstract
Background: Magnesium sulfate is an important electrolyte used in the prevention of major arrhythmias. Magnesium supplementation is generally preferred in cardiac surgery in order to increase the response to potassium supplementation and to prevent the formation of atrial fibrillation. In this study, the effect of magnesium on postoperative arrhythmias in patients undergoing cardiopulmonary bypass surgery was investigated.
Materials and Methods: Thirty patients who underwent cardiopulmonary bypass surgery were included in the study and randomly divided into two groups. 10 cc magnesium sulfate was added to the prime solution of the patients in the study group (n=15). 5 cc magnesium sulfate was added to the prime solution of the patients in the control group (n=15). Blood samples were taken preoperatively before the application of magnesium sulfate, intraoperatively after adding magnesium sulfate to the prime solution, and within the first 4 hours postoperatively.
Results: The difference between the study and control groups in the demographic data of the patients was not found to be statistically significant. (p>0.05). When the groups were compared in terms of atrial fibrillation in the postoperative period, no major arrhythmias including atrial fibrillation were observed in the study group (p>0.05). Atrial fibrillation was seen in 33.3% of the patients in the control group (p<0.05) and was found to be statistically significant.
Conclusions: In patients with similar demographic data and who will undergo cardiopulmonary bypass surgery, it is thought that increasing the magnesium sulfate values applied in cardiopulmonary bypass applications and added to the prime solution and giving a higher dose to the patient are effective on postoperative atrial fibrillation and arrhythmias.
Keywords
Magnezyum Atriyal Fibrilasyon Prime Solüsyon Kalp-Akciğer Makinesi Kardiyopulmoner Bypass Magnesium Atrial Fibrillation Prime Solution Heart-Lung Pump Cardiopulmonary Bypass
Supporting Institution
Harran Üniversitesi Bilimsel Araştırma Projeleri Koordinasyon Birimi
Project Number
784
References
- 1. Aftabuddin M, Rajbhandhari N, Rahman MZ, Islam N, Khan OS. Cardiopulmonary bypass induced hematolo-gical changes in patients undergoing cardiac surgery. Bangladesh Heart Journal. 2015;30(2):53-57.
- 2. Merkle J, Daka A, Deppe AC, Wahlers T, Paunel-Gorgulu A. High levels of cell-free DNA accurately pre-dict late acute kidney injury in patients after cardiac surgery. PLoS One. 2019;14(6).
- 3. Li Z, Fan G, Zheng X, Gong X, Chen T, Liu X, et al. Risk factors and clinical significance of acute kidney injury after on-pump or off-pump coronary artery bypass grafting: a propensity score-matched study. Interact Cardiovasc Thorac Surg. 2019;28(6):893–9.
- 4. Miles LF, Coulson TG, Galhardo C, Falter F. Pump pri-ming practices and anticoagulation in cardiac surgery: results from the global cardiopulmonary bypass sur-vey. Anesth Analg. 2017;125:1871‐1877.
- 5. Sander M, von Heymann C, von Dossow V, Spaethe C, Konertz WF, Jain U, et al. Increased interleukin-6 after cardiac surgery predicts infection. Anesth Analg. 2006;102(6):1623–9.
- 6. Passaron AC, Silva MAM, Yoshida WB. Cardiopulmo-nary bypass: development of John Gibbon's heart-lung machine. Rev Bras Cir Cardiovasc. 2015;30(2):235-45.
- 7. Gröber U, Schmidt J, Kisters K. Magnesium in Preven-tion and Therapy. Nutrients. 2015:8199–8226.
- 8. Workinger JL, Doyle RP, Bortz J. Challenges in thediag-nosis of magnesium status. Nutrients. 2018;10:1202.
- 9. Reddy ST, Soman SS, Yee J. Magnesium balanceand measurement. Adv Chronic Kidney Dis 2018;25:224-9.
- 10. Jahnen-Dechent J, Ketteler M. Magnesium basics. Clin. Kidney J. 2012;5:i3–i14.
- 11. Nielsen FH, Johnson LAK. Data from controlled meta-bolicward studies provide guidance for the determina-tion of status indicators and dietary requirements for magnesium. Biol Trace Elem Res. 2017;177:43-52.
- 12. Rude RK. Magnesium depletion and hypermagnese-mia. Primer Metab Bone Dis Disorders Miner Metab 1: 2008;Chapter 70:p.328.
- 13. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med. 1992;152:40–5.
- 14. Raiten JM, Ghadimi K, Augoustides JGT, Ramakrishna H, Patel PA, Weiss SJ, et al. Atrial fibrillation after car-diac surgery: Clinical update on mechanisms and prophylactic strategies. J Cardiothorac Vasc Anesth. 2015;29:806–16.
- 15. Campbell NG, Allen E, Sanders J, Swinson R, Birch S, Sturgess J, et al. The impact of maintaining serum po-tassium >/=3.6 mEq/L vs >/=4.5 mEq/L on the inciden-ce of new-onset atrial fibrillation in the first 120 hours after isolated elective coronary artery bypass graf-ting—Study protocol for a randomised feasibility trial for the proposed Tight K randomized non-inferiority trial. Trials. 2017;18:618.
- 16. Protsyk V, Rasmussen BS, Guarracino F, Erb J, Turton E, Ender J. Fluid management in cardiac surgery: results of a survey in European cardiac anesthesia depart-ments. J Cardiothorac Vasc Anesth. 2017;31:1624-1629.
- 17. Mazur A, Maier JAM, Rock E, Gueux E, Nowacki W, Rayssiguier Y. Magnesium and the inflammatory res-ponse: Potential physiopathological implications. Arch. Biochem. Biophys. 2007;458:48–56.
- 18. Cheungpasitporn W, Thongprayoon C, Qian Q. Dys-magnesemia in Hospitalized Patients: Prevalence and Prognostic Importance. Mayo Clin Proc. 2015;90(8):1001-10.
- 19. Saver JL, Starkman S, Eckstein M, Stratton SJ, Pratt FD, Hamilton S, et al. Prehospital use of magnesium sulfate as neuroprotection in acute stroke. N. Engl. J. Med. 2015;372:528–536.
- 20. Chrysant SG, Chrysant GS. Association of hypomagne-semia with cardiovascular diseases and hypertension. Int J Cardiol Hypertens. 2019;1:100005.
- 21. Salaminia S, Sayehmiri F, Angha P, Sayehmiri K, Mote-dayen M. Evaluating the Effect of Magnesium Supple-mentation and Cardiac Arrhythmias after Acute Coro-nary Syndrome: A Systematic Review and Meta-Analysis. BMC Cardiovasc. Disord. 2018;18:129.
- 22. Fairley JL, Zhang L, Glassford NJ, Bellomo R. Magne-sium status and magnesium therapy in cardiac surgery: A systematic review and meta-analysis focusing on arrhythmia prevention. J Crit Care. 2017;42:69-77.
- 23. Khan AM, Lubitz SA, Sullivan LM, Sun JX, Levy D, Vasan RS, et al. Low serum magnesium and the development of atrial fibrillation in the community: the Framingham Heart Study. Circulation. 2013;127(1):33-8.
- 24. Chaudhary R, Garg J, Turagam M, Chaudhary R, Gupta R, Nazir T, et al. Role of Prophylactic Magnesium Supp-lementation in Prevention of Postoperative Atrial Fib-rillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials. J Atr Fibrillation. 2019;12(1):2154.
- 25. Shah NC, Shah GJ, Li Z, Jiang XC, Altura BT, Altura BM. Short-term magnesium deficiency downregulates te-lomerase, upregulates neutral sphingomyelinase and induces oxidative DNA damage in cardiovascular tis-sues: relevance to atherogenesis, cardiovascular dise-ases and aging. Int J Clin Exp Med. 2014;7(3):497-514.
- 26. Montezano AC, Zimmerman D, Yusuf H, Burger D, Chignalia AZ, Wadhera V, et al. Vascular Smooth Musc-le Cell Differentiation to an Osteogenic Phenotype In-volves TRPM7 Modulation by Magnesium. Hyperten-sion. 2010;56:453–462.
- 27. Negrea L, DeLozier SJ, Janes JL, Rahman M, Dobre M. Serum Magnesium and Cardiovascular Outcomes and Mortality in CKD: The Chronic Renal Insufficiency Co-hort (CRIC). Kidney Med. 2021;3(2):183-192.
- 28. O'Brien B, Burrage PS, Ngai JY, Prutkin JM, Huang CC, Xu X, et al. Society of Cardiovascular Anes-thesiologists/European Association of Cardiothoracic Anaesthetists practice advisory for the management of perioperative atrial fibrillation in patients undergo-ing cardiac surgery. J Cardiothorac Vasc Anesth. 2019;33:12– 26.
- 29. Larsson SC, Drca N, Michaëlsson K. Serum Magnesium and Calcium Levels and Risk of Atrial Fibrillation. Circ Genom Precis Med. 2019;12(1):e002349.
- 30. Bagheri A, Naghshi S, Sadeghi O, Larijani B, Esmaillza-deh A. Total, Dietary, and Supplemental Magnesium Intakes and Risk of All-Cause, Cardiovascular, and Can-cer Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Stu-dies. Adv. Nutr. 2021;12:1196–1210.
- 31. Howitt SH, Grant SW, Campbell NG, Malagon I, McCol-lum C. Are Serum Potassium and Magnesium Levels Associated with Atrial Fibrillation After Cardiac Sur-gery?. J Cardiothorac Vasc Anesth. 2020;34(5):1152-1159.
Abstract
Background: Magnesium sulfate is an important electrolyte used in the prevention of major arrhythmias. Magnesium supplementation is generally preferred in cardiac surgery in order to increase the response to potassium supplementation and to prevent the formation of atrial fibrillation. In this study, the effect of mag-nesium on postoperative arrhythmias in patients undergoing cardiopulmonary bypass surgery was investigat-ed.
Materials and Methods: Thirty patients who underwent cardiopulmonary bypass surgery were included in the study and randomly divided into two groups. 10 cc magnesium sulfate was added to the prime solution of the patients in the study group (n=15). 5 cc magnesium sulfate was added to the prime solution of the pa-tients in the control group (n=15). Blood samples were taken preoperatively before the application of magne-sium sulfate, intraoperatively after adding magnesium sulfate to the prime solution, and within the first 4 hours postoperatively.
Results: The difference between the study and control groups in the demographic data of the patients was not found to be statistically significant. (p>0.05). When the groups were compared in terms of atrial fibrilla-tion in the postoperative period, no major arrhythmias including atrial fibrillation were observed in the study group (p>0.05). Atrial fibrillation was seen in 33.3% of the patients in the control group (p<0.05) and was found to be statistically significant.
Conclusions: In patients with similar demographic data and who will undergo cardiopulmonary bypass surgery, it is thought that increasing the magnesium sulfate values applied in cardiopulmonary bypass applications and added to the prime solution and giving a higher dose to the patient are effective on postoperative atrial fibrillation and arrhythmias.
Key Words: Magnesium, Atrial Fibrillation, Prime Solution, Heart-Lung Pump, Cardiopulmonary Bypass
Project Number
784
References
- 1. Aftabuddin M, Rajbhandhari N, Rahman MZ, Islam N, Khan OS. Cardiopulmonary bypass induced hematolo-gical changes in patients undergoing cardiac surgery. Bangladesh Heart Journal. 2015;30(2):53-57.
- 2. Merkle J, Daka A, Deppe AC, Wahlers T, Paunel-Gorgulu A. High levels of cell-free DNA accurately pre-dict late acute kidney injury in patients after cardiac surgery. PLoS One. 2019;14(6).
- 3. Li Z, Fan G, Zheng X, Gong X, Chen T, Liu X, et al. Risk factors and clinical significance of acute kidney injury after on-pump or off-pump coronary artery bypass grafting: a propensity score-matched study. Interact Cardiovasc Thorac Surg. 2019;28(6):893–9.
- 4. Miles LF, Coulson TG, Galhardo C, Falter F. Pump pri-ming practices and anticoagulation in cardiac surgery: results from the global cardiopulmonary bypass sur-vey. Anesth Analg. 2017;125:1871‐1877.
- 5. Sander M, von Heymann C, von Dossow V, Spaethe C, Konertz WF, Jain U, et al. Increased interleukin-6 after cardiac surgery predicts infection. Anesth Analg. 2006;102(6):1623–9.
- 6. Passaron AC, Silva MAM, Yoshida WB. Cardiopulmo-nary bypass: development of John Gibbon's heart-lung machine. Rev Bras Cir Cardiovasc. 2015;30(2):235-45.
- 7. Gröber U, Schmidt J, Kisters K. Magnesium in Preven-tion and Therapy. Nutrients. 2015:8199–8226.
- 8. Workinger JL, Doyle RP, Bortz J. Challenges in thediag-nosis of magnesium status. Nutrients. 2018;10:1202.
- 9. Reddy ST, Soman SS, Yee J. Magnesium balanceand measurement. Adv Chronic Kidney Dis 2018;25:224-9.
- 10. Jahnen-Dechent J, Ketteler M. Magnesium basics. Clin. Kidney J. 2012;5:i3–i14.
- 11. Nielsen FH, Johnson LAK. Data from controlled meta-bolicward studies provide guidance for the determina-tion of status indicators and dietary requirements for magnesium. Biol Trace Elem Res. 2017;177:43-52.
- 12. Rude RK. Magnesium depletion and hypermagnese-mia. Primer Metab Bone Dis Disorders Miner Metab 1: 2008;Chapter 70:p.328.
- 13. Whang R, Whang DD, Ryan MP. Refractory potassium repletion. A consequence of magnesium deficiency. Arch Intern Med. 1992;152:40–5.
- 14. Raiten JM, Ghadimi K, Augoustides JGT, Ramakrishna H, Patel PA, Weiss SJ, et al. Atrial fibrillation after car-diac surgery: Clinical update on mechanisms and prophylactic strategies. J Cardiothorac Vasc Anesth. 2015;29:806–16.
- 15. Campbell NG, Allen E, Sanders J, Swinson R, Birch S, Sturgess J, et al. The impact of maintaining serum po-tassium >/=3.6 mEq/L vs >/=4.5 mEq/L on the inciden-ce of new-onset atrial fibrillation in the first 120 hours after isolated elective coronary artery bypass graf-ting—Study protocol for a randomised feasibility trial for the proposed Tight K randomized non-inferiority trial. Trials. 2017;18:618.
- 16. Protsyk V, Rasmussen BS, Guarracino F, Erb J, Turton E, Ender J. Fluid management in cardiac surgery: results of a survey in European cardiac anesthesia depart-ments. J Cardiothorac Vasc Anesth. 2017;31:1624-1629.
- 17. Mazur A, Maier JAM, Rock E, Gueux E, Nowacki W, Rayssiguier Y. Magnesium and the inflammatory res-ponse: Potential physiopathological implications. Arch. Biochem. Biophys. 2007;458:48–56.
- 18. Cheungpasitporn W, Thongprayoon C, Qian Q. Dys-magnesemia in Hospitalized Patients: Prevalence and Prognostic Importance. Mayo Clin Proc. 2015;90(8):1001-10.
- 19. Saver JL, Starkman S, Eckstein M, Stratton SJ, Pratt FD, Hamilton S, et al. Prehospital use of magnesium sulfate as neuroprotection in acute stroke. N. Engl. J. Med. 2015;372:528–536.
- 20. Chrysant SG, Chrysant GS. Association of hypomagne-semia with cardiovascular diseases and hypertension. Int J Cardiol Hypertens. 2019;1:100005.
- 21. Salaminia S, Sayehmiri F, Angha P, Sayehmiri K, Mote-dayen M. Evaluating the Effect of Magnesium Supple-mentation and Cardiac Arrhythmias after Acute Coro-nary Syndrome: A Systematic Review and Meta-Analysis. BMC Cardiovasc. Disord. 2018;18:129.
- 22. Fairley JL, Zhang L, Glassford NJ, Bellomo R. Magne-sium status and magnesium therapy in cardiac surgery: A systematic review and meta-analysis focusing on arrhythmia prevention. J Crit Care. 2017;42:69-77.
- 23. Khan AM, Lubitz SA, Sullivan LM, Sun JX, Levy D, Vasan RS, et al. Low serum magnesium and the development of atrial fibrillation in the community: the Framingham Heart Study. Circulation. 2013;127(1):33-8.
- 24. Chaudhary R, Garg J, Turagam M, Chaudhary R, Gupta R, Nazir T, et al. Role of Prophylactic Magnesium Supp-lementation in Prevention of Postoperative Atrial Fib-rillation in Patients Undergoing Coronary Artery Bypass Grafting: a Systematic Review and Meta-Analysis of 20 Randomized Controlled Trials. J Atr Fibrillation. 2019;12(1):2154.
- 25. Shah NC, Shah GJ, Li Z, Jiang XC, Altura BT, Altura BM. Short-term magnesium deficiency downregulates te-lomerase, upregulates neutral sphingomyelinase and induces oxidative DNA damage in cardiovascular tis-sues: relevance to atherogenesis, cardiovascular dise-ases and aging. Int J Clin Exp Med. 2014;7(3):497-514.
- 26. Montezano AC, Zimmerman D, Yusuf H, Burger D, Chignalia AZ, Wadhera V, et al. Vascular Smooth Musc-le Cell Differentiation to an Osteogenic Phenotype In-volves TRPM7 Modulation by Magnesium. Hyperten-sion. 2010;56:453–462.
- 27. Negrea L, DeLozier SJ, Janes JL, Rahman M, Dobre M. Serum Magnesium and Cardiovascular Outcomes and Mortality in CKD: The Chronic Renal Insufficiency Co-hort (CRIC). Kidney Med. 2021;3(2):183-192.
- 28. O'Brien B, Burrage PS, Ngai JY, Prutkin JM, Huang CC, Xu X, et al. Society of Cardiovascular Anes-thesiologists/European Association of Cardiothoracic Anaesthetists practice advisory for the management of perioperative atrial fibrillation in patients undergo-ing cardiac surgery. J Cardiothorac Vasc Anesth. 2019;33:12– 26.
- 29. Larsson SC, Drca N, Michaëlsson K. Serum Magnesium and Calcium Levels and Risk of Atrial Fibrillation. Circ Genom Precis Med. 2019;12(1):e002349.
- 30. Bagheri A, Naghshi S, Sadeghi O, Larijani B, Esmaillza-deh A. Total, Dietary, and Supplemental Magnesium Intakes and Risk of All-Cause, Cardiovascular, and Can-cer Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Stu-dies. Adv. Nutr. 2021;12:1196–1210.
- 31. Howitt SH, Grant SW, Campbell NG, Malagon I, McCol-lum C. Are Serum Potassium and Magnesium Levels Associated with Atrial Fibrillation After Cardiac Sur-gery?. J Cardiothorac Vasc Anesth. 2020;34(5):1152-1159.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Project Number | 784 |
| Early Pub Date | April 27, 2023 |
| Publication Date | April 27, 2023 |
| Submission Date | February 20, 2023 |
| Acceptance Date | March 22, 2023 |
| Published in Issue | Year 2023 Volume: 20 Issue: 1 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty