| Prophylactic intravenous magnesium sulfate for treatment of aneurysmal subarachnoid hemorrhage: a randomized, placebo-controlled, clinical study. | |
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MedLine Citation:
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PMID: 20228677 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To examine whether the maintenance of elevated magnesium serum concentrations by intravenous administration of magnesium sulfate can reduce the occurrence of cerebral ischemic events after aneurysmal subarachnoid hemorrhage. DESIGN: Prospective, randomized, placebo-controlled study. SETTING: Neurosurgical intensive care unit of a University hospital. INTERVENTIONS: One hundred ten patients were randomized to receive intravenous magnesium sulfate or to serve as controls. Magnesium treatment was started with a bolus of 16 mmol, followed by continuous infusion of 8 mmol/hr. Serum concentrations were measured every 8 hrs, and infusion rates were adjusted to maintain target levels of 2.0-2.5 mmol/L. Intravenous administration was continued for 10 days or until signs of vasospasm had resolved. Thereafter, magnesium was administered orally and tapered over 12 days. MEASUREMENTS AND MAIN RESULTS: Delayed ischemic infarction (primary end point) was assessed by analyzing serial computed tomography scans. Transcranial Doppler sonography and digital subtraction angiography were used to detect vasospasm. Delayed ischemic neurologic deficit was determined by continuous detailed neurologic examinations; clinical outcome after 6 months was assessed using the Glasgow outcome scale. Good outcome was defined as Glasgow outcome scale score 4 and 5.The incidence of delayed ischemic infarction was significantly lower in magnesium-treated patients (22% vs. 51%; p = .002); 34 of 54 magnesium patients and 27 of 53 control patients reached good outcome (p = .209). Delayed ischemic neurologic deficit was nonsignificantly reduced (9 of 54 vs. 15 of 53 patients; p = .149) and transcranial Doppler-detected/angiographic vasospasm was significantly reduced in the magnesium group (36 of 54 vs. 45 of 53 patients; p = .028). Fewer patients with signs of vasospasm had delayed cerebral infarction. CONCLUSION: These data indicate that high-dose intravenous magnesium can reduce cerebral ischemic events after aneurysmal subarachnoid hemorrhage by attenuating vasospasm and increasing the ischemic tolerance during critical hypoperfusion. |
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Authors:
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Thomas Westermaier; Christian Stetter; Giles H Vince; Mirko Pham; Jose Perez Tejon; Jörg Eriskat; Ekkehard Kunze; Cordula Matthies; Ralf-Ingo Ernestus; Laszlo Solymosi; Klaus Roosen |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Critical care medicine Volume: 38 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-04-21 Completed Date: 2010-05-14 Revised Date: 2010-09-24 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1284-90 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurosurgery, University of Wuerzburg, Wuerzburg, Germany. Westermaier.T@nch.uni-wuerzburg.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Calcium Channel Blockers / administration & dosage, therapeutic use* Female Hospitals, University Humans Hypoxia-Ischemia, Brain / etiology, prevention & control Infusions, Intravenous Intensive Care Units Intracranial Aneurysm / complications* Magnesium Sulfate / administration & dosage, therapeutic use* Male Middle Aged Prospective Studies Subarachnoid Hemorrhage / drug therapy*, etiology Vasospasm, Intracranial / etiology, prevention & control* |
| Chemical | |
Reg. No./Substance:
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0/Calcium Channel Blockers; 7487-88-9/Magnesium Sulfate |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2010 Oct;38(10):2083-4; author reply 2084-5
[PMID:
20856005
]
Crit Care Med. 2010 May;38(5):1382-4 [PMID: 20404634 ] Crit Care Med. 2010 Oct;38(10):2083; author reply 2084-5 [PMID: 20856006 ] |
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