Blood Ionized Magnesium Concentrations During Cardiopulmonary Bypass and Their Correlation with Other Circulating Cations

Aziz, Salim; Haigh, W. Geoffrey; Norman, Gail A. Van; Kenny, Richard J.; Kenny, Margaret A.

doi:10.1111/j.1540-8191.1996.tb00060.x

Cited by 23 publications

(13 citation statements)

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three decades [1][2][3][4][5][6][7][8][9][10][11]. In addition, it is shown that hypomagnesemia following cardiac surgery is associated with an increase in the incidence of dysrhythmia, and Mg administration could contribute to fewer postoperative dysrhythmias [5][6][7] or better myocardial recovery [7].

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confidence: 98%

Changes in plasma total and ionized magnesium concentrations and factors affecting magnesium concentrations during cardiac surgery

et al. 2004

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The purpose of this study was to measure blood total and ionized magnesium concentrations ([TMg] and [Mg(2+)], respectively) and to investigate factors that might be affecting their changes during cardiac surgery using hypothermic cardiopulmonary bypass. Eight patients were examined. All the patients received diuretics and predeposited autologous blood during surgery. No drugs containing Mg(2+) were administered. Nine blood samples and eight urine samples were collected from the pre-induction period to the end of surgery. Hematocrit, [TMg], [Mg(2+)], plasma concentrations of calcium ([Ca(2+)]), creatinine, parathyroid hormone (PTH), urinary concentrations of TMg, and creatinine were measured, and the fractional excretion of Mg (FEMg) was calculated. Both [TMg] and [Mg(2+)] decreased significantly in the prebypass period and remained significantly depressed thereafter. The ionized fraction of magnesium ([Mg(2+)]/[TMg]) was decreased during the postbypass period. Hematocrit decreased significantly from the prebypass period, and FEMg increased significantly after aortic cross-clamping. In conclusion, hemodilution and renal loss were main causes of hypomagnesemia, and citrate in predeposited autologous blood may contribute to the decrease in [Mg(2+)]/[TMg] in the postbypass period. These results suggest that magnesium supplementation under close monitoring of [Mg(2+)] should be required during cardiac surgery.

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confidence: 98%

Changes in plasma total and ionized magnesium concentrations and factors affecting magnesium concentrations during cardiac surgery

et al. 2004

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“…Isto explica, pelo menos em parte, os efeitos benéficos de sua presença no momento da reperfusão, fato que permanecia ainda obscuro quando considerados seus efeitos apenas por ação direta nas musculaturas cardíaca e lisa vascular. Assim, justifica-se sua indicação precoce na vigência do binômio isquemia/reperfusão comum na prática cardiológica moderna incluindo recanalização de artérias após trombólise, angioplastias e particularmente despinçamento aórtico (4)(5)(6)18,44) .…”

Section: Implicações Clínicasunclassified

“…Ressaltese, o uso de diuréticos, o estresse, as restrições dietéticas e a administração pré-operatória de catecolaminas contribuem significativamente para queda dos níveis circulantes de magnésio nos pacientes cirúrgicos (6,44,45) . Adicionalmente a composição do perfusato por soluções que não possuem magnésio, como a solução de Ringer, propicia queda adicional na concentração sérica de magnésio induzida pela hemodiluição (4,6,44,47) . Os fatores acima descritos são relativamente freqüentes e exacerbam a disfunção endotelial causada pela isquemia/reperfusão.…”

Section: Implicações Clínicasunclassified

“…O conhecimento dos efeitos benéficos da infusão de magnésio no per-operatório de cirurgias cardíacas (3,4,5,6) levantou a possibilidade de sua influência positiva atenuando a disfunção endotelial decorrente da lesão de isquemia/reperfusão. Na tentativa de compreender os mecanismos responsáveis pelo efeito protetor observado com a infusão do magnésio em cirurgia cardíaca, estudos demonstraram que o magnésio tem um papel importante na via clássica da liberação de NO (7,8) .…”

Section: Introductionunclassified

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Disfunção endotelial após isquemia global e reperfusão em cirurgia cardíaca com circulação extracorpórea: estudo do papel do magnésio em artérias coronarianas caninas

Volpe

Carneiro

Magna³

et al. 2002

Rev Bras Cir Cardiovasc

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Introduction: Hypomagnesemia and ischemia followed by reperfusion often occur in cardiac surgery. Both of them are associated with endothelial dysfunction which interfers VOLPE, MA ET AL -Disfunção Endotelial após Isquemia Global e Reperfusão em Cirurgia Cardíaca com Circulação Extracorpórea: Estudo do Papel do Magnésio em Artérias Coronarianas Caninas Atualização e análise crítica. Cardiovasc 2002; 17(3): 187-200 Objective: The present study focuses on the endothelial dysfunction consequent to the lesion resulting from global ischemia followed by reperfusion and the potential protective influence of magnesium on the endothelium functional integrity in isolated coronaries of dogs. Rev Bras CirMethod: Segments of canine coronary arteries were suspended in organ chambers to measure isometric force. Endothelial dysfunction was evaluated by the ability of these segments to produce nitric oxide changing the initial isometric force. Four groups with six dogs in each one were selected: SEM CEC (control), CEC (110 minutes of perfusion without ischemia), ISQ (45 minutes of ischemia), ISQ/REP (45 minutes of ischemia followed by 60 minutes of reperfusion). The magnesium action was evaluated in three different phases: I (organ chambers with magnesium), II (organ chambers without magnesium) and III (organ chambers with restored magnesium). Three pharmacological agonists were used which represented the main steps involved in the nitric oxide production: the membrane receptor of the endothelial cell -acetylcholine (ACh); transduction of the signal between the receptor and the intracellular processes through the G-protein -sodium fluoride (NaF); liberation of intracellular stocks of calcium -calcium ionophore (A 23187 ). The study of endothelial function was combined with the evaluation of smooth muscle activity dependent on GMPcsodium nitroprusside (NPS).Results: The major findings of this investigation were as follows: 1) presence of magnesium in priming seemed to attenuate the endothelial dysfunction caused by global ischemia followed by reperfusion; 2) presence of magnesium in the organ chamber (phase I) was associated with the greatest relaxation in response to agonists of the nitric oxide production; 3) removal of magnesium in the organ chamber (phase II) was linked to the reduction in the relaxation intensity in response to agonists of the nitric oxide production; 4) the magnesium restoration to the organ chamber (phase III) allowed restoration of the relaxation observed in the phase I, only in response to the direct stimulation of the G-proteins. For the rest of the remaining agonists, the restoration was associated with the additional reduction in the relaxation intensity; 5) the smooth muscle received the influence of the magnesium concentration in the organ chamber.Conclusion: It was concluded that magnesium favorably influences the nitric oxide production by the coronary endothelium attenuating the endothelial dysfunction caused by global ischemia followed by reperfusion.Descriptors: Magnesium. Endotheli...

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“…34 For example, after cardiopulmonary bypass and in agreement with our hypothesis, the protein-bound fraction of Mg decreased consecutively to the dilutional hypoalbuminemia following surgery, without affecting the MgI levels. 35,36 Finally, in abdominal surgery, without massive transfusion and no cardiopulmonary bypass, MgI and MgT both decreased. The MgT decrease correlated with the degree of hypoalbuminemia.…”

Section: Postoperative Injured and Critically Ill Patientsmentioning

confidence: 96%

Practical Interest of Circulating Total and Ionized Magnesium Concentration Evaluation in Experimental and Clinical Magnesium Disorders

Pagès¹,

Bac²,

Maurois³

et al.

New Perspectives in Magnesium Research

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Magnesium (Mg) is essentially an intracellular ion, which makes it diffi cult to evaluate Mg status. Both circulating total (MgT) and ionized Mg 2+ (MgI) are used in clinical practice but their respective interest is still debated. In the present review, we list various studies comparing MgT and MgI in either Mg imbalances or Mg status dysregulations. In simple Mg imbalances (either therapeutic Mg overload or Mg defi ciency), the evaluation of MgT appears a better marker than MgI because it seems that a subtle physiological homeostatic compensatory reaction modifi es the proportion of MgI, the most biologically active fraction of blood Mg, in order to reduce the effects of Mg imbalance. In contrast, in Mg dysregulations (either Mg pathological overload or Mg depletion) both fractions may vary independently, depending mainly on the renal status and on the equilibrium between MgI and Mg complexed with proteins and anions. The choice of the more appropriate marker is discussed.Magnesium is an essential cofactor in numerous cellular functions.1 In addition to a balance between intestinal absorption and renal excretion, the bone is involved in magnesium homeostasis.2 Exchanges between the circulating Mg forms also occur.

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Blood Ionized Magnesium Concentrations During Cardiopulmonary Bypass and Their Correlation with Other Circulating Cations

Abstract: Blood iMg depletion occurs frequently in CPB patients. iMg changes are not readily predictable. The association of intraoperative iMg depletion with postsurgical atrial fibrillation--reported to have a hypomagnesemic connection- should be investigated.

Cited by 23 publications

References 25 publications

Changes in plasma total and ionized magnesium concentrations and factors affecting magnesium concentrations during cardiac surgery

Changes in plasma total and ionized magnesium concentrations and factors affecting magnesium concentrations during cardiac surgery

Disfunção endotelial após isquemia global e reperfusão em cirurgia cardíaca com circulação extracorpórea: estudo do papel do magnésio em artérias coronarianas caninas

Practical Interest of Circulating Total and Ionized Magnesium Concentration Evaluation in Experimental and Clinical Magnesium Disorders

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