Changes in Ionized and Total Magnesium Concentration during Spinal Surgery

Chang, Chul Ho; Nam, Seok Woo; Lee, Jong Seok; Han, Dong Woo; Lee, Hyun Kyu; Shin, Cheung Soo

doi:10.4097/kjae.2007.52.6.s37

Cited by 4 publications

(14 citation statements)

References 22 publications

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“…Embora a hipomagnesemia seja um dos distúrbios eletrolí-ticos mais comuns em pacientes hospitalizados, especialmente nos criticamente doentes 1,2 e no período pós-operatório 1 , é também considerado o distúrbio mais subdiagnosticado 3 . Ocorre em cerca de 11% dos pacientes hospitalizados; em 20% dos pacientes admitidos em Unidade de Terapia Intensiva (UTI); e em 61% dos pacientes admitidos em UTI cirúrgica 3 .…”

Section: Introductionunclassified

“…Ocorre em cerca de 11% dos pacientes hospitalizados; em 20% dos pacientes admitidos em Unidade de Terapia Intensiva (UTI); e em 61% dos pacientes admitidos em UTI cirúrgica 3 . É associado a hospitalização prolongada, com maior tempo de permanência em UTI e maior mortalidade, tanto em pacientes clínicos quanto cirúrgicos 1 .…”

Section: Introductionunclassified

“…Na literatura, há poucos relatos de pacientes ortopédicos com hipomagnesemia 1,3 , porém chama a atenção sua elevada frequência no pós-operatório de pacientes submetidos a cirurgias com grande envolvimento ósseo, como a artro-dese de coluna 1,3,4 . A etiologia da deficiência de magnésio, nesses casos, é descrita como multifatorial: associação com transfusão sanguínea (o citrato atua como quelante, com formação do citrato de magnésio) 1,3 dilucional, devido à administração de grandes quantidades de fluido hipotônico durante a cirurgia 1,3,4 ; e alteração transitória da função das paratireoides, consequente ao rompimento do periósteo e tecido ósseo 4 .…”

Section: Introductionunclassified

“…A etiologia da deficiência de magnésio, nesses casos, é descrita como multifatorial: associação com transfusão sanguínea (o citrato atua como quelante, com formação do citrato de magnésio) 1,3 dilucional, devido à administração de grandes quantidades de fluido hipotônico durante a cirurgia 1,3,4 ; e alteração transitória da função das paratireoides, consequente ao rompimento do periósteo e tecido ósseo 4 . Independente de sua etiologia, o paciente com hipomagnesemia pode apresentar, principalmente: arritmias atriais e ventriculares 2 , isquemia miocárdica 3,5 , insuficiência cardíaca 2 e alterações neurológicas, como crises convulsivas 2,4,6,7 e rebaixamento do nível de consciência 6 .…”

Section: Introductionunclassified

“…Já no estudo feito por Chang et al 1 , a incidência de hipomagnesemia foi menor (13%), porém a queda nos níveis séricos de magnésio nos períodos pré e pós-operatório também foi significativa. Ambos os estudos foram feitos em adultos.…”

Section: Introductionunclassified

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Hypomagnesemia after spinal fusion

Chrun¹,

João²

2012

J Pediatr (Rio J)

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Objectives: To determine the frequency of hypomagnesaemia in pediatric patients after spinal fusion, to verify whether postoperative magnesium levels were lower than preoperative levels and, if so, to identify possible causes and assess the clinical repercussions for patients. Methods:This was a retrospective descriptive study of pediatric patients admitted to a pediatric intensive care unit (ICU) after spine fusion surgery, between March 1 and August 31, 2011. Preoperative magnesium, phosphorus and total and ionized calcium concentrations were compared with the results of tests conducted during the first 24 hours after admission to the ICU. Results:A total of 45 patients were enrolled on the study. Median age was 13.1 years. Preoperative mean serum magnesium was 1.8±0.2 mg/dL and postoperative serum magnesium was 1.4±0.2 mg/dL, which was a significant reduction between the two periods (p < 0.001). The frequency of hypomagnesaemia rose from 1 patient (2%) in the preoperative period to 31 patients (68%) during the postoperative period. There were also significant reductions in concentrations of phosphorus (p < 0.001) and total calcium (p < 0.001). There was a significant correlation between magnesium reductions and the volume of fluids administered during the surgery (p = 0.03), transfused blood volume (p < 0.001) and number of vertebrae fused (p < 0.05). Seven of the 31 patients with hypomagnesemia exhibited symptoms (22%). Conclusion:There was an elevated frequency of hypomagnesemia in patients who underwent spinal fusion. Serum magnesium should be assayed when patients are admitted to the pediatric ICU, so appropriate supplementation can be initiated immediately, minimizing the risk of complications.J Pediatr (Rio J). 2012;88(3):227-32: Hypomagnesemia, pediatric ICU, spine fusion. ResumoObjetivos: Verificar a frequência de hipomagnesemia em pacientes pediátricos submetidos a artrodese de coluna, avaliando se há queda significativa nas dosagens de magnésio sérico nos períodos pré e pós-operatório, quais suas possíveis causas e quais as consequências clínicas para os pacientes. Métodos:Estudo retrospectivo e descritivo dos pacientes admitidos em uma Unidade de Terapia Intensiva pediátrica no pós-operatório de artrodese de coluna, no período de 1º de março a 31 de agosto de 2011. Foram comparados os níveis de magnésio, fósforo, cálcio total e ionizado no pré-operatório com os valores encontrados após a admissão na Unidade de Terapia Intensiva. Resultados:Foram incluídos 45 pacientes, com idade média de 13,1 anos. No pré-operatório, o valor médio do magnésio foi de 1,8±0,2 mg/dL, e no pós-operatório, de 1,4±0,2 mg/dL, o que demonstra uma queda significativa entre os dois períodos (p < 0,001). A frequência de hipomagnesemia foi de somente um paciente (2%) no pré-operatório para 31 (68%) no pós-operatório. Houve também queda significativa nos níveis de fósforo (p < 0,001) e cálcio total (p < 0,001). Houve correlação significativa entre a queda do magnésio e o volume de fluido recebido durante a cirurgia (p =...

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Hypomagnesemia after spinal fusion

Chrun¹,

João²

2012

J Pediatr (Rio J)

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Hypomagnesemia following posterior spinal fusion in adolescent idiopathic scoliosis

Marrero-Barrera

Ramírez

Olivella

et al. 2020

Journal of Pediatric Orthopaedics B

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Adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) usually require surveillance in the pediatric ICU (PICU). Some reports have documented evidence of hypomagnesemia following PSF at PICU. Little has been studied about relationship between AIS and postoperative serum magnesium (Mg+2) levels. The aim of this study is to determine the prevalence and risk factors of hypomagnesemia in AIS patients admitted to PICU after PSF. IRB approved the cross-sectional study of AIS patients admitted to PICU after PSF from January 2016 to May 2017. Serum electrolyte levels of phosphorous, calcium, sodium, potassium and hemoglobin were taken preoperative and 24 h postoperative and compared with postoperative magnesium levels. Blood volume reinfused from cell saver return (CSR), estimated blood loss (EBL), volume of fluids intraoperative and average of vertebra levels operated were charted and compared with postoperative magnesium levels. A total of 46 AIS patients undergoing PSF met inclusion criteria, with an average age of 15 years (78% female). Postoperatively, hypomagnesemia was reported in 24/46 patients (53%).No association was found between hypomagnesemia and serum electrolyte (phosphorous, calcium, sodium and potassium) or hemoglobin levels. In addition, no statistical association was found with age, operative time, vertebrae level fused, CSR, EBL and volume of fluids intraoperatively. Fifty-three percent of pediatric patients developed hypomagnesemia after surgical correction for AIS. Further investigation of this electrolyte disturbance will likely result in a useful clinical tool for physician in the management of AIS.

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Magnesium Sulfate Attenuate Opioid Tolerance in Patients undergoing Major Abdominal Surgery

et al. 2009

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Background: Magnesium is a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptor. Magnesium is thought to be involved in opioid tolerance by way of inhibiting calcium entry into cells.Methods: The patients were randomly assigned to three groups according to the anesthetic regimens: Group M received magnesium sulfate and Group C received saline intravenously under remifentanil-based anesthesia. Group S received saline intravenously under sevoflurane based anesthesia in place of remifentanil. The patients in the group M received 25% magnesium sulfate 50 mg/kg in 100 ml of saline, and those patients in groups C and S received an equal volume of saline before induction of anesthesia; this was followed by 10 mg/kg/h infusion of either magnesium sulfate (group M) or an equal volume of saline (groups C and S) until the end of surgery. Pain was assessed on a visual analog scale at 1, 6, 12, 24, and 36 hours after the operation. The time to the first postoperative analgesic requirement and the cumulative analgesic consumption were evaluated in the three groups.Results: The visual analog scales for pain and the cumulative analgesic consumption were significantly greater in group C than in other groups. The time to first postoperative analgesic requirement was significantly shorter in group C than that in the other groups. There were no differences between group M and S for side effects.Conclusions: A relatively high dose and continuous remifentanil infusion is associated with clinically relevant evidence of acute opioid tolerance. NMDA-receptor antagonist, magnesium sulfate as an adjuvant analgesic prevents opioid tolerance in patients who are undergoing major abdominal surgery under high dose and continuous remifentanil infusion-based anesthesia. (Korean J Pain 2009; 22: 58-64)

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Changes in Ionized and Total Magnesium Concentration during Spinal Surgery

Cited by 4 publications

References 22 publications

Hypomagnesemia after spinal fusion

Hypomagnesemia after spinal fusion

Hypomagnesemia following posterior spinal fusion in adolescent idiopathic scoliosis

Magnesium Sulfate Attenuate Opioid Tolerance in Patients undergoing Major Abdominal Surgery

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