Prevention of Atrial Tachyarrhythmias After Non-Cardiac Thoracic Surgery by Infusion of Magnesium Sulfate

Abstract

The possible role of magnesium sulfate (MgSO4) infusion in the prevention of atrial tachyarrhythmias after non-cardiac thoracic surgery was evaluated through a prospective study of two hundred patients who underwent non-cardiac thoracic surgery. The patients (who fulfilled the following requirements among others: no myocardial infarction in the previous six months, normal renal function, no use of digitalis or antiarrhythmic drugs, not undergone emergency operations or video-assisted thoracic surgery), were randomly assigned to receive MgSO4 infusion in all circumstances (Mg group), or either no treatment or, if aged over 70 or in cases of pneumonectomy or an intrapericardial procedure, application of digoxin starting on the day of operation (control group). 95 patients were enrolled in the Mg group and 105 in the control group. 93 patients in the Mg group and 101 in the control group were evaluated. Post-operative atrial tachyarrhythmias, mainly atrial fibrillation, occurred in 10 patients (10.7%) in the Mg group and in 27 (26.7%) patients in the control group (chi 2 = 7.009, df = 1. p = 0.008). It is concluded that infusion of MgSO4 is an effective means of reducing the incidence of atrial tachyarrhythmias after non-cardiac thoracic surgery.

Anesthesia for Esophagectomy

“…87 The use of the potential prophylactic properties of magnesium sulfate, digoxin, b-adrenergic receptor blockade, diltiazem, and amiodarone has been proposed. 107,108,[112][113][114][115] A meta-analysis supports the use of calcium-channel blockers and b-blockers in the general thoracic surgical population 111 ; however, following the publication of the POISE trial and a further meta-analysis, the use of b-blockade in patients undergoing low-risk or intermediate-risk noncardiac surgery is not supported. 116,117 Although there is no evidence that prophylactic digoxin is effective at reducing the incidence of supraventricular arrhythmias in esophagectomy patients, 112 a prophylactic infusion of amiodarone has been shown to significantly reduce the incidence of atrial fibrillation in patients undergoing transthoracic esophagectomy.…”

Postoperative Care of Patients Undergoing Lung Resection

“…Magnesium sulphate is often used as an anti-arrhythmic agent in the perioperative setting as it reduces the rate of the sino-atrial node impulses and increases the refractory period of the atrioventricular node [63] Data on magnesium effectiveness are still conflicting. While Terzi et al [64] in a prospective, randomized, open, placebo controlled trial showed a statistically significant reduction in the incidence of SVA from 26.7% in the control group to 10.7% in the magnesium group, Saran et al [65] observed no reduction in the incidence of SVA with prophylactic magnesium, even though it reduced their incidence in the high risk cohort of patients undergoing pneumonectomy. Statin drugs, which have anti-inflammatory properties, have also been shown to be associated with a reduction in the incidence of post-pulmonary resection AF [66] but their use is not supported by clear evidence.…”

Postthoracotomy atrial fibrillation

“…Partial sympathectomy with epidural analgesia did not reduce atrial fibrillation after cardiac surgery and only marginally attenuated the incidence after thoracic surgery in a small study in which the control and treated arms were poorly matched for age [32,33]. Unless hypomagnesemia is present, the role of prophylactic administration of magnesium during general thoracic surgery to reduce the incidence of postoperative supraventricular arrhythmias is not clear and data are available only from one study in which some control patients who had hypomagnesemia received magnesium after randomization [34]. Intriguingly, the use of statins before thoracic or cardiac surgery has been associated with a reduced incidence of postoperative atrial fibrillation but further study is needed to determine whether this strategy can be added to proven prevention strategies [22 ,35 ].…”