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Anesth Analg 2003;96:1838
© 2003 International Anesthesia Research Society

LETTERS TO THE EDITOR

Magnesium Sulfate and Neuroprotection

Federico Bilotta, MD PhD, and Giovanni Rosa, MD

Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Rome "La Sapienza", Rome, Italy

To the Editor:

We read with great interest the article from Wilkes et al. (1) reporting that correcting ionized plasma magnesium during cardiopulmonary bypass in patients undergoing coronary artery bypass grafting (CABG) reduces the risk of postoperative cardiac arrhythmia. In their article, Wilkes and colleagues mention some of the systemic effects of magnesium sulfate administration and the underlying cellular mechanisms. But they fail to mention its neuroprotective effects. Magnesium sulfate has major neuroprotective effects in experimental head trauma models (2), spinal cord ischemia (3), and ischemia after middle cerebral artery occlusion (4). Cardiopulmonary bypass for CABG is complicated by postoperative neurocognitive decline (5), possibly related to diffuse ischemic brain damage. By competing with Ca2+, magnesium reduces the ischemia-related rise in intracellular Ca2+, thereby preventing cell death. In the brain, magnesium causes a dose-dependent vasodilation of pial arterioles, dilates the basilar artery, and improves cortical blood flow during middle cerebral artery occlusion. In patients undergoing cardiopulmonary bypass for CABG, administration of magnesium sulfate to correct ionized plasma magnesium may also play a beneficial role in perioperative neuroprotection.

Footnotes

Dr. Wilkes does not wish to respond.

References

  1. Wilkes NJ, Mallett SV, Peachey T, et al. Correction of ionized plasma magnesium during cardiopulmonary bypass reduces the risk of postoperative cardiac arrhythmia. Anesth Analg 2002; 95: 828–34.[Abstract/Free Full Text]
  2. McIntosh TK, Vink R, Yanakami I, Faden A. Magnesium protects against neurological deficit after brain injury. Brain Res 1989; 482: 252–60.[Web of Science][Medline]
  3. Vacanti TX, Ames A. Mild hypothermia and Mg++ protect against irreversible damage during CNS ischemia. Stroke 1984; 15: 695–8.[Abstract/Free Full Text]
  4. Izumi Y, Roussel S, Pinard E, Seylaz J. Reduction of infarct volume by magnesium after middle cerebral artery occlusion in rats. J Cereb Blood Flow Metabol 1991; 11: 1025–30.[Web of Science][Medline]
  5. Newman MF, Kirchner JL, Phillips-Butte B, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 2001; 344: 395–402.[Abstract/Free Full Text]




This Article
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2003 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press