Isabel Gracia, Neus Fàbregas, Paola Hurtado, Nicolás DE Riva, Teresa Boget, Georgina Casanovas, Laura Oleaga, Núria Bargalló, Josep González, Jordi Rumià, Javier Tercero, Marta García-Orellana, Enrique Carrero, Gabriel Pujol-Fontrodona, Gemma Cabedo, Eugenia Pujol-Ayach, Ricard Valero
{"title":"Effect of perioperative magnesium sulfate on neurological outcome in neurosurgical patients: a randomized double-blind controlled trial.","authors":"Isabel Gracia, Neus Fàbregas, Paola Hurtado, Nicolás DE Riva, Teresa Boget, Georgina Casanovas, Laura Oleaga, Núria Bargalló, Josep González, Jordi Rumià, Javier Tercero, Marta García-Orellana, Enrique Carrero, Gabriel Pujol-Fontrodona, Gemma Cabedo, Eugenia Pujol-Ayach, Ricard Valero","doi":"10.23736/S0375-9393.24.18401-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Supplemental magnesium sulfate has a potential neuroprotective role in acute brain injury. It is safe, widely available, and inexpensive. This study evaluated the effect of perioperative intravenous administration of magnesium sulfate on brain damage caused by neurosurgery.</p><p><strong>Methods: </strong>Prospective randomized double-blind controlled study. Fifty adult patients undergoing supratentorial neurosurgery (25 were assigned to magnesium sulfate group and 26 to the control group). On arrival to the operating room, the intervention group received intravenous magnesium sulfate, 4 g bolus in 100 mL of 0.9% saline solution lasting 20 min followed by 20 g in 1000 mL saline lasting 24 h. The control group received the same volume of saline. Serum S100B-protein levels 2 h after surgery was the primary outcome. Secondary outcomes were neuron-specific enolase, magnetic resonance imaging (MRI) parameters, neuropsychological testing, Glasgow Outcome Scale, and mortality, during hospital stay and at six and 12 months after surgery.</p><p><strong>Results: </strong>Statistically significant differences in the primary outcome were not found. At six months, MRI showed a mean surgical cavity volume of 10.0 cm<sup>3</sup> (95% confidence interval [CI] 4.4-15.6) in the magnesium group vs. 26.9 cm<sup>3</sup> (95% CI 13.8-39.9) in controls (P=0.02), gliosis/edema in 55% vs. 90.5% (P=0.014), and contrast enhancement around the cavity in 33.3% vs. 80% (P=0.041), respectively. Patients in the magnesium group showed better scores in some neuropsychological tests. There were no relevant adverse effects in magnesium group.</p><p><strong>Conclusions: </strong>Neurosurgical patients treated with supplemental magnesium sulfate showed macroscopic improvement in some MRI parameters related to blood-brain barrier permeability and better performance in some focal cognitive domain.</p>","PeriodicalId":18522,"journal":{"name":"Minerva anestesiologica","volume":"91 1-2","pages":"45-57"},"PeriodicalIF":2.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minerva anestesiologica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23736/S0375-9393.24.18401-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Supplemental magnesium sulfate has a potential neuroprotective role in acute brain injury. It is safe, widely available, and inexpensive. This study evaluated the effect of perioperative intravenous administration of magnesium sulfate on brain damage caused by neurosurgery.
Methods: Prospective randomized double-blind controlled study. Fifty adult patients undergoing supratentorial neurosurgery (25 were assigned to magnesium sulfate group and 26 to the control group). On arrival to the operating room, the intervention group received intravenous magnesium sulfate, 4 g bolus in 100 mL of 0.9% saline solution lasting 20 min followed by 20 g in 1000 mL saline lasting 24 h. The control group received the same volume of saline. Serum S100B-protein levels 2 h after surgery was the primary outcome. Secondary outcomes were neuron-specific enolase, magnetic resonance imaging (MRI) parameters, neuropsychological testing, Glasgow Outcome Scale, and mortality, during hospital stay and at six and 12 months after surgery.
Results: Statistically significant differences in the primary outcome were not found. At six months, MRI showed a mean surgical cavity volume of 10.0 cm3 (95% confidence interval [CI] 4.4-15.6) in the magnesium group vs. 26.9 cm3 (95% CI 13.8-39.9) in controls (P=0.02), gliosis/edema in 55% vs. 90.5% (P=0.014), and contrast enhancement around the cavity in 33.3% vs. 80% (P=0.041), respectively. Patients in the magnesium group showed better scores in some neuropsychological tests. There were no relevant adverse effects in magnesium group.
Conclusions: Neurosurgical patients treated with supplemental magnesium sulfate showed macroscopic improvement in some MRI parameters related to blood-brain barrier permeability and better performance in some focal cognitive domain.
期刊介绍：
Minerva Anestesiologica is the journal of the Italian National Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care. Minerva Anestesiologica publishes scientific papers on Anesthesiology, Intensive care, Analgesia, Perioperative Medicine and related fields.
Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors.
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