HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Peter Wearden Victor Morell Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Manrique, A. M. Articles by Munoz, R. Search for Related Content PubMed PubMed Citation Articles by Manrique, A. M. Articles by Munoz, R. Related Collections Anesthesia Cardiac - pharmacology Congenital - acyanotic Congenital - cyanotic

J Thorac Cardiovasc Surg 2010;139:162-169
© 2010 The American Association for Thoracic Surgery

Perioperative Management

Magnesium supplementation during cardiopulmonary bypass to prevent junctional ectopic tachycardia after pediatric cardiac surgery: A randomized controlled study

^a Department of Pediatrics, Heart Center, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
^b Department of Medicine, Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pa
^c Department of Medicine, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa
^d Department of Anesthesiology, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
^e Department of Cardiothoracic Surgery Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
^f Department of Critical Care Medicine, Division of Cardiac Intensive Care, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa

Presented and awarded at the European Symposium of the Pediatric Cardiac Intensive Care Society (March 2008) (Young Investigator Award).

Received for publication September 30, 2008; revisions received May 27, 2009; accepted for publication July 23, 2009.

^_* Address for reprints: Ricardo Munoz, MD, FAAP, FCCM, Chief, Cardiac Intensive Care Division; Director, Cardiac Recovery Program, Children's Hospital of Pittsburgh of UPMC Heart Center, 3705 Fifth Ave, Pittsburgh, PA 15213. (Email: munorx{at}ccm.upmc.edu).

Objectives: We analyzed the role of magnesium sulfate (MgSO₄) supplementation during cardiopulmonary bypass in pediatric patients undergoing cardiac surgery, assessing the incidence of hypomagnesemia and the incidence of junctional ectopic tachycardia.

Methods: We performed a randomized, double-blind, controlled trial in 99 children. MgSO₄ or placebo was administered during the rewarming phase of cardiopulmonary bypass: group 1, placebo group (29 patients); group 2, 25 mg/kg of MgSO₄ (30 patients); and group 3, 50 mg/kg of MgSO₄ (40 patients).

Results: At the time of admission to the cardiac intensive care unit, groups receiving MgSO₄ had significantly greater levels of ionized magnesium (group 1, 0.51 ± 0.07; group 2, 0.57 ± 0.09; group 3, 0.59 ± 0.09). Hypomagnesemia before bypass was common (75%–86.2%) and not significantly different among the groups. The proportion of hypomagnesemia decreased significantly at admission to the cardiac intensive care unit in groups receiving MgSO₄ (group 1, 77.8%; group 2, 63%; group 3, 47.4%). Patients receiving placebo (group 1) had a significantly greater occurrence of junctional ectopic tachycardia than groups receiving MgSO₄ (group 1, n = 5 [17.9%]; group 2, n = 2 [6.7%]; group 3, n = 0 [0%]). Age (<1 month), Aristotle score (>4), and history of cardiac failure were associated with junctional ectopic tachycardia. None of the patients with those characteristics in group 3 had junctional ectopic tachycardia. No association was found between study groups and the Pediatric Risk of Mortality score or length of stay in the cardiac intensive care unit.

Conclusions: Supplementation with MgSO₄ during cardiopulmonary bypass seems to reduce the incidence of hypomagnesemia and junctional ectopic tachycardia at admission to the cardiac intensive care unit. This effect seems to be dose related.

This article has been cited by other articles:

				R. Lopez, G. Lema, A. Gonzalez, C. Carvajal, R. Canessa, P. Carrasco, V. Lazo, C. Hudson, R. Gonzalez, and P. Frangini Plasma levels of potassium and magnessium after modified ultrafiltration in pediatric cardiac surgery with cardiopulmonary bypass Perfusion, January 1, 2012; 27(1): 40 - 42. [Abstract] [PDF]

				C. Chrysostomou, J. Sanchez-de-Toledo, P. Wearden, E. H. Jooste, S. E. Lichtenstein, P. M. Callahan, T. Suresh, E. O'Malley, D. Shiderly, J. Haney, et al. Perioperative Use of Dexmedetomidine Is Associated With Decreased Incidence of Ventricular and Supraventricular Tachyarrhythmias After Congenital Cardiac Operations Ann. Thorac. Surg., September 1, 2011; 92(3): 964 - 972. [Abstract] [Full Text] [PDF]

				L. Mildh, A. Hiippala, P. Rautiainen, V. Pettila, H. Sairanen, and J.-M. Happonen Junctional ectopic tachycardia after surgery for congenital heart disease: incidence, risk factors and outcome Eur J Cardiothorac Surg, January 1, 2011; 39(1): 75 - 80. [Abstract] [Full Text] [PDF]

				Y. S. Verma, S. Chauhan, P. Gharde, R. Lakshmy, and U. Kiran Role of magnesium in the prevention of postoperative arrhythmias in neonates and infants undergoing arterial switch operation Interact CardioVasc Thorac Surg, November 1, 2010; 11(5): 573 - 576. [Abstract] [Full Text] [PDF]