Role of Magnesium Sulfate in Preventing Vasospasm and Maintaining Hemodynamic Stability in Patients Undergoing Endovascular Coiling for Brain Aneurysm

Document Type: Original Article

Authors

1 Cardiac Anesthesiologist, Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Neurosurgeon, Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Community Medicine ,Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran

5 Internal Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Themaintenance of hemodynamic stability in brain aneurysm surgery has paramount clinical significance in order to prevent vasospasm in the patients with aneurysmal subarachnoid hemorrhage. Regarding this, the present study was conducted to assess the role of magnesium sulfate in preventing vasospasm and maintaining hemodynamic stability during endovascular coiling procedure for brain aneurysm.

Materials and Methods: This double-blind clinical trial was conducted on 60 patients who were candidates for undergoing endovascular coiling for brain aneurysm. The patients were subjected to angiography through femoral artery catheterization. Then, they were randomly assigned into two treatment groups of case receiving magnesium sulfate and control administered normal saline. The vasospasm and hemodynamic status were measured and recorded during and following the surgery.
Results: According to the results, no significant difference was observed between the two groups in terms of heart rate (p=0.98) and mean arterial pressure =p) 0.89(  one hour post-surgery. Furthermore, there was no statistical difference between the two groups regarding the use of nimodipine ( p=0.11). Nevertheless, the frequency of vasospasm was significantly lower in the patients receiving magnesium sulfate, during surgery (p=0.037) and after surgery (p=0.02), compared to those administered normal saline.
Conclusion: As the findings indicated, magnesium sulfate could lower the incidence of vasospasm during and following the endovascular coiling procedure for brain aneurysm. Moreover, it resulted in no adverse effects on the hemodynamic status of the patients.

Keywords


1.         Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke. 2000;31(10):2369-77. Epub 2000/10/07.

2.         Wermer MJ, van der Schaaf IC, Velthuis BK, Algra A, Buskens E, Rinkel GJ. Follow-up screening after subarachnoid haemorrhage: frequency and determinants of new aneurysms and enlargement of existing aneurysms. Brain : a journal of neurology. 2005;128(Pt 10):2421-9. Epub 2005/07/08.

3.         Naidech AM, Janjua N, Kreiter KT, Ostapkovich ND, Fitzsimmons BF, Parra A, et al. Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage. Archives of neurology. 2005;62(3):410-6. Epub 2005/03/16.

4.         Hop JW, Rinkel GJ, Algra A, van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997;28(3):660-4. Epub 1997/03/01.

5.         Pocock SJ, Elbourne DR. Randomized trials or observational tribulations? The New England journal of medicine. 2000;342(25):1907-9. Epub 2000/06/22.

6.         Rahimi M, Heidari SM, Yaraghi SA, Hashemi SJ, Nahvaji PA. Effects of Magnesium Sulphate in Delibrated Hypotension for Mastoidectomy Surgery. Journal of Isfahan Medical School. 2007;25(85):31-23.

7.         Chamani J. Comparison of the conformational stability of the non-native α-helical intermediate of thiol-modified β-lactoglobulin upon interaction with sodium n-alkyl sulfates at two different pH. Journal of Colloid and Interface Science 2006; 299 (2): 636-46. Epub 2006/03/03.

8.         Schulz-Stubner S, Wettmann G, Reyle-Hahn SM, Rossaint R. Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients. European journal of anaesthesiology. 2001;18(11):723-9. Epub 2001/10/03.

9.         Reinhart RA. Clinical correlates of the molecular and cellular actions of magnesium on the cardiovascular system. American heart journal. 1991;121(5):1513-21. Epub 1991/05/01.

10.       Miller RD. Textbook of Anesthesia. 7th ed. Philadelphia: Churchill livingstone Co; 2010. 1705-39.

11.       Seyhan TO, Tugrul M, Sungur MO, Kayacan S, Telci L, Pembeci K, et al. Effects of three different dose regimens of magnesium on propofol requirements, haemodynamic variables and postoperative pain relief in gynaecological surgery. British journal of anaesthesia. 2006;96(2):247-52. Epub 2005/11/29.

12.       James MF, Beer RE, Esser JD. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation. Anesthesia and analgesia. 1989;68(6):772-6. Epub 1989/06/01.

13.       Bakaeean B, Kabiri M, Iranfar H, Saberi MR, Chamani J. Binding effect of common ions to human serum albumin in the presence of norfloxacin: investigation with spectroscopic and zeta potential approaches. Journal of Solution Chemistry 2012; 41(10): 1777-1801. Epub 2012/10/18.

14.       Westermaier T, Stetter C, Vince GH, Pham M, Tejon JP, Eriskat J, et al. Prophylactic intravenous magnesium sulfate for treatment of aneurysmal subarachnoid hemorrhage: a randomized, placebo-controlled, clinical study. Critical care medicine. 2010;38(5):1284-90. Epub 2010/03/17.

15.       Yamamoto T, Mori K, Esaki T, Nakao Y, Tokugawa J, Watanabe M. Preventive effect of continuous cisternal irrigation with magnesium sulfate solution on angiographic cerebral vasospasms associated with aneurysmal subarachnoid hemorrhages: a randomized controlled trial. Journal of neurosurgery. 2016;124(1):18-26. Epub 2015/08/01.

16.       Jeon JS, Sheen SH, Hwang G, Kang SH, Heo DH, Cho YJ. Intravenous magnesium infusion for the prevention of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Journal of Korean Neurosurgical Society. 2012;52(2):75-9. Epub 2012/10/24.