Surgery and Magnesium

Surgery and Magnesium

When magnesium levels are corrected by the administration of magnesium before, during and after surgery medical complications are significantly reduced to the point where it becomes simply imprudent to perform surgery without it.

Everyone scheduled for surgery needs to increase their stores of magnesium. In the pre and postoperative phases magnesium can help alleviate pain, decrease blood pressure, alleviate certain heart arrhythmias; it works to prevent blood clotting, relieves depression so common after bypass surgery, and improves energy and cognitive abilities.

Safer Surgery with Magnesium: Before, During and After

All patients were found to have low serum magnesium
levels postoperatively, but to a greater degree and
for a longer period following open-heart surgery.

Thorax. 1972 March; 27(2): 212–218. Magnesium in patients undergoing open-heart surgery M. P. Holden, M. I. Ionescu, and G. H. Wooler

Complications such as arrhythmias, kidney failure, stroke and infections may occur after major surgery.

The level of serum magnesium during open-
heart surgery showed a significant fall below
normal values during the first postoperative day.

Departments of Cardiothoracic Surgery and Cardiology, Gentofte Hospital, Copenhagen, Denmark
DOI: 10.3109/14017437809100355

The high rate of hypomagnesemia after cardiac surgery is well established. After heart surgery, mean magnesemia is reduced,[3] and the frequency of hypomagnesemia increases from 19.2% preoperatively to 71% immediately after surgery before dropping slightly to 65.6% 24 hours later.

Speziale G, Ruvolo G, Fattouch K, et al. Arrhythmia prophylaxis after coronary artery bypass grafting: regimens of magnesium sulfate administration. Thorac Cardiovasc Surg 2000; 48: 22–6.[Medline]

The use of magnesium in the preoperative and early post-
operative periods is highly effective in reducing the incidence of Atrial fibrillation after coronary artery bypass grafting. - Dr. Fevzi Toraman

Ann Thorac Surg 2001;72:1256-1262

The incidence of atrial fibrillation after coronary artery bypass surgery remains relatively high (26.83%). Lower serum magnesium levels have been found to be associated with an increased incidence of atrial fibrillation, which was decreased in several studies by the prophylactic administration of magnesium after coronary artery bypass grafting.  In cardiac surgery, magnesium has proved to be as efficient as more toxic pharmaceutical drugs in controlling arterial pressure during cardiopulmonary bypass procedures.

Delhumeau A, Granry JC, Cottineau C, Bukowski JG, Corbeau JJ, Moreau X. Comparative vascular effects of magnesium sulphate and nicardipine during cardiopulmonary bypass (French). Ann Fr Anesth Réanim 1995; 14: 149–53.[Medline]

Magnesium administration is safe and improves short-term
postoperative neurologic function after cardiac surgery,
particularly in preserving short-term memory and
cortical control over brainstem functions. - Dr. Sunil K. Bhudia.

Magnesium as a neuroprotectant in cardiac surgery: A randomized clinical trial. The Journal of Thoracic and Cardiovascular Surgery August 2007 (Vol. 134, Issue 2, Page A25)

While magnesium deficiency is fairly common, it is frequently overlooked as a source of problems by surgeons. Various changes in magnesium can occur before, during and after surgery of any kind. Plasma concentrations are decreased after abdominal or orthopedic surgery.

Koinig H, Wallner T, Marhofer P, Andel H, Hörauf K, Mayer N. Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg 1998; 87: 206–10.

And researchers at Duke University reported that patients with low magnesium levels experienced a two-fold increase in heart attacks and all-cause mortality rate as long as one year after surgery compared to those with normal magnesium levels.

The incidence of atrial fibrillation after coronary artery bypass surgery remains relatively high (26.83%) and this is principally due to strong deficiencies in magnesium. While magnesium deficiency is fairly common, it is frequently overlooked as a source of problems. The reason is that serum magnesium levels (the test most doctors use) do not reflect body stores of magnesium. Blood levels are kept within the normal range at the expense of other tissues.

When magnesium levels are corrected by the administration of magnesium before, during and after surgery medical complications are significantly reduced to the point where it becomes simply imprudent to perform surgery without it.

Dr. Minato at the Department of Thoracic and Cardiovascular Surgery, in Japan, strongly recommends the correction of hypomagnesemia during and after off-pump coronary artery bypass grafting (OPCAB) for the prevention of perioperative coronary artery spasm and his team has actually said that they won’t perform this surgery without its use any longer.

Perioperative coronary artery spasm in off-pump coronary artery bypass grafting and its possible relation with perioperative hypomagnesemia. Ann Thorac Cardiovasc Surg. 2006 Feb;12(1):32-6.
PMID: 16572072 [PubMed - indexed for MEDLINE]  Pubmed

Magnesium is depleted from the blood during CABG[9], and if extracorporeal circulation is used as part of the procedure, the depletion is even greater than if not used.

The CABG with extracorporeal circulation resulted in a significant decrease in blood Mg concentration. Changes of blood magnesium concentration in patients undergoing surgical myocardial revascularization. Pasternak, et al;  Magnes Res. 2006 Jun;19(2):107-12j;http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db
=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16955722

Off pump bypass surgery has now been shown to have a high incidence of post surgical arterial spasm triggered by hypomagnesemia.  Postoperative incidence of hypomagnesemia was as high as 89% of patients (40 out of 45 patients) in a recent study on the causes of post surgical arterial spasm in Japan in 2005. When magnesium levels were corrected by the administration of magnesium both during and after surgery, no further coronary artery spasm occurred.

Potentially fatal blood clots after surgery are a much greater risk than has previously been thought, a British study finds. “What is most striking is that not only is the risk higher, but that it lasts much longer than people have thought,” said Dr. Jane Green, a clinical epidemiologist at the University of Oxford and a leader of the team reporting the findings in the Dec. 4 online edition of BMJ.

http://news.yahoo.com/s/hsn/20091205/hl_hsn/bloodclotthreataftersurgeryworsethanthought

Blood clots in the deep veins and the lungs, formally called venous thromboembolism, have long been known as a possible complication after any form of surgery. The risk of such a blood clot remained high for at least 12 weeks after surgery, the study found.

Magnesium has an effective antithrombotic activity
in vivo, and treatment with magnesium may lower
the risk of thromboembolic-related disorders.

Journal International Journal of Hematology. ISSN                0925-5710 Issue  Volume 77, Number 4 / May, 2003

“It is the surgeon’s primary responsibility to make sure not only that the surgery is effective, but also to make sure that the complication rate of surgery is minimized as much as possible,”  instructs Dr. Alexander Cohen, an honorary consultant vascular physician at King’s College Hospital in London.

Magnesium has an important role to play in preventing blood clots and keeping the blood thin-much like aspirin but without the side effects.
Dr. Carolyn Dean
Author of The Miracle of Magnesium

Dr. Sarah Mayhill says, “Magnesium deficiency also predisposes to an increased clotting tendency in the blood and to an increased vulnerability of the arterial wall to damage from other factors such as have been discussed elsewhere in this paper. These tendencies improve with magnesium supplementation. Clotting is of course the central event in the formation of coronary thrombosis. The build up of homocysteine levels discussed earlier is due mostly to the vitamin B6, B 12 and folic acid deficiencies, but also partly to magnesium deficiency.”

Magnesium prevents blood clots and thins the blood without side effects. Dr. Mayhill continues saying, “Magnesium has both a thrombolytic (able to dissolve thrombosis) effect, but also protects against adverse effects of stunning. From the mid 1980’s there has been increasing evidence that the use of intravenous magnesium, given as early as possible (and before reperfusion) has a major beneficial effect on the outcome of this life threatening situation.

Positive studies have shown between a 50% and 82.5% improved survival rate after doses of intravenous magnesium given by drips in the dosage range of 32 – 66 mmol in the first 24 hours.”

http://www.drmyhill.co.uk/article.cfm?id=325

We recommend routine measurement of magnesium levels after CPB in pediatric patients undergoing heart surgery, with timely magnesium supplementation in the postoperative period. - Dr. B. Hugh Dorman, et al.

American Heart Journal. 2000;139(3)

Magnesium depletion found to occur commonly after cardiac surgery in children and adults was shown to cause significant neurological and cardiac symptoms. Studies demonstrated an almost universal occurrence of magnesium depletion during and after cardiac surgery, but also demonstrated that supplementation may be preventive.

Ann R Coll Surg Engl. 1997 September; 79(5): 349–354.

Maintenance of magnesium levels within the normal reference range in the immediate postoperative period of heart surgery decreased junctional ectopic tachycardia. Plasma depletion and total body magnesium depletion also occur in pediatric patients after heart surgery and may be more pronounced than in adults because the volume of prime for CPB is large compared with blood volume, and preoperative magnesium levels may be below normal, especially in critically ill neonates.

American Heart Journal. 2000;139(3)

Ways of decreasing post-operative analgesic drug requirements are of special interest after major surgery. Magnesium alters pain processing and reduces the induction and maintenance of central sensitization by blocking the N-methyl-d-aspartate (NMDA) receptor in the spinal cord. In patients undergoing orthopedic surgery, supplementation of spinal anesthesia with combined intrathecal and epidural magnesium significantly reduces patients’ post-operative analgesic requirements.

Acta Anaesthesiologica Scandinavica, Volume 51, Number 4, April 2007 , pp. 482-489(8)

Magnesium infusion  during general anaesthesia reduces
anaesthetic consumption and analgesic requirements.

European Journal of Anaesthesiology: October 2004 – Volume 21 – Issue 10 – pp 766-769

Magnesium administration at the time of the induction of anesthesia improves hemodynamics in patients with CAD undergoing CABG and is associated with lesser hemodynamic and ST segment changes compared with lidocaine at the time of endotracheal intubation in these patients.

The Effect of Magnesium Sulphate on Hemodynamics and Its Efficacy in Attenuating the Response to Endotracheal Intubation in Patients with Coronary Artery Disease G. D. Puri, MD, PhD*, K. S. Marudhachalam, MD, DA, DNB*, Pramila Chari, MD, FAMS, MAMS, DA?, and R. K. Suri, MS, FAMst Departments of *Anaesthesia and Intensive Care and tcardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, Indiahttp://www.anesthesia-analgesia.org/cgi/reprint/87/4/808.pdf

Magnesium sulfate is used intravenously to prevent hypertensive crises or seizures associated with toxemia of pregnancy.

Management of Obstetric Hypertensive Crises;  OBG management; July 2005 · Vol. 17, No. 7http://www.obgmanagement.com/article_pages.asp?AID=3573&UID=

A high rate of postoperative hypomagnesemia has also been observed in pediatric heart surgery. Junctional ectopic tachycardia occurred in 27% of children who were not given Mg postoperatively, whereas those who received magnesium had no rhythm disorders.

Dorman BH, Sade RM, Burnette JS, et al. Magnesium supplementation in the prevention of arrhythmias in pediatric patients undergoing surgery for congenital heart defects. Am Heart J 2000; 139: 522–8.[Medline]

Stress from surgery has contributed toward increasing the clinical importance of detecting and correcting blood levels of magnesium. Orders for serum magnesium testing at our hospital have had astounding increases over the last 20 to 25 years, with more than 125,000 total magnesium measurements ordered in 2005. The frequency of hypomagnesemia in critical care settings is well noted.

The Journal of Near-Patient Testing & Technology: June 2007 – Volume 6 – Issue 2 – pp 129-133

In another study a group of 40 men were divided into two groups and half were given preoperative oral magnesium supplementation, the other half were not. Measurements of magnesium, epinephrine, and norepheniphrine were taken before, during and after surgery.

The findings were that magnesium levels dropped and epinephrine and norepinephrine levels elevated as a result of surgery in both groups, but to a significantly greater extent in the group that did not receive the supplements. They concluded that magnesium supplementation prior to surgery substantially reduces intra- and postoperative disorders.

The effect of preoperative magnesium supplementation on blood catecholamine concentrations in patients undergoing CABG.  Pasternak, et al; Magnes Res. 2006 Jun;19(2):113-22;http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=
AbstractPlus&list_uids=16955723&itool=iconabstr&itool=pubmed

Surgeons need to become familiar with the transdermal approach for then they can start their patients off with heavy application weeks before surgery and for weeks after since this method of application can easily be done at home by patients.

It behooves everyone scheduled for surgery to increase their stores of magnesium through supplementation including using magnesium oil in baths, foot baths or as a body spray. Doctors who know what they are doing will not perform surgery without using magnesium for to do so involves increasing risks and unnecessary complications.

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