Changes in cerebrospinal fluid magnesium levels in patients undergoing spinal anaesthesia for hip arthroplasty: does intravenous infusion of magnesium sulphate make any difference? A prospective, randomized, controlled study
Changes in cerebrospinal fluid magnesium levels in patients undergoing spinal anaesthesia for hip arthroplasty: does intravenous infusion of magnesium sulphate make any difference? A prospective, randomized, controlled study
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DOI：
10.1093/bja/aes146
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发表时间：
2012-08-01
影响因子：
9.8
通讯作者：
Arcioni, R.
中科院分区：
文献类型：
--
作者：
Mercieri, M.;De Blasi, R. A.;Arcioni, R.
大多数研究人员认为，在脊髓或全身麻醉期间静脉注射硫酸镁（MgSO4）的患者术后疼痛或麻醉药物需求的减少与中枢n -甲基-d-天冬氨酸（NMDA）受体镁（Mg）活性有关。在这项研究中，我们研究了脊髓麻醉后脑脊液（CSF） Mg浓度的变化，以及外周输注MgSO4是否会影响中枢Mg水平。45例接受髋关节置换术连续脊髓麻醉的患者被随机分配接受静脉注射MgSO4，剂量为50mg kg(1)，稀释在100ml 0.9生理盐水溶液中，然后15mg kg(1) h(1)，持续6小时，或接受相同体积的生理盐水[平均（sd） 64 (10) ml]。测定脊髓麻醉前后6个时间点脑脊液、血清总Mg浓度和游离Mg浓度的变化。次要结局变量包括血清和脑脊液电解质和蛋白质。35名患者完成了这项研究。我们发现脊髓麻醉使脑脊液中总Mg浓度和离子Mg浓度降低了约10%。将血清Mg浓度增加到基线值的80以上，脑脊液Mg水平保持不变。在接受髋关节置换术的患者中，脊髓麻醉意外地降低了脑脊液总Mg浓度和离子Mg浓度，尽管其机制尚不清楚。在本研究中，外周MgSO4输注剂量对接受脊髓麻醉的神经健康患者的中枢Mg浓度没有影响。如果脑脊液Mg浓度是Mg脑生物利用度的可靠标志，那么脊髓麻醉期间外周输注MgSO4不太可能影响中枢NMDA受体活性。
Most investigators have attributed the reduced postoperative pain or anaesthetic drug requirements in patients receiving i.v. magnesium sulphate (MgSO4) infusion during spinal or general anaesthesia to central N-methyl-d-aspartate (NMDA) receptor magnesium (Mg) activity. In this study, we investigated how cerebrospinal fluid (CSF) Mg concentrations change after spinal anaesthesia, and whether peripherally infusing MgSO4 influences central Mg levels.Forty-five patients undergoing continuous spinal anaesthesia for hip arthroplasty were randomly assigned to receive either i.v. MgSO4 at a dose of 50 mg kg(1) diluted in 100 ml 0.9 saline solution followed by 15 mg kg(1) h(1) for 6 h or saline at the same volume [mean (sd) 64 (10) ml]. The changes in CSF and serum total and ionized Mg concentrations were assessed at six time points before and after spinal anaesthesia. Secondary outcome variables included serum and CSF electrolytes and proteins.Thirty-five patients completed the study. We found that spinal anaesthesia reduced total and ionized Mg concentrations in CSF by about 10. Increasing serum Mg concentration over 80 of the baseline value left CSF Mg levels unchanged.Spinal anaesthesia unexpectedly reduced CSF total and ionized Mg concentrations in patients undergoing hip arthroplasty, although the mechanism is unclear. The dose used for peripheral MgSO4 infusion in this study had no influence on central Mg concentrations in neurologically healthy patients undergoing spinal anaesthesia. If CSF Mg concentration is a reliable marker of Mg brain bioavailability, peripherally infused MgSO4 during spinal anaesthesia is unlikely to influence central NMDA receptor activity.