Magnesium research : official organ of the International Society for the Development of Research on Magnesium
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Neuroprotective activity with magnesium associated with animal models of cerebral ischaemia, seizure, perinatal hypoxia/ischaemia, subarachnoid haemorrhage and traumatic brain injury has provided the justification for clinical stroke trials. However, the recent IMAGES stroke clinical trial found magnesium to be largely ineffective. Hence, due to the negative stroke trial outcome, current FAST-MAG trial and our own experience with magnesium in cerebral ischaemia animal models, we thought it prudent to review these preclinical and clinical studies. ⋯ Moreover, data from our own laboratory indicates that magnesium is only neuroprotective when combined with post-ischaemic hypothermia. These data provide a possible explanation of why the IMAGES trial was largely unsuccessful, as current stroke patient management does not involve hypothermia induction. Future preclinical and clinical cerebral ischaemia trials with magnesium should consider combining treatment with mild hypothermia.
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Review Comparative Study
Magnesium chloride or magnesium sulfate: a genuine question.
MgSO4 is routinely used in therapeutics despite its toxicity. The aim of the present review was to compare MgSO4 and MgCl2 effects in order to answer the question whether MgSO4 could be or not replaced by MgCl2. Considering that the two salts have both similar and proper effects, a clear-cut conclusion is not easy to draw. However, choosing MgCl2 seems advisable because of its more interesting clinical and pharmacological effects and its lower tissue toxicity as compared to MgSO4.
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Subarachnoid hemorrhage from a ruptured aneurysm is a subset of stroke. The young age (median 55 years) and poor outcome (50% of patients die; 30% of survivors remain dependent) explain why in the population the loss of productive life years from aneurysmal subarachnoid hemorrhage (SAH) is as large as that from brain infarcts, the most common type of stroke. Ischemia plays an important role in the pathophysiological process after SAH. ⋯ Magnesium is also a non-competitive antagonist of voltage dependent calcium channels, has cerebrovascular dilatory activity and is an important co-factor of cellular ATPases, including the Na/K-ATPase. Magnesium can reverse delayed cerebral vasospasm and reduces the extent of acute ischemic cerebral lesions after experimental subarachnoid hemorrhage in rats. In this article we discuss the neuroprotective potency of magnesium in SAH by describing the pathophysiology of ischaemia after SAH and the many ways magnesium may interfere with this.
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The role of magnesium in coronary artery disease has been evaluated extensively during the last three decades. The intravenous application of magnesium in acute myocardial infarction is of major importance, the beneficial effects have been underlined in several studies. Magnesium is of significance in the pathomechanisms of reperfusion injury and reduction of malign arrhythmias in the critical acute phase of myocardial infarction, if applied intravenously. ⋯ Nevertheless, because of conflicting results of prior trials doubts on the efficacy of intravenous magnesium in myocardial infarction still remain. The multinational, multicenter trial MAGIC has been set up to evaluate the optimal patient cohort as well as the ideal dose regimen for the application of intravenous magnesium sulphate in patients with acute myocardial infarction. The answer on the open questions on intravenous magnesium sulphate in myocardial infarction could be "MAGIC".
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Randomized Controlled Trial Clinical Trial
Prophylactic effects of intravenous magnesium on hypertensive emergencies after cataract surgery. A new contribution to the pharmacological use of magnesium in anaesthesiology.
The pharmacological effects of magnesium sulphate heptahydrate (MgSO4.7H2O) on hypertensive patients during the perioperative period were used, to control critical rises of blood pressure. This double-blind study included 40 hypertensive elderly patients, who underwent eye surgery under local anaesthesia; they were divided into two groups (A and B) of 20 patients each. An intravenous dose of 4g MgSO4.7H2O was given to group. ⋯ None of the patients who received MgSO4.7H2O showed any ECG disturbances. Systolic and diastolic blood pressure, as well as heart rate, fluctuated outside the critical range, whereas in the control group an increase of blood pressure was noted which was treated with other anti hypertensive drugs. The results indicated that parenteral administration of MgSO4.7H2O in hypertensive patients before surgery stabilized blood pressure fluctuations outside the critical range, without causing the pressure to fall to a level that might risk undesirable side effects during eye surgery under local anaesthesia.