Is magnesium sulfate efficacious as classic cocktails for the
prevention of radial vasospasm and is it interesting in
hemo...
Disclosure : Hajlaoui N , M.D
• Dr <Hajlaoui N>has no relevant financial
interests to disclose
INTRODUCTION
• Radial access reduces bleeding and vascular
complications.
•

Different vasodilating cocktails are used to
...
OBJECTIVE
• To compare a cocktail regimen of magnesium
sulfate (150mg) + Heparin (50mg) (C1) to a
cocktail of Nitroglyceri...
METHODS
• Prospective randomised single blinded trial
including
patients
undergoing
radial
coronarography performed by adv...
RESULTS
• 70 patients included
• 35 received C1 and 35 received C2.
• 4 patients excluded (1 for impossibility of left
mai...
RESULTS
• Baseline demographic characteristics were
similar between C1 and C2 groups.
• No significant difference between ...
RESULTS
• RV in 23% of procedures (n=15).
• 10/34 patient in C1 group presented RV versus 5/32 in C2
group the (p=0,13).
•...
DISCUSSION
• There is no significant difference between the
compared cocktails for the prevention of RV
• Although the dif...
Magnesium sulfate during transradial cardiac
catheterization: a new use for an old drug?
• Prospective, double-blind, rand...
CONCLUSION
• Trend to less hemodynamic impairment with
Magnesium sulfate
• Study underpowerd to demonstrate
significant di...
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Hajlaoui N - AIMRADIAL 2013 - Magnesium and spasm

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Is magnesium sulfate efficacious as classic cocktails for the prevention of radial vasospasm and is it interesting in hemodynamically impaired patient?

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Hajlaoui N - AIMRADIAL 2013 - Magnesium and spasm

  1. 1. Is magnesium sulfate efficacious as classic cocktails for the prevention of radial vasospasm and is it interesting in hemodynamically impaired patient ? N HAJLAOUI, N BEN MANSOUR, B JEDAIDA, A HAGGUI, D LAHIDHEB, T FILALI, W FEHRI, H HAOUALA Cardiology department of the Military Hospital of Tunis
  2. 2. Disclosure : Hajlaoui N , M.D • Dr <Hajlaoui N>has no relevant financial interests to disclose
  3. 3. INTRODUCTION • Radial access reduces bleeding and vascular complications. • Different vasodilating cocktails are used to prevent vasospasm. • The most widespread used ones associates nitroglycerine and a calcium channel inhibitor. • Little studies demonstrate the superiority of magnesium sulfate for RV prevention.
  4. 4. OBJECTIVE • To compare a cocktail regimen of magnesium sulfate (150mg) + Heparin (50mg) (C1) to a cocktail of Nitroglycerin (1mg) + Nicardipine (1mg) + Heparin (50mg) (C2) for the effectiveness to prevent RV.
  5. 5. METHODS • Prospective randomised single blinded trial including patients undergoing radial coronarography performed by advanced training operators. • Radial vasospasm was defined by visual analogic scale>5 or manipulation difficulties reported by the operators.
  6. 6. RESULTS • 70 patients included • 35 received C1 and 35 received C2. • 4 patients excluded (1 for impossibility of left main canulation, 1 for extreme arterial tortuosity, 1 for subclavian artery occlusion and 1 for anaphylactic choc). • 66 patients analyzed.
  7. 7. RESULTS • Baseline demographic characteristics were similar between C1 and C2 groups. • No significant difference between groups for procedure duration, quantity of sedative drugs received, type of sheath used, attempts of radial puncture, number of catheter used , quantity of nitroglycerin administrated during procedure and radiation exposure.
  8. 8. RESULTS • RV in 23% of procedures (n=15). • 10/34 patient in C1 group presented RV versus 5/32 in C2 group the (p=0,13). • Conversion to femoral approach in 3 cases, all in C2 group. • Mean SBP was not significantly different between two groups before cocktail administration (160mmHg vs. 159mmHg), after cocktail administration, the mean SBP was significantly lower in the C2 group (151mmHg vs. 129mmHg) (p=0, 01). • 2 patients from C2 group presented during the procedure severe hypotension necessitating administration of macromolecular solutes versus any patient in C1 group, the difference is not statistically significant.
  9. 9. DISCUSSION • There is no significant difference between the compared cocktails for the prevention of RV • Although the difference is not significant, magnesium sulfate seems to cause less hemodynamic impairment • Magnesium sulfate may be the right cocktail for patient at high risk of severe hypotension with nitroglycerine and calcium channel inhibitor cocktail.
  10. 10. Magnesium sulfate during transradial cardiac catheterization: a new use for an old drug? • Prospective, double-blind, randomized trial of 86 patients undergoing radial catheterization. • Magnesium sulfate (150 mg) Vs verapamil (1 mg) • Following administration of the study drug, there was an increase in radial artery diameter in both groups (p < 0.01), although the increase seen was greater in the group receiving magnesium (magnesium 0.36 +/- 0.03 mm; verapamil 0.27 +/- 0.03 mm; p < 0.05). Administration of verapamil resulted in a fall in mean arterial pressure (MAP) (change in MAP -6.6 +/- 1.4 mmHg; p < 0.01), whereas magnesium did not have a hemodynamic effect.
  11. 11. CONCLUSION • Trend to less hemodynamic impairment with Magnesium sulfate • Study underpowerd to demonstrate significant difference • Larger studies are needed

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