Perioperative systemic magnesium sulfate minimizes the incidence of atrial fibrillation after thoracotomy for lung resection: a prospective observational study

BACKGROUND: Postoperative atrial fibrillation (POAF) is the most common complication following general thoracic surgery. POAF significantly increases the risk of adverse cardiovascular events, such as thromboembolism, heart failure, and mortality. Additionally, it also leads to prolonged hospital stays and higher costs. The objective of this observational study was to examine the impact of perioperative administration of magnesium sulphate (MgS(O4)) on the incidence of POAF. METHODS: A prospective observational study was conducted, enrolling one hundred patients undergoing thoracotomy for lung resection. We compared the incidence of atrial fibrillation (AF) before and after implementing a change in our standard anesthetic management, which involved the addition of MgS(O4). MgS(O4) was administered during anesthesia induction at a dose of 40 mg/kg over ten minutes, followed by a 24-hour infusion at a rate of 10 mg/kg/h. The primary outcome was the incidence of POAF within the first seven days after surgery. RESULTS: Within the initial three days following surgery, there was no significant difference in the cumulative incidence of POAF between the MgS(O4) group and the control group. However, on postoperative day 7, patients treated with MgS(O4) exhibited a reduced incidence of POAF compared to the control group (4% vs. 26%; P=0.01). In the subgroup of patients not receiving pre-existing β-blockers, the addition of MgS(O4) significantly decreased the occurrence of POAF (14% vs. 80%; P<0.001). CONCLUSIONS: Prophylactic administration of MgS(O4) is a potentially beneficial approach for reducing the incidence of POAF after non-cardiac surgery, particularly in patients not receiving long-term β-blocker treatment.