Effect of Combined Infusion of Nitroglycerin and Nicardipine on Femoral-to-Radial Arterial Pressure Gradient After Cardiopulmonary Bypass

Abstract

Nitrates and calcium channel blockers are frequently administered during cardiac surgery. We simultaneously measured femoral arterial pressure and radial arterial pressure to investigate whether nitrates, in conjunction with calcium channel blockers, would influence the central-to-peripheral arterial pressure gradient. Combined nitroglycerin and nicardipine infusion during cardiac surgery involving coronary artery bypass grafting or valve replacement resulted in a significant increase above baseline levels in the femoral-to-radial arterial pressure gradient at 60 min after cardiopulmonary bypass. In control patients there was no significant increase in the femoral-to-radial arterial pressure gradient at 60 min after completion of cardiopulmonary bypass. A subsequent study in patients given nitroglycerin and nicardipine identified that the difference in the systolic arterial pressure between femoral and radial arteries was observed 15, 60, and 120 min after completion of cardiopulmonary bypass. However, there was no difference in the mean arterial pressure between femoral and radial arteries throughout the same period. We conclude that combined infusion of nitroglycerin and nicardipine, a new calcium channel blocker, intensifies the magnitude and duration of the femoral-to-radial arterial pressure gradient after cardiopulmonary bypass.

Pressure difference between radial and femoral artery pressure in minimally invasive cardiac surgery using retrograde perfusion

“…Interestingly, several studies from the 1980s suggested that vasodilatory agents might intensify PD. 10,12 Maruyama et al 16 reported that the use of vasodilating agents such as nitroglycerin and calcium channel blockers could promote PD. The authors of these studies suggested that a decrease in peripheral vascular resistance could cause a loss of arterial wave reflection and blunting of the arterial pressure wave resulting in underestimation of radial artery pressure.…”

Accuracy of radial arterial pressure measurement during surgery under controlled hypotension

“…demonstrated that sodium nitroprusside, droperidol, ketanserin and phenylephrine did not affect the magnitude and duration of the pressure gradient during cardiopulmonary bypass (18). On the contrary, according to Maruyama et al., continuous infusion of nitroglycerine and nicardipine intensified the pressure gradient after cardiopulmonary bypass (19). Hynson et al.…”

Radial-to-femoral pressure gradient quantification in cardiac surgery

“…Since its first description by Stern and colleagues in 1985, 23 numerous studies have suggested various explanations. Changes in distal arterial elasticity, 29 aging with a reduction in leg postjunctional alpha-adrenoceptor responsiveness to endogenous noradrenaline, 30 lower hematocrit level, 7 lower minimal body temperature, 8 CPB and clamping times, 1 , 2 vasoactive medication, 1 , 2 , 9 , 10 , 31 , 32 plasma catecholamine levels, 9 , 10 vascular thrombosis, 33 vascular decoupling in vasoplegia, 34 and demographic data 1 , 2 have all been described as potential risk factors. There is also a discrepancy in regard to vasoactive medication, since vasopressors and vasodilators have both been associated with the RFPG in different studies.…”

“…There is also a discrepancy in regard to vasoactive medication, since vasopressors and vasodilators have both been associated with the RFPG in different studies. 9 , 28 , 31 , 32 , 35 Although none of these risk factors can explain the phenomenon by itself, most of them are related to vasoconstriction and thus to radial artery diameter. Our observations support the concept that a smaller preoperative radial artery diameter can affect pulse pressure and thereby generate an abnormally low reduction in radial arterial pressure compared with central or femoral arterial pressures.…”