Nitroglycerin application during cesarean delivery: Plasma levels, fetal/maternal ratio of nitroglycerin, and effects in newborns

David, Matthias; Walka, Matthias M.; Schmid, Bernhard; Sinha, Pranav; Veit, S; Lichtenegger, W.

doi:10.1016/s0002-9378(00)70353-x

Cited by 20 publications

(10 citation statements)

References 13 publications

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“…Two trials report that bolus doses of 2 mg of nitroglycerin given up to 10 times in 3-to 5-min intervals were tolerated in emergency treatment of heart failure (23,24). Boluses of 250 to 500 g were well tolerated by both fetus and mother in separate clinical trials with pregnant females (25). Furthermore, nitroglycerin is known to be metabolized by…”

Section: Discussionmentioning

confidence: 99%

A Novel Nonantibiotic Nitroglycerin-Based Catheter Lock Solution for Prevention of Intraluminal Central Venous Catheter Infections in Cancer Patients

Chaftari

Hachem

Szvalb

et al. 2017

Antimicrob Agents Chemother

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For long-term central lines (CL), the lumen is the major source of central line-associated bloodstream infections (CLABSI). The current standard of care for maintaining catheter patency includes flushing the CL with saline or heparin. Neither agent has any antimicrobial activity. Furthermore, heparin may enhance staphylococcal biofilm formation. We evaluated the safety and efficacy of a novel nonantibiotic catheter lock solution for the prevention of CLABSI. Between November 2015 and February 2016, we enrolled 60 patients with hematologic malignancies who had peripherally inserted central catheters (PICC) to receive the study lock solution. The study lock consisted of 15 or 30 g/ml of nitroglycerin in combination with 4% sodium citrate and 22% ethanol. Each lumen was locked for at least 2 h once daily prior to being flushed. After enrollment of 10 patients at the lower nitroglycerin dose without evidence of toxicity, the dose was escalated to the higher dose (30 g/ml). There were no serious related adverse events or episodes of hypotension with lock administration. Two patients experienced mild transient adverse events (one headache and one rash) possibly related to the lock and that resolved without residual effect. The CLABSI rate was 0 on lock days versus 1.6/1,000 catheter days (CD) off lock prophylaxis, compared with a rate of 1.9/1,000 CD at the institution in the same patient population. In conclusion, the nitroglycerin-based lock prophylaxis is safe and well tolerated. It may prevent CLABSI when given daily to cancer patients. Large, prospective, randomized clinical trials are needed to validate these findings. (This study has been registered at ClinicalTrials.gov under identifier NCT02577718.) KEYWORDS nitroglycerin, catheter, lock solution, central venous catheter, infections, cancer patients C entral venous catheters (CVC) are imperative for the treatment and management of cancer patients, particularly those with hematological malignancies who require a long-term access for the administration of chemotherapy, antibiotics, blood products, and fluids as well as for frequent blood draws. However, these lifelines are the leading source of bloodstream infections, causing at least 400,000 episodes of bloodstream infections yearly in cancer patients (1) and contributing to up to 62% of the bloodstream infections in patients with long-term CVC (2, 3). These catheter-associated infections constitute a major public health challenge, with an estimated mortality rate of 10 to 25% (4) and estimated cost of $45,000 per episode (5).

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Section: Discussionmentioning

confidence: 99%

A Novel Nonantibiotic Nitroglycerin-Based Catheter Lock Solution for Prevention of Intraluminal Central Venous Catheter Infections in Cancer Patients

Chaftari

Hachem

Szvalb

et al. 2017

Antimicrob Agents Chemother

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“…One minute following i.v. GTN administration, the median UV/MV ratio of GTN concentration was approximately 0.0024 and 0.0051 in the 0.25 and 0.5mg GTN groups, respectively (David et al 2000). During the "chronic" maternal GTN administration that often occurs in pregnancy, the steady-state plasma concentrations would be expected to be significantly different.…”

Section: Discussionmentioning

confidence: 93%

Steady-state maternal and fetal plasma concentrations of glyceryl trinitrate (GTN) in the preterm sheep

Bustard¹,

Farley²,

Bennett³

et al. 2003

Can. J. Physiol. Pharmacol.

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The administration of glyceryl trinitrate (GTN; nitroglycerin) is increasing during preterm pregnancies, yet its disposition and, importantly, the extent of fetal exposure remain to be elucidated. When used as a tocolytic (pharmacological agent that stops uterine contractions), it is administered transdermally (24-48 h). Here, we quantified the maternal and fetal steady-state plasma concentrations of maternal intravenous GTN in preterm sheep and continuously monitored maternal and fetal vascular parameters to observe possible dose-dependent vascular effects. Preterm (120 days gestation) pregnant sheep (n = 6) were instrumented with maternal femoral arterial (MA) and venous (MV) and fetal femoral arterial (FA) and umbilical venous (UV) polyethylene blood-sampling catheters. During maternal GTN infusion (3.0 micro g.kg-1.min-1, 60-min duration) the steady-state GTN concentrations ([GTN]) were as follows: MA, 98.6 +/- 9.0 nM; UV, 17.4 +/- 7.6 nM; and FA, <5 nM. There were no changes in maternal and fetal mean arterial pressure and heart rate or in uterine activity. Overall, the steady-state [GTN] was established by 5 min, and the UV/MA ratio of [GTN] was 0.18. The FA [GTN] (<5 nM) indicates that the fetus cleared essentially all GTN in the UV, and the maternal and fetal heart rate and mean arterial pressure appear to be independent of maternal GTN infusion.

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“…6 Relaxation of the uterus is mediated by nitric oxide, which leads to an increase in intracellular guanosine monophosphate. 4,5,7,8 Advantages of its use include rapid onset of action, effective uterine relaxation, short half-life, intravenous administration, and possible avoidance of general anesthesia. 4,5,7,8 Advantages of its use include rapid onset of action, effective uterine relaxation, short half-life, intravenous administration, and possible avoidance of general anesthesia.…”

Section: Commentmentioning

confidence: 99%

Nitroglycerin for Relaxation to Establish a Fetal Airway (EXIT Procedure)

Clark¹,

Viscomi²,

Lowell³

et al. 2004

Obstetrics &Amp; Gynecology

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Nitroglycerin application during cesarean delivery: Plasma levels, fetal/maternal ratio of nitroglycerin, and effects in newborns

Cited by 20 publications

References 13 publications

A Novel Nonantibiotic Nitroglycerin-Based Catheter Lock Solution for Prevention of Intraluminal Central Venous Catheter Infections in Cancer Patients

A Novel Nonantibiotic Nitroglycerin-Based Catheter Lock Solution for Prevention of Intraluminal Central Venous Catheter Infections in Cancer Patients

Steady-state maternal and fetal plasma concentrations of glyceryl trinitrate (GTN) in the preterm sheep

Nitroglycerin for Relaxation to Establish a Fetal Airway (EXIT Procedure)

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