Nitroglycerin Infusion during Coronary-artery Surgery

Kaplan, Joel A.; Dunbar, Ronald W.; Jones, Ellis L.

doi:10.1097/00000542-197607000-00004

Cited by 123 publications

(32 citation statements)

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“…TNG was more consistent control of ischemic episodes during the first 24 hours of treatment, presumably due to more effective titration to the optimal nitrate dose. Although both treatment regimens resulted in a significant decline in the frequency of ischemic episodes, neither regimen con- 10 ng/ml, compared with a concentration of 16.4 + 12.1 ng/ml in the present study. The results suggest that with the different routes and dosages used here the systemic availability of nitrates was similar to that in other studies.…”

Section: Discussioncontrasting

confidence: 59%

Intravenous nitroglycerin in the treatment of spontaneous angina pectoris: a prospective, randomized trial.

Curfman¹,

Heinsimer²,

Lozner³

et al. 1983

Circulation

106

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SUMMARY A prospective, randomized study of i.v. nitroglycerin (TNG) 276 included a randomized control, which is especially important in assessing the therapeutic efficacy of antianginal agents because of the spontaneous variability in the occurrence of ischemic episodes.'6We therefore performed a prospective, randomized trial comparing the therapeutic effect of i.v. TNG with that of oral isosorbide dinitrate (ISDN) in combination with 2% nitroglycerin ointment (NO) in patients with repetitive episodes of spontaneous angina. Although we might have chosen other regimens, we studied these two long-acting agents because they are commonly used together to manage refractory unstable angina. Methods Patient PopulationForty consecutive patients of both sexes admitted to the coronary care units of the Dartmouth-Hitchcock Medical Center with a diagnosis of unstable angina pectoris who satisfied the following entry criteria were prospectively enrolled in this investigation. All patients had sustained at least two episodes of spontaneous myocardial ischemia during a 48-hour pretreatment control period. In 38 of 40 patients, ischemic episodes were accompanied by typical cardiac pain or discomfort; in two patients, some ischemic episodes were reflected only by spontaneous electrocardiographic changes not accompanied by symptoms. To confirm that symptoms were related to myocardial ischemia, we required that chest pain last less than 15 by guest on May 9, 2018 http://circ.ahajournals.org/ Downloaded from

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Section: Discussioncontrasting

confidence: 59%

Intravenous nitroglycerin in the treatment of spontaneous angina pectoris: a prospective, randomized trial.

Curfman¹,

Heinsimer²,

Lozner³

et al. 1983

Circulation

106

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“…[6][7][8][9] Glyceryl Trinitrate (Nitroglycerin or NTG) which is a predominant veno-dilator has been recently introduced as lingual pump spray or pen spray, to attenuate the stress response to laryngoscopy and endotracheal intubation. 9 Fentanyl citrate, an opioid is a phenylpiperidine of the 4-aminopiperidine series structurally related to pethidine and controls both heart rate and blood pressure responses. 10,11 However, Fentanyl can produce complex respiratory depression and truncal rigidity at higher doses.…”

Section: Introductionmentioning

confidence: 99%

Attenuation of stress response to laryngoscopy and intubation: sublingual nitroglycerin spray vs intravenous fentanyl and sublingual nitroglycerin spray

Pegu

Dutta

Pathak

et al. 2017

Int J Basic Clin Pharmacol

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INTRODUCTIONLaryngoscopy and tracheal intubation are mandatory for most patients undergoing operations under general anaesthesia, which invariably is associated with certain cardiovascular changes such as tachycardia, rise in blood pressure and a wide variety of cardiac arrhythmias.1 The hemodynamic response to laryngoscopy and intubation was first described by Reid and Brace in 1940. A typical pressor response can leads to an average increase in blood pressure by 40-50% and heart rate by 20% and an elevation of both epinephrine and norepinephrine levels.These effects are generally well tolerated by overall healthy patients but can be lethal to patients with preexisting conditions such as coronary artery disease, recent myocardial infarction, hypertension, geriatric population pre-eclampsia, and cerebrovascular pathology such as tumours, aneurysms or increased intracranial pressure etc., and are at increased risk of morbidity and mortality. 2Geriatric and elderly patients which make up an increasingly large percentage of both the inpatient and outpatient hospital population, have an increased ABSTRACT Background: Laryngoscopy and tracheal intubation is invariably associated with certain cardiovascular changes such as tachycardia, rise in blood pressure and a wide variety of cardiac arrhythmias. 1 Such complications are highly detrimental in patients with limited cardiovascular reserve specially in geriatric and elderly population. Various pharmacological agents have been used to attenuate these stress responses but none has yet been considered ideal. Therefore, purpose of this study is to investigate the efficacy of sublingual Nitroglycerine spray alone and sublingual Nitroglycerine spray with intravenous Fentanyl to attenuate the pressor response to laryngoscopy and intubation in normotensive patients. Methods: A total of 120 ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into 3 groups of 40 in each group. Group 1 control group, Group 2, received NTG sub-lingual spray (0.4mg/spray) two min. before induction, and Group 3 received inj. Fentanyl (2µg/kg) 5min before + NTG sublingual spray (0.4 mg/spray) 2min before induction. Vital parameters before and after induction and thereafter at specified time interval following laryngoscopy and intubation were recorded for comparison. Results: Demographic characteristics and baseline vital parameters in both the groups were comparable. Significant differences in mean arterial pressure (MAP) and heart rate (HR) were observed in between the groups during postintubation period. Conclusions: Combination of intravenous Fentanyl plus Nitroglycerin spray is more effective than NTG alone in attenuating the stress response following laryngoscopy and intubation.

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“…4,5 Although we gave nitroglycerin, diltiazem and nicorandil to produce coronary dilatation, the prophylactic treatment was not effective. The ST depression was not affected by injection of nitroglycerin, but was improved by intravenous diltiazem followed by nasal nifedipine (Figure 1), suggesting that calcium channel blockers may have been more effective in treating myocardial ischemia than was nitroglycerin in this patient.…”

Section: Discussionmentioning

confidence: 98%

Treatment of acute right coronary artery occlusion during anesthesia

Nakamura

Hayashi

Kagawa

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: Perioperative coronary artery occlusion is a potentially dangerous complication causing myocardial infarction and circulatory collapse. We report a case showing severe ST segment depression in leads II and V5 during anesthesia. Diltiazem and nifedipine, but not nitroglycerine, partially improved the ST changes which were normalized by a percutaneous cardiopulmonary system (PCPS).Clinical Features: A 71-yr-old man with cerebrovascular disease was scheduled for coronary artery bypass grafting (CABG). Past medical history included myocardial infarction due to right coronary artery (RCA) occlusion. Both the femoral artery and vein were cannulated percutaneously before operation and the PCPS was prepared as a back-up system. Depression of the ST segments in leads V5 and II was observed following heparinization. Although hemodynamic stability was maintained with continuous infusion of catecholamines, the ST changes were not improved by intravenous nitroglycerine. Intravenous diltiazem followed by nasal nifedipine partially improved the ST changes. The changes were normalized after induction of PCPS. No neurological complications were observed. The postoperative coronary angiography confirmed the total occlusion of RCA.Conclusion: Calcium channel blockers were more effective than nitroglycerine in treating perioperative ST depression. However, none of them produced complete reversal of the ischemic changes which were normalized with PCPS.Objectif : L'occlusion périopératoire de l'artère coronaire est une complication potentiellement dangereuse et peut causer un infarctus du myocarde et un collapsus circulatoire. Nous signalons un cas qui montre un sousdécalage sévère en D II et V5 pendant l'anesthésie. Le diltiazem et la nifédipine, mais non la nitroglycérine, ont partiellement amélioré les changements du segment ST qui ont été normalisés par un système cardiopulmonaire percutané (SCPP).Éléments cliniques : Un homme de 71 ans, victime d'accidents vasculaires cérébraux, devait subir un pontage aortocoronarien. Ses antécédents comprenaient un infarctus du myocarde provoqué par une occlusion de l'artère coronaire droite (ACD). On a inséré des canules percutanées dans l'artère et la veine fémorales avant l'opération et le SCPP a été préparé en qualité de système de réserve. L'abaissement des segments ST en V5 et II a été observé à la suite de l'héparinisation. Même si la stabilité hémodynamique a été maintenue avec une perfusion continue de catécholamines, les changements ST n'ont pas été améliorés par la nitroglycérine intraveineuse. Le diltiazem intraveineux, suivi de nifédipine nasale, a partiellement amélioré les changements ST. Les modifications ont été normalisées après l'entrée en fonction du SCPP. Aucune complication neurologique n'a été observée. L'angiographie coronaire postopératoire a confirmé l'occlusion totale de l'ACD. Conclusion :Les inhibiteurs calciques ont été plus efficaces que la nitroglycérine pour traiter la dépression péri-opératoire du segment ST. Cependant, aucun d'eux n'a produit de renv...

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Nitroglycerin Infusion during Coronary-artery Surgery

Cited by 123 publications

References 0 publications

Intravenous nitroglycerin in the treatment of spontaneous angina pectoris: a prospective, randomized trial.

Intravenous nitroglycerin in the treatment of spontaneous angina pectoris: a prospective, randomized trial.

Attenuation of stress response to laryngoscopy and intubation: sublingual nitroglycerin spray vs intravenous fentanyl and sublingual nitroglycerin spray

Treatment of acute right coronary artery occlusion during anesthesia

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