The Effects of Nitroglycerine (Ntg) Sublingual Spray to Blunt the Haemodynamic Response to Endotracheal Extubation in Lumbar Disc Surgery

Singh, Deepak Kumar; Sundrani, Omprakash; Tagalpallewar, Ameya Arun; Sahare, Kamal Kishore; Bhagat, Chandrapal; Patel, Daksesh

doi:10.14260/jemds/2015/2023

Cited by 2 publications

(1 citation statement)

References 13 publications

(9 reference statements)

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“…Nitroglycerin is known to produce reflex tachycardia due to sympathetic stimulation however in our study none of the patient showed any significant tachycardia. In the study done by Deepak Singh et al named "Effect of Nitroglycerin spray to blunt the hemodynamic response to endotracheal extubation in lumbar disc surgery [7] , concluded that tachycardia was insignificant in NTG group. Similarly study by "Anant S et al and Dich-Niels et al " [8] found that following intranasal NTG spray there was attenuated pressor response to laryngoscopy and intubation without significant increase in heart rate.…”

Section: Discussionmentioning

confidence: 99%

Effect of 1 puff of sublingual nitroglycerin spray versus 1 puff of normal saline spray in attenuating pressor response to extubation

Tenagi¹,

Gogate²

2021

Int. J. Med. Anesthesiology

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Ideal agent to attenuate hemodynamic response to extubation should be readily available, easy to administer, cost effective with fast onset of action and peak with minimal side effects. Nitroglycerin is one of the most widely used drug to control intra-operative rise in blood pressure. Nitroglycerin is potent vasodilator, predominantly acting on venules than arterioles by generating nitric oxide (NO) in vascular smooth muscle. A thorough pre-anaesthetic evaluation was done on day before surgery. Detailed medical history was elicited and detailed physical examination was carried out. Patients were kept nil per orally for 8 hours prior to surgery. Preoperatively investigations like CBC, RBS and Sr. Creatinine were done. ECG and CXR were done if patient was more than 40 years of age. In our study patient received 1 puff (0.4mg) which resulted in a small although insignificant increase in BP till 3 minutes. It may be possible to attenuate this small increase in BP by using higher dose of NTG spray instead of 0.4mg and requires further evaluation. It was observed that there was tachycardia as Injection Glycopyrrolate was given just before intervention since, both the groups received the same drug it will not act as bias.

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Section: Discussionmentioning

confidence: 99%

Effect of 1 puff of sublingual nitroglycerin spray versus 1 puff of normal saline spray in attenuating pressor response to extubation

Tenagi¹,

Gogate²

2021

Int. J. Med. Anesthesiology

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Comparison of NTG vs Dexmedetomidine for Control of Haemodynamic Response in Patients During Emergence From Anaesthesia and Extubation Following Laparoscopy

Ranjan

Vennel

Sathe

et al. 2022

Global Journal for Research Analysis

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Endotracheal intubation as well as extubation are associated with various cardiovascular and airway responses leading to increase in heart rate (tachycardia), hypertension (HTN), cardiac arrhythmias, myocardial ischemia (MI), coughing, agitation, bronchospasm, increased bleeding, raised intracranial tension etc. Pneumoperitoneum creation in laparoscopic surgeries, leads to adverse changes in various systems of human body including cardiovascular, respiratory and acid base balance system. Various factors which leads to haemodynamic changes in patient are release of catecholamine, carbon di-oxide absorption, vasopressin release and position of the patient. NTG generate NO (Nitric oxide) which causes vasodilatation in vascular smooth muscle leading to decrease in blood pressure. It also relaxes the respiratory tract smooth muscle and hence it is preferred by anaesthesiologist to prevent laryngospasm. Dexmedetomidine is an 2-adrenoreceptor agonist used to facilitate the extubation after surgeries. Dexmedetomidine used in the intraoperative period causes decrease in serum catecholamine levels by 90%, which in turn blunts the haemodynamic response to laryngoscopy, tracheal intubation, pneumo-peritoneum and extubation. So we did the comparative study between IV dexmedetomidine and IV NTG on hemodynamic response during extubation in laparoscopic surgeries. To study and compare the effect of intravenous nitro-glycerine (NTG) with dexmedetomidine in patients undergoing laparoscopic surgery and during recovery in terms of haemodynamic response during tracheal extubation, airway reexes during tracheal extubation by using extubation quality score, sedation by using Ramsay Sedation Scale & side effects of drug. 60 patients of ASA grade 1 and 2 undergoing laparoscopic surgery were divided into two groups of thirty each. GROUP D (n=30) will receive Dexmedetomidine infusion at the rate of 0.75 mics/kg over 10 minutes and GROUP N (n=30) will receive NTG infusion at the rate of 2 mics/kg over 10 minutes .patients were assessed on the basis of ramsay sedation scale , extubation quality scale and vas scale every 1, 3, 5, 10 and 15 minutes. When both the groups were compared it was found out there was statistically signicant difference in dexmedetomidine group as compared to NTG in terms of decrease in HR , BP, SBP , DBP, MAP , extubation quality score , ramsay sedation scale, and VAS scale .there was no overall complication in both groups. In conclusion, the Dexmedetomidine at a dose of 0.75µg/kg body weight as compared to NTG ( 2 µg/kg body weight )when administered as infusion over 10 minutes, before tracheal extubation attenuates the airway reexes and hemodynamic responses effectively during emergence from anaesthesia providing smooth extubation. It provide adequate sedation, maintaining patient's arousability and delay the need for analgesia in the post-operative period.

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The Effects of Nitroglycerine (Ntg) Sublingual Spray to Blunt the Haemodynamic Response to Endotracheal Extubation in Lumbar Disc Surgery

Cited by 2 publications

References 13 publications

Effect of 1 puff of sublingual nitroglycerin spray versus 1 puff of normal saline spray in attenuating pressor response to extubation

Effect of 1 puff of sublingual nitroglycerin spray versus 1 puff of normal saline spray in attenuating pressor response to extubation

Comparison of NTG vs Dexmedetomidine for Control of Haemodynamic Response in Patients During Emergence From Anaesthesia and Extubation Following Laparoscopy

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