| Effects of nitroglycerin infusion on segmental wall motion abnormalities after anesthetic induction. | |
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MedLine Citation:
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PMID: 8910152 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To assess the effect of intravenous nitroglycerin (NTG) on segmental wall motion abnormalities (SWMAs) and global ventricular function after anesthetic induction in patients undergoing coronary artery bypass grafting (CABG). DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Twenty patients scheduled for elective CABG. INTERVENTIONS: Patients demonstrating SWMAs in at least two myocardial segments after induction received intravenous NTG at 2 micrograms/kg/min. MEASUREMENT AND MAIN RESULTS: Transesophageal echocardiography (TEE) was performed before and after the NTG infusion for analysis of segmental wall motion abnormalities. Mean arterial pressure (MAP), central venous pressure, and pulmonary capillary wedge pressure decreased significantly after NTG infusion, whereas cardiac index and heart rate remained unchanged. End-diastolic area and end-systolic area decreased, and consequently fractional area change increased significantly. Two of 20 patients (10%) showed electrocardiogram evidence of ischemia after induction. After NTG infusion, 15 of 20 patients (75%) showed an increase in a wall motion score more than two points. In these 15 patients with NTG-responsive wall motion abnormalities, the mean ratio of peak early diastolic filling velocity (E) to peak late diastolic filling velocity (A) increased from 0.89 +/- 0.20 to 1.04 +/- 0.25 (p < 0.01) after NTG infusion despite a decrease in filling pressure. Systolic wall thickening improved in segments with poor preoperative function from a pre-NTG value (mean +/- SD) of -1.0% +/- 7.4% to a post-NTG value of 31.4% +/- 24.9% (p < 0.01). CONCLUSIONS: Intravenous NTG improved postinduction SWMAs in 75% of patients with known coronary artery disease. TEE-guided NTG infusion after induction may provide an optimal baseline echocardiogram for monitoring intraoperative myocardial ischemia by improving the reversible portion of postinduction SWMAs. |
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Authors:
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Y Niimi; S Morita; T Watanabe; S Yamamoto; R Rubsamen; F Ichinose |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of cardiothoracic and vascular anesthesia Volume: 10 ISSN: 1053-0770 ISO Abbreviation: J. Cardiothorac. Vasc. Anesth. Publication Date: 1996 Oct |
Date Detail:
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Created Date: 1997-02-13 Completed Date: 1997-02-13 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9110208 Medline TA: J Cardiothorac Vasc Anesth Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 734-40 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, Teikyo University School of Medicine, Ichihara Hospital, Chiba, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anesthesia Coronary Artery Bypass* Echocardiography, Transesophageal Female Humans Male Middle Aged Myocardial Contraction / drug effects* Myocardial Ischemia / prevention & control, ultrasonography Nitroglycerin / pharmacology* Prospective Studies Vasodilator Agents / pharmacology* Ventricular Function / drug effects |
| Chemical | |
Reg. No./Substance:
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0/Vasodilator Agents; 55-63-0/Nitroglycerin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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