Document Detail


Prophylactic nitroglycerin infusion during noncardiac surgery does not reduce perioperative ischemia.
MedLine Citation:
PMID:  8466005     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We evaluated the impact of prophylactic nitroglycerin on the incidence of perioperative myocardial ischemia in patients with known or suspected coronary artery disease who undergo noncardiac surgery. Our goals were to better define the role of nitroglycerin in the management of high-risk patients and to explore the mechanisms of perioperative myocardial ischemia. Patients were assigned randomly to either a control group (n = 23) or to receive 0.9 micrograms.kg-1.min-1 of intravenous nitroglycerin (n = 22). The diagnosis of myocardial ischemia was based on a review of Holter electrocardiogram (ECG) recordings. There was no difference in the incidence of ischemia between groups. Seven control patients (30%) and seven nitroglycerin patients (32%) exhibited ECG evidence of ischemia. The preponderance of myocardial ischemia occurred during emergence from anesthesia (of the 14 patients exhibiting ischemia, 12 did so at emergence). There was an acute increase in heart rate at the onset of ischemia in all patients exhibiting ischemia with 14 of 18 episodes associated with an increase of 20% or greater. The heart rate associated with the onset of ischemia was greater in the nitroglycerin-treated patients than in the control group. We also found that the occurrence of myocardial ischemia on a preoperative Holter recording was strongly predictive of the subsequent occurrence of perioperative ischemia. In conclusion, the addition of nitroglycerin to standard anesthetic management of these high-risk patients does not measurably reduce perioperative ischemia.
Authors:
T M Dodds; J G Stone; J Coromilas; M Weinberger; D G Levy
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  76     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  1993 Apr 
Date Detail:
Created Date:  1993-05-03     Completed Date:  1993-05-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  705-13     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure / physiology
Coronary Disease / complications,  physiopathology
Double-Blind Method
Electrocardiography, Ambulatory
Female
Heart Rate / physiology
Humans
Infusions, Intravenous
Intraoperative Complications / prevention & control*
Male
Middle Aged
Myocardial Ischemia / etiology,  physiopathology,  prevention & control*
Nitroglycerin / therapeutic use*
Prognosis
Systole / physiology
Chemical
Reg. No./Substance:
55-63-0/Nitroglycerin
Comments/Corrections
Comment In:
Anesth Analg. 1994 Nov;79(5):1022-3   [PMID:  7978388 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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