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Comparison of systemic vasodilators: effects on flow in internal mammary and radial arteries
D Zabeeda1, B Medalion, S Jackobshvilli
1Department of Anesthesia, E. Wolfson Medical Center, Holon, Israel.
Insights
Systemic vasodilators were tested in coronary artery bypass surgery patients. Intravenous nitroglycerin effectively increased blood flow in both the internal mammary artery and radial artery conduits.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Vascular Physiology
Background:
- Arterial conduits, such as the radial artery and internal mammary artery (IMA), are crucial for coronary artery bypass grafting (CABG).
- Spasm of these arterial grafts is a significant clinical concern, potentially compromising graft patency and patient outcomes.
- Evaluating the effects of systemic vasodilators on in vivo arterial conduit flow is essential for optimizing perioperative management.
Purpose of the Study:
- To compare the effects of various systemic vasodilators on the in vivo blood flow of the radial artery and IMA.
- To identify the most effective vasodilator for promoting arterial conduit patency during CABG surgery.
Main Methods:
- Fifty patients undergoing primary CABG were randomized into five groups receiving nitroglycerin, nitroprusside, dobutamine, milrinone, or normal saline (control).
- Radial artery and IMA flows, blood pressure, central venous pressure, and heart rate were measured before and 10 minutes after drug administration.
- Statistical analysis, including a multivariate general linear model, was employed to determine the impact of each agent.
Main Results:
- Nitroglycerin and nitroprusside significantly decreased mean arterial pressure, while dobutamine increased it.
- No significant differences in IMA or radial artery flow were observed among groups prior to drug administration.
- Nitroglycerin was identified as the sole predictor for increased flow in both the IMA (p < 0.001) and radial artery (p = 0.009).
Conclusions:
- Intravenous nitroglycerin effectively induces in vivo vasodilation of both the internal mammary artery and radial artery.
- Nitroglycerin is a suitable systemic vasodilator for administration during the harvesting of these arterial conduits in CABG.
Background:
Spasm is a major concern with the use of arterial conduits in coronary artery bypass surgery (CABG). We evaluated the effect of systemic vasodilators on in vivo radial artery flow compared with internal mammary artery (IMA) flow.
Methods:
Fifty patients undergoing primary CABG with a mean age of 69 +/- 5 years enrolled in this study and were randomized to 1 of 5 groups based on the vasodilating agent administered (nitroglycerin, nitroprusside, dobutamine, milrinone, and normal saline as control group). Radial artery and IMA flows, blood pressure, central venous pressure, and heart rate were measured before and 10 minutes after drug administration.
Results:
Mean arterial pressure decreased significantly after drug administration in both the nitroglycerin (p = 0.007) and nitroprusside (p < 0.001) groups and increased in the dobutamine group (p < 0.001). There were no significant differences between IMA flow or radial flow among the groups before drug administration. A multivariate general linear model was created and revealed drug (specifically nitroglycerin) as the only predictor to increase flow in the IMA (p < 0.001) or the radial artery (p = 0.009).
Conclusions:
We conclude that intravenous nitroglycerin causes in vivo vasodilatation of both the IMA and radial artery and is a good systemic vasodilator to be given when harvesting these two conduits.