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Effect of Subcutaneous Versus Topical Nitroglycerin on the Radial Artery Dimensions in Pediatric Patients Undergoing
Chandni Verma1, Varun Mahajan1, Rajarajan Ganesan1
1Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Objectives:
To compare the changes in radial artery dimensions produced by subcutaneous nitroglycerin (NTG) versus a topical NTG patch in pediatric patients.
Design:
Randomized controlled non-inferiority trial.
Setting:
Pediatric and cardiac operating rooms at a tertiary care hospital.
Participants:
Forty-five children aged 2 to 8 years undergoing surgery requiring radial arterial catheterization for hemodynamic monitoring or blood gas sampling.
Interventions:
Patients were randomized to receive either subcutaneous NTG (5 µg/kg diluted in 0.5 mL of saline solution, administered under ultrasound guidance) or a topical NTG patch (Releasing approximately 200 µg/h) applied over the radial artery 30 minutes before induction. Radial artery dimensions were measured ultrasonographically at baseline and after NTG administration.
Measurements And Main Results:
The increase in post-intervention vertical diameter in the topical NTG group met the predefined criterion for non-inferiority when compared with the subcutaneous NTG group (non-inferiority margin, -0.3 mm). Compared with subcutaneous NTG, topical NTG produced a significantly greater percentage increase in vertical diameter (0.45% ± 11.76% v 15.6% ± 16.18%, p = 0.002), horizontal diameter (3.53% ± 16.01% v 19.72% ± 16.42%, p = 0.001), and cross-sectional area (3.6% ± 18.02% v 38.29% ± 26.65%, p < 0.001). Subcutaneous NTG resulted in a markedly greater increase in radial artery depth when compared with topical NTG (84.35% ± 47.09% v -0.37% ± 15.8%, p < 0.001). The first-attempt cannulation success rate was lower in the subcutaneous NTG group (81.8% v 100%, p = 0.049). No NTG-related adverse events or significant hemodynamic changes were observed in either group.
Conclusions:
Topical NTG was statistically non-inferior to subcutaneous NTG in increasing the radial artery vertical diameter. Although the absolute post-intervention dimensions were similar between groups-likely influenced by the slightly smaller baseline arterial dimensions in the topical NTG group-the topical application produced larger percentage increases from baseline and did not cause the depth increase observed with subcutaneous NTG.
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