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Hemodynamics of intravenous nitroglycerin during aortic clamping
Insights
Nitroglycerin infusion during aortic cross-clamping (CCL) maintained cardiac contractility and peripheral blood flow in patients with arteriosclerotic disease. This suggests nitroglycerin is beneficial for hemodynamic stability during this surgical procedure.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Aortic cross-clamping (CCL) is a critical surgical step with potential hemodynamic complications.
- Standardization of anesthetic management and vasodilator use during CCL is lacking in current research.
Purpose of the Study:
- To evaluate the efficacy of intraoperative nitroglycerin infusion in maintaining hemodynamic stability during aortic cross-clamping (CCL).
- To compare cardiac contractility and peripheral blood flow in patients undergoing CCL with and without nitroglycerin.
Main Methods:
- A prospective study of 25 patients with arteriosclerotic aortic disease undergoing CCL.
- Comparison of 6 patients receiving nitroglycerin (0.25 mcg/kg/min) during CCL versus 19 patients without nitroglycerin, all under standardized anesthesia.
Main Results:
- Nitroglycerin infusion maintained cardiac contractility during CCL, unlike in the control group.
- Peripheral blood flow remained adequate in the nitroglycerin group despite a low cardiac index.
- Increased intrapulmonary shunt in the nitroglycerin group did not significantly impair Pao2.
Conclusions:
- Intraoperative nitroglycerin infusion appears beneficial for preserving pre-CCL cardiac contractility.
- Nitroglycerin administration aids in maintaining adequate peripheral blood flow during aortic cross-clamping.
- Nitroglycerin may be a valuable adjunct in managing patients undergoing aortic cross-clamping, particularly those with arteriosclerotic disease.
Abstract:
Anesthetic management and dosage schedules of vasodilators have not been standardized in many studies of aortic cross clamping (CCL). For this reason, 25 consecutive patients with arteriosclerotic disease of the aorta were studied, all having received the same anesthetic management. Six patients who received nitroglycerin during the cross clamp period, at a dosage of 0.25 micrograms/kg/min, were compared with 19 who underwent CCL without the drug. Contractility was maintained in the nitroglycerin group, but not in the other group. Despite a low cardiac index in both groups, peripheral blood flow was adequate only in the nitroglycerin group. Intrapulmonary shunt was higher in the nitroglycerin group, but it did not significantly decrease the Pao2. Nitroglycerin infusion seems to be helpful in maintaining pre-CCL contractility and adequacy of peripheral blood flow.