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[Clinical evaluation of prophylactic nitroglycerin infusion during coronary artery bypass grafting]
H Amano1, M Okuda, K Furuhashi
1Department of Anesthesiology, Mie University School of Medicine, Tsu.
Insights
Prophylactic nitroglycerin (TNG) infusions did not benefit patients undergoing coronary artery bypass grafting (CABG). TNG infusions during CABG were associated with lower perfusion pressure and increased myocardial ischemia, indicating TNG is not beneficial for preventing perioperative ischemia.
Area of Science:
- Cardiology
- Cardiac Surgery
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac surgery procedure.
- Perioperative ischemia remains a concern during CABG.
- Nitroglycerin (TNG) is sometimes used prophylactically to mitigate ischemia.
Purpose of the Study:
- To retrospectively evaluate the benefit of prophylactic nitroglycerin (TNG) infusions during elective coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective analysis of 73 patients undergoing elective CABG.
- Anesthesia maintained with high-dose fentanyl.
- Comparison between 37 patients receiving TNG infusion (0.3 microgram.kg-1.min-1) and 36 patients not receiving TNG.
Main Results:
- TNG-infused patients showed lower perfusion pressure during cardiopulmonary bypass (CPB).
- TNG-infused patients required more inotropic administrations.
- Higher serum creatine phosphokinase-MB (CPK-MB) levels were observed in TNG-infused patients postoperatively.
- These findings suggest TNG may not prevent perioperative ischemia and could potentially worsen outcomes.
Conclusions:
- Prophylactic administration of nitroglycerin (TNG) does not prevent perioperative ischemia during coronary artery bypass grafting (CABG).
- TNG infusions may be associated with adverse effects, including lower perfusion pressure and increased myocardial ischemia markers.
- Further research is needed to understand the implications of TNG use in this context.
Abstract:
We evaluated retrospectively the benefit of prophylactic nitroglycerin (TNG) infusions during elective coronary artery bypass grafting (CABG) in 73 patients. In all patients anesthesia was maintained with high dose fentanyl. Thirty-seven patients were infused TNG 0.3 microgram.kg-1.min-1 during surgery and 36 patients were not. The TNG-infused patients demonstrated lower perfusion pressure during cardiopulmonary bypass (CPB) and higher incidence of inotropic administrations than the uninfused patients. Serum myocardial creatine phosphokinase (CPK-MB) levels of TNG-infused patients were higher than those of TNG-uninfused patients on the first postoperative day. We speculate that inotropic administrations under low myocardial perfusion pressure at the time of weaning from CPB induces myocardial ischemia which in turn causes an increase in serum CPK-MB level. We conclude that prophylactic administration of TNG does not prevent perioperative ischemia during CABG.