Nitroglycerin infusion during coronary-artery surgery

The effects of an intravenous infusion of nitroglycerin were studied in 20 acutely hypertensive patients during coronary-artery surgery. Eight patients had histories of essential hypertension and six had been treated for it. They were anesthetized with morphine, diazepam, N2O, O2, pancuronium, and enflurane. Control measurements were obtained after sternotomy. Nitroglycerin was then administered until the blood pressure returned to normal, and the measurements then repeated. The mean dose of nitroglycerin was 80.0 +/- 4.7 mug/min, or 0.96 mug/kg/min. This produced significant decreases (P less than .05) in systolic, diastolic, and mean arterial blood pressures, central venous pressure, pulmonary capillary wedge pressure, systemic vascular resistance, and left ventricular stroke work index. Cardiac index, stroke index, and heart rate were unchanged. Two indices of myocardial oxygen demand (rate-pressure product and tension-time index) were significantly decreased by nitroglycerin (P less than .005). Fifty per cent of the patients had improvement in ST-segment depression on the electrocardiogram. These findings demonstrate that nitroglycerin can be safely administered intravenously during operation, and suggest that nitroglycerin decreases myocardial oxygen demand and relieves myocardial ischemia.