Abstract
Purpose
To determine whether or not intravenous nitroglycerin (IV NTG) can prevent a decrease in near-infrared spectros-copy (NIRS) values during cardiopulmonary bypass
Methods
We conducted a randomized double-blinded study in a tertiary academic center including 30 patients with a Parsonnet score ≥ 15 scheduled for a high-risk cardiac surgery. The patients were randomized to receive either IV NTG (initial dose of 0.05 µg·kg-1 ·min-1, followed by 0.1 µg·kg-1·min-1) or placebo after anesthetic induction until the end of The primary outcome was a decrease of 10% in NIRS values during CPB.
Results
Despite the absence of between-group difference in the mean cerebral oxygen saturation during there was a significant decrease in NIRS values during CPB in the placebo group, whereas mean NIRS values were maintained in the IV NTG group (-16.7%vs 2.3% in the NTG,P = 0.019). Major hemodynamic variables were similar at corresponding time periods in both groups, while patients in the IV NTG group had higher CK-MB values and experienced greater blood loss during the first 24 hr postoperatively.
Conclusion
Intravenous nitroglycerin administration before and during CPB may prevent a decrease in NIRS values associated with CPB in high-risk cardiac surgery. Further studies are warranted to determine the efficacy and the risks associated with IV NTG infusion for this indication during CPB in high-risk patients.
Résumé
Objectif
Déterminer si la nitroglycérine intraveineuse (NTG IV) peut empêcher ou non une diminution des valeurs de la spectroscopie par infrarouge (NIRS) pendant la circulation extracorporelle (CEC).
Méthode
Nous avons mené une étude randomisée à double insu dans un centre universitaire tertiaire incluant 30 patients présentant un score de Parsonnet ≥ 15 et devant subir une chirurgie cardiaque à haut risque. Les patients ont été randomisés en deux groupes: NTG IV (dose initiale de 0,05 µg·kg-1 ·min-1, suivie de 0,1 µg·kg-1 ·min-1), ou placebo après l’induction de l’anesthésie et jusqu’à la fin de la CEC. Le résultat primaire a été une diminution de 10% des valeurs de NIRS pendant la CEC.
Résultats
Malgré l’absence de différence inter-groupe dans la saturation d’oxygène cérébrale moyenne durant la CEC, une diminution significative des valeurs de NIRS pendant la CEC a été observée dans le groupe placebo, alors que les valeurs moyennes de NIRS se sont maintenues dans le groupe NTG IV (-16,7% vs 2,3 % dans le groupe NTG, P = 0,019). Les variables hémodynamiques principales ont été semblables pour des périodes temporelles correspondantes dans les deux groupes, bien que les patients du groupe NTG IV aient présenté des valeurs CK-MB plus élevées et perdu davantage de sang durant les premières 24 h postopératoires.
Conclusion
L’administration de nitroglycérine intraveineuse avant et pendant la CEC pourrait empêcher une diminution des valeurs de NIRS associées à la CEC dans les chirurgies cardiaques à haut risque. Des études supplémentaires sont nécessaires afin de déterminer l’efficacité et les risques associés à une infusion NTG IV pour cette indication pendant la CEC chez des patients à haut risque.
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Supported by the Fonds de la recherche en santé du Québec, the Fondation de l’Institut de Cardiologie de Montréal, Montréal, QC; the Canadian Institutes of Health Research, Ottawa, ON, Canada. Presented at the Canadian Anesthesiologists’ Society Meeting in Toronto, June 2006. Dr. Tardif is the recipient of the Canadian Institutes of Health Research and Pfizer Chair in Atherosclerosis. Conflicts of interest: None declared.
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Piquette, D., Deschamps, A., Bélisle, S. et al. Effect of intravenous nitroglycerin on cerebral saturation in high-risk cardiac surgery. Can J Anesth 54, 718–727 (2007). https://doi.org/10.1007/BF03026868
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DOI: https://doi.org/10.1007/BF03026868