This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Piquette, D. Articles by Denault, A. Y. Search for Related Content PubMed PubMed Citation Articles by Piquette, D. Articles by Denault, A. Y.

Effect of intravenous nitroglycerin on cerebral saturation in high-risk cardiac surgery

[L’effet de la nitroglycérine intraveineuse sur la saturation cérébrale dans les chirurgies cardiaques à haut risque]

Dominique Piquette, MD FRCPC^*,||, Alain Deschamps, MD PhD FRCPC^*,||, Sylvain Bélisle, MD FRCPC^*,||, Michel Pellerin, MD FRCPS^,||, Sylvie Levesque, MSc^,||, Jean-Claude Tardif, MD FRCPC^,|| and André Y. Denault, MD FRCPC^*,||

^* From the Departments of Anesthesiology,
Surgery,
Medicine,
Biostatistics, and the
^|| Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.

Address correspondence to: Dr. André Y. Denault, Department of Anesthesiology and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Bélanger Street, Montréal, Québec H1T 1C8, Canada. Phone: 514-376-3330, ext. 3732; Fax: 514-376-8784; E-mail: denault{at}videotron.ca.

Purpose: To determine whether or not intravenous nitroglycerin (IV NTG) can prevent a decrease in near-infrared spectroscopy (NIRS) values during cardiopulmonary bypass (CPB).

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 CPB. 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 CPB, 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.

This article has been cited by other articles:

				G. M.T. Hare Nitroglycerin and cerebral oxygen saturation Can J Anesth, January 1, 2008; 55(1): 52 - 53. [Full Text] [PDF]

				A. Denault, A. Deschamps, and J. M. Murkin A Proposed Algorithm for the Intraoperative Use of Cerebral Near-Infrared Spectroscopy Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 274 - 281. [Abstract] [PDF]