Nitroglycerin Infusion During Cardiac Surgery
Summary
Hypothermic cardiopulmonary bypass results in peripheral vasoconstriction and heparin trapping. Hypoperfusion and ischemic-reperfusion injury are associated with systemic inflammatory response, while insufficient and delayed neutralization of heparin by protamine may contribute to more blood loss during rewarming stage. Nitroglycerin infusion, an NO-related vasodilator, is an established and effective treatment for unstable angina, myocardial infarction, congestive heart failure, and perioperative hemodynamic management for cardiac surgery. Therefore, we hypothesize that nitroglycerin infusion during rewarming corrects systemic ischemic stress and facilitates heparin neutralization in cardiac surgery.
Timeline
- Start
- 2013-07-08
- Primary completion
- 2017-06-08
- Completion
- 2017-06-08
Outcome
Missed primary endpoint
registry analysis (superiority test); High-dose NTG vs Low-dose NTG; p = 0.618; t-test, 2 sided NCT01901419 ↗
registry COUNT_OF_PARTICIPANTS High-dose NTG: 6 Participants COUNT_OF_PARTICIPANTS Low-dose NTG: 0 Participants NCT01901419 ↗
registry analysis (superiority test); High-dose NTG vs Low-dose NTG; p <0.001; Fisher Exact NCT01901419 ↗
Publications
- Background Piquette D, Deschamps A, Belisle S, Pellerin M, Levesque S, Tardif JC, Denault AY. Effect of intravenous nitroglycerin on cerebral saturation in high-risk cardiac surgery. Can J Anaesth. 2007 Sep;54(9):718-27. doi: 10.1007/BF03026868.
- Background Masoumi G, Pour EH, Sadeghpour A, Ziayeefard M, Alavi M, Anbardan SJ, Shirani S. Effect of different dosages of nitroglycerin infusion on arterial blood gas tensions in patients undergoing on- pump coronary artery bypass graft surgery. J Res Med Sci. 2012 Feb;17(2):123-7.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Nitroglycerin | Unknown | 0.1 ug/kg | — |
| Subject | Nitroglycerin | Unknown | 5 ug/kg | — |