Nitroglycerine-induced volume loading.
Fifty-five patients who underwent elective aortic aneurysmorrhaphy were studied intraoperatively to assess ventricular function responses to volume loading and nitroglycerine/inotrope mini-infusions. Assessments of preoperative cardiac reserve and risk of perioperative myocardial infarction were based on ejection fraction (EF); an algorithm was developed to direct differential preanesthetic loading to maximize ventricular performance in normal (EF, greater than 60%), moderate-risk (EF, 35% to 60%), and high-risk (EF, less than 35%) patients. Sixty percent of the patients in the series were at significant risk of myocardial infarction, including 25 with an EF from 35% to 60% and seven with an EF less than 35%; the perioperative myocardial infarction rate was zero. Nitroglycerine-induced volume loading in this series allowed aortic aneurysmorrhaphy without any decrease in ventricular function at the critical points of anesthetic induction, aortic cross clamping, or declamping; such optimization of myocardial performance appears to prevent perioperative myocardial infarction, even in high-risk patients.
D001012:Aorta, Abdominal; D001014:Aortic Aneurysm / Q000601:surgery*; D003327:Coronary Disease / Q000150:complications; D004341:Drug Evaluation; D006352:Heart Ventricles / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000517:prevention & control*; D009203:Myocardial Infarction / Q000517:prevention & control*; D005996:Nitroglycerin / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D011292:Premedication; D012306:Risk; D013318:Stroke Volume
D005996:Nitroglycerin