Prophylactic nitroglycerin did not reduce myocardial ischemia during accelerated recovery management of coronary artery bypass graft surgery patients.
OBJECTIVE
To evaluate the use of a high dose of nitroglycerin (NTG) for prophylaxis against myocardial ischemia and infarction in patients undergoing coronary artery bypass graft (CABG) surgery with accelerated recovery.


METHODS
Prospective, double-blind, placebo-controlled randomized study.


METHODS
A university-based medical center.


METHODS
Forty adult patients presenting for elective CABG surgery.


METHODS
Forty patients were divided into 2 blinded study groups. Twenty patients received 2 microg/kg/min of NTG starting before induction of anesthesia and continuing for 6 hours after extubation in the intensive care unit. The placebo group (n = 20) received normal saline during this same interval.


RESULTS
Hemodynamics, incidence and severity of myocardial ischemia, and myocardial infarction rates were determined. There were no differences in hemodynamic parameters between groups. The incidence of ischemia was approximately 35% in each group. Myocardial infarction (as determined by elevated creatine kinase-MB fraction, troponin I, and electrocardiogram criteria) was 10% in the placebo group and 5% in the NTG group (p = 0.234).


CONCLUSIONS
This study shows a high incidence of myocardial ischemia and infarction in patients presenting for CABG surgery with an accelerated recovery management scheme. NTG was well tolerated clinically; however, it was not found to be protective against myocardial ischemia or infarction in this setting.
Zvara
D A
DA
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA.
Groban
L
L
Rogers
A T
AT
Prielipp
R C
RC
Murphy
B
B
Hines
M
M
Hammon
J W
JW
Kon
N D
ND
Royster
R L
RL
D000328:Adult; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000517:prevention & control*; D005996:Nitroglycerin / Q000627:therapeutic use*; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D005996:Nitroglycerin