Intravenous nitroglycerin does not preserve gastric microcirculation during gastric tube reconstruction: a randomized controlled trial.
BACKGROUND
Complications of oesophagectomy and gastric tube reconstruction include leakage and stenosis, which may be due to compromised microvascular blood flow (MBF) in gastric tissue. We recently demonstrated that decreased MBF could be improved perioperatively by topical administration of nitroglycerin. The aim of the present study was to investigate whether nitroglycerin, administered intravenously during gastric tube reconstruction, could preserve tissue blood flow and oxygenation in the gastric fundus, and reduce the incidence of postoperative leakage.


METHODS
In this single-centre, prospective, double-blinded study, we randomized 32 patients scheduled for oesophagectomy into two groups. The intervention group received intravenous nitroglycerin during gastric tube reconstruction, and the control group received normal saline. Baseline values for MBF, microvascular haemoglobin oxygen saturation and microvascular haemoglobin concentration were determined at the gastric fundus before and after gastric tube construction and after pulling up the gastric tube to the neck.


RESULTS
MBF and microvascular haemoglobin oxygen saturation decreased similarly in both groups during gastric tube reconstruction and were comparable. The oesophageal anastomosis was controlled by contrast radiography before discharge from the hospital; leakage was observed in two patients (13%) in the nitroglycerin group and five patients (31%) in the control group (not significant).


CONCLUSIONS
Under stable systemic haemodynamic conditions, continuous intravenous administration of nitroglycerin could not prevent deterioration in gastric microvascular perfusion and microvascular haemoglobin saturation during gastric tube reconstruction.
Buise
Marc
M
Department of Anesthesiology, Erasmus MC Rotterdam, Gravendijkwal, 3015 CE Rotterdam, The Netherlands. buisejan@xs4all.nl
van Bommel
Jasper
J
Jahn
Alexander
A
Tran
Khe
K
Tilanus
Huug
H
Gommers
Diederik
D
D000368:Aged; D004311:Double-Blind Method; D016629:Esophagectomy; D004947:Esophagus / Q000098:blood supply / Q000187:drug effects / Q000601:surgery; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012039:Regional Blood Flow / Q000187:drug effects; D013270:Stomach / Q000098:blood supply* / Q000187:drug effects* / Q000601:surgery
D005996:Nitroglycerin