title: Systemic effects of intracoronary nitroglycerin during coronary angiography in children after heart transplantation.
abstract: Coronary spasm during coronary angiography for vasculopathy in children can be prevented by the intracoronary administration of nitroglycerin. We reviewed the anesthesia and catheterization reports and charts for pediatric transplant recipients who underwent angiography from 2005 through 2010. Correlation analysis was used to study the relation of post-injection systolic blood pressure (SBP) to nitroglycerin dose. Forty-one angiographic evaluations were performed on 25 patients (13 male and 12 female). Mean age was 9.9 ± 3.2 years (range, 3.3-16.1 yr). The mean total dose of nitroglycerin was 2.93 ± 1.60 µg/kg (range, 1-8 µg/kg). There was a significant drop between the baseline SBP (mean, 106 ± 21.6 mmHg) and the lowest mean SBP before nitroglycerin administration (78 ± 13.2, P <0.0001, paired t test). There was no significant additional change in SBP (mean after nitroglycerin administration, 80.7 ± 13.1 mmHg; P = 0.2). There was a significant drop in lowest heart rate between baseline (109 ± 16.5 beats/min) and before nitroglycerin administration (89 ± 14.3 beats/min; P <0.0001, paired t test). There was no significant additional change in heart rate (mean heart rate after nitroglycerin, 84 ± 17.7 beats/min; P = 0.09). There were 2 interventions for SBP before nitroglycerin and 2 after nitroglycerin. One child experienced a transient ST-T-segment change during angiography after nitroglycerin. In the highest dose range, the additional decrease in SBP was 7.2 mmHg (P=0.03). Routine intracoronary nitroglycerin administration in this dose range produced no significant changes in SBP or heart rate in children.
authors: Departments of Pediatrics (Drs. Lara and Olive) and Anesthesiology (Dr. Steenwyck), and Divisions of Cardiothoracic Surgery (Dr. George and Mr. Brown) and Pediatric Cardiology (Drs. Carlo, Colvin, and Pearce), University of Alabama School of Medicine, Birmingham, Alabama 35294.
authors: Diego A
authors: DA
authors: Lara
authors: Mary K
authors: MK
authors: Olive
authors: James F
authors: JF
authors: George
authors: Robert N
authors: RN
authors: Brown
authors: Waldemar F
authors: WF
authors: Carlo
authors: Edward V
authors: EV
authors: Colvin
authors: Brad L
authors: BL
authors: Steenwyck
authors: F Bennett
authors: FB
authors: Pearce
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001794:Blood Pressure / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage* / Q000009:adverse effects; D011237:Predictive Value of Tests; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin