Effect of 1 puff of sublingual nitroglycerin spray versus 1 puff of normal saline spray in attenuating pressor response to extubation

Abstract

Ideal agent to attenuate hemodynamic response to extubation should be readily available, easy to administer, cost effective with fast onset of action and peak with minimal side effects. Nitroglycerin is one of the most widely used drug to control intra-operative rise in blood pressure. Nitroglycerin is potent vasodilator, predominantly acting on venules than arterioles by generating nitric oxide (NO) in vascular smooth muscle. A thorough pre-anaesthetic evaluation was done on day before surgery. Detailed medical history was elicited and detailed physical examination was carried out. Patients were kept nil per orally for 8 hours prior to surgery. Preoperatively investigations like CBC, RBS and Sr. Creatinine were done. ECG and CXR were done if patient was more than 40 years of age. In our study patient received 1 puff (0.4mg) which resulted in a small although insignificant increase in BP till 3 minutes. It may be possible to attenuate this small increase in BP by using higher dose of NTG spray instead of 0.4mg and requires further evaluation. It was observed that there was tachycardia as Injection Glycopyrrolate was given just before intervention since, both the groups received the same drug it will not act as bias.