Effects Of Nitroglycerin Research Articles

Computed tomography angiography (CTA) of anomalous aortic origin of a coronary artery (AAOCA): Which measurements are accurate and reliable?

BackgroundThe variation and accuracy of computed tomography angiography (CTA) features of anomalous aortic origin of a coronary artery (AAOCA) have not been completely characterized. We evaluated anomalous right (AAORCA) and left (AAOLCA) coronary arteries by CTA, with an emphasis on reproducibility, comparison with surgical measurements, and effect of nitroglycerin. MethodsCTAs were interpreted for location of coronary origin & exit from the aorta, course, and dominance; minor & major diameters of the proximal & distal coronaries; shape of orifice; and intramural length. Relationships between vessel measurements, body surface area (BSA), and nitroglycerin use were evaluated. Comparisons between CTA and surgical measurements included intramural length, surgical probe size pre-intervention vs. CTA proximal AAOCA diameter, and surgical probe size post-intervention vs. CTA distal AAOCA diameter. ResultsOf 104 patients [81 (78%) AAORCA], all but 1 were intramural. Compared to AAOLCA, AAORCA patients were more likely to have a high origin (91% vs. 31%, p ​< ​0.01), and slit-like orifice (58% vs. 26%, p ​< ​0.01). When CTAs with nitroglycerin were compared to those without, no difference in proximal AAOCA dimensions was identified; however distal AAOCA and normal-origin coronary dimensions were larger in scans with nitroglycerin. Aside from slit-like orifice, reliability of coronary CTA measurements, including proximal AAOCA minor diameter and intramural length, was moderate to good between readers. In a subgroup of 54 patients, proximal AAOCA minor diameter and intramural length had good agreement and correlation with surgery. ConclusionProximal AAOCA dimensions and intramural length are reproducible variables. The lack of difference in proximal AAOCA dimensions with nitroglycerin may reflect abnormal vessel mechanics. Multicenter studies are an important next step in understanding the generalizability of our findings.

Effect of randomized prophylactic nitroglycerin on radial artery spasm during transradial catheterization: An analysis based on operator experience.

One limitation to transradial access (TRA) is the occurrence of spasms (RAS), for which the use of prophylactic medications is recommended. Improvement in TRA material combined with the increase in operators' expertise, might mitigate this benefit. We assess the effect of preventive nitroglycerin on RAS during TRA, evaluating the role of the operator's experience. Patients received 500 μg nitroglycerin or placebo. The operator's expertise was classified as: inexperienced (I), intermediate (M), and experienced (E). 2040 patients were included. Prophylactic use of nitroglycerin did not reduce RAS (10.8% vs. 13.4% (placebo), p = 0.07). RAS incidence was 14.5% in I, 12.5% in M, and 9.7% in E (p = 0.01). In group I, nitroglycerin reduced RAS (17.4% vs. 11.1%, p = 0.04), which was not observed in other groups. Overall, nitroglycerin does not prevent RAS, which is more common among inexperienced operators. More experienced operators could abolish preventive nitroglycerin use.

PACAP-PAC1 receptor inhibition is effective in opioid induced hyperalgesia and medication overuse headache models

Opioids prescribed for pain and migraine can produce opioid-induced hyperalgesia (OIH) or medication overuse headache (MOH). We previously demonstrated that pituitary adenylate cyclase activating polypeptide (PACAP) is upregulated in OIH and chronic migraine models. Here we determined if PACAP acts as a bridge between opioids and pain chronification. We tested PACAP-PAC1 receptor inhibition in novel models of opioid-exacerbated trigeminovascular pain. The PAC1 antagonist, M65, reversed chronic allodynia in a model which combines morphine with the migraine trigger, nitroglycerin. Chronic opioids also exacerbated cortical spreading depression, a correlate of migraine aura; and M65 inhibited this augmentation. In situ hybridization showed MOR and PACAP co-expression in trigeminal ganglia, and near complete overlap between MOR and PAC1 in the trigeminal nucleus caudalis and periaqueductal gray. PACAPergic mechanisms appear to facilitate the transition to chronic headache following opioid use, and strategies targeting this system may be particularly beneficial for OIH and MOH.

Comparison of the effects of tranexamic acid, nitroglycerin, and remifentanil on the prevention of bleeding during herniated lumbar intervertebral disc surgery: A randomized clinical trial.

Surgery is a well-known and effective method of treating lumbar intervertebral disc herniation. The present study aimed to compare the effects of administering tranexamic acid (TXA), nitroglycerin (NTG), and remifentanil (REF) on hemorrhage prevention during herniated lumbar intervertebral disc surgery. A double-blind clinical trial was conducted on 135 participants undergoing lumbar intervertebral disc surgery. A randomized block design was used for subject assignment to three groups including TXA, NTG, and REF. The hemodynamic parameters, bleeding rate, hemoglobin level, and the amount of infused propofol were measured and recorded after surgery. Data were then analyzed in SPSS software using Chi-square test and analysis of variance. The mean age of participants in the study was 42.12 ± 7.93 years, and all three groups were equal in terms of demographic characteristics (P > 0.05). The mean arterial pressure (MAP) of the TXA and NTG groups was notably higher than the REF group (P < 0.008). The mean heart rate (HR) of the TXA and NTG groups was notably higher than the REF group (P < 0.05). The propofol dosage used in the TXA group was higher than the two groups of NTG and REF (P < 0.001). Among participants undergoing lumbar intervertebral disc surgery, the greatest MAP variability was observed in the NTG group. Higher mean HR and propofol consumption was observed in the NTG and TXA groups when compared to REF. No statistically significant differences were noted between groups in oxygen saturation or bleeding risk. Based on these findings, REF may be considered a preferred surgical adjunct over TXA and NTG during lumbar intervertebral disc surgery.

Effect of Topical Nitroglycerin on the Survival of Random Pattern Vascular Skin Flaps in a Rat Model: Pilot Study

Effect of Topical Nitroglycerin on the Survival of Random Pattern Vascular Skin Flaps in a Rat Model: Pilot Study

Impact of nitroglycerin on machine-learning fractional flow reserve in coronary computed tomography (CT)-angiography.

Nitroglycerin administration prior to examination improves stenosis assessment of coronary computed tomography (CT) angiography (CCTA). However, whether nitroglycerin influences CT-derived fractional flow reserve (FFR, CT-FFR) evaluation remains unclear. This study aimed to investigate the effect of nitroglycerin on diagnostic performance of CT-FFR. In this single-center retrospective study, 107 consecutive patients suspected of coronary artery disease (CAD) with nitroglycerin administration prior to CCTA in 2019 were matched to 107 patients without nitroglycerin in 2016 from Fuwai Hospital. All patients underwent CCTA and invasive FFR in a month. Vessel-based and patient-based accuracy and diagnostic performance of CT-FFR were compared between the two groups, as well as image quality, coronary artery diameter and evaluability. Quantitative variables were compared by Kruskal-Wallis H test. Categorical variables and rates were compared by χ2 test or Fisher exact test. A total of 214 patients (56.1±8.9 years, 155 male) with 237 target lesion vessels were analyzed, including 120 vessels in nitroglycerin and 117 vessels in non-nitroglycerin group. Per-vessel based accuracy of CT-FFR was higher in nitroglycerin group {80.0% [95% confidence interval (CI): 71.7-86.7%] vs. 68.4% (59.1-76.7%), P=0.041}. On a per-patient basis, nitroglycerin administration improved the accuracy [83.2% (74.7-89.7%) vs. 68.2% (58.5-76.9%), P=0.01], specificity [82.7% (69.7-91.8%) vs. 61.9% (48.8-73.9%), P=0.01], positive predictive value (PPV) [83.6% (73.6-90.4%) vs. 58.6% (50.0-66.9%), P=0.004], and area under the curve (AUC) [0.83 (0.75-0.89) vs. 0.71 (0.61-0.79), P=0.03] of CT-FFR. Vessel diameters (left main arteries: 4.3 vs. 3.8 mm, P<0.001; left anterior descending arteries: 3.1 vs. 2.9 mm, P=0.001; left circumflex arteries: 2.9 vs. 2.7 mm, P=0.01; right coronary arteries: 3.7 vs. 3.4 mm, P=0.001) and number of evaluable coronary arteries (11.0 vs. 8.0, P<0.001) were larger in nitroglycerin group. Nitroglycerin administration prior to CCTA has positive effects on diagnostic performance of CT-FFR.

Evaluation and Comparison the Effectiveness of Remifentanil, Nitroglycerin, Esmolol, and Nitroglycerin + Esmolol on Blood Pressure And Heart Rate During Rhinoplasty Surgery

Background: Rhinoplasty is still one of the top five aesthetic surgeries performed and is considered one of the most challenging procedures in otorhinolaryngology surgery. Bleeding is one of the most important factors affecting an operation's success. The controlled hypotension method reduces bleeding; therefore, it provides a satisfying bloodless surgical field during operation. Objective: To evaluate and compare the effectiveness of (Remifentanil, Nitroglycerin, Esmolol, and Nitroglycerin + Esmolol) on hemodynamic parameters and the effectiveness of these drugs in providing a satisfactory bloodless surgical field during rhinoplasty surgery. Patients and Methods: 200 adults aged 20 to 45 years were randomly divided into four groups: Remifentanil (R), Nitroglycerin (N), Esmolol (E), Nitroglycerin + Esmolol (N+E). Systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate (SBP, DBP, MBP, and HR) were recorded before anesthesia induction until the operation's end. The bleeding score and the visibility of the surgical field were rated by the surgeon as follows: (0) No bleeding, (1) Mild bleeding - no aspiration required, (2) Mild bleeding - intermittent aspiration is required, (3) Moderate bleeding - frequent aspiration is required, (4) Severe bleeding-constant aspiration is required, (5) Severe bleeding, operation stopped because of surgical field invisibility. Results: As a result, during operation, decreased values of (SBP, DBP, and MBP) were statistically significant in all groups. At the same time, the value of HR showed a statistically significant decrease in the (E) and (R) groups, while there was a statistically significant increase in the (N) and (N+ E) groups. Patients in the (E) and (R) groups had a statistically significantly lower bleeding score than the patients in the (N) and (N + E) groups. Conclusion: Patients had better Hemodynamic stability and surgical field visibility after applying Esmolol and Remifentanil. Keywords: Controlled hypotension, Rhinoplasty, Esmolol, Remifentanil, Nitroglycerin, and Nitroglycerin + Esmolol, Bleeding score, Surgical field visibility.

Evaluation and Comparison the Effectiveness of Remifentanil, Nitroglycerin, Esmolol, and Nitroglycerin + Esmolol on Blood Pressure And Heart Rate During Rhinoplasty Surgery

Background: Rhinoplasty is still one of the top five aesthetic surgeries performed and is considered one of the most challenging procedures in otorhinolaryngology surgery. Bleeding is one of the most important factors affecting an operation's success. The controlled hypotension method reduces bleeding; therefore, it provides a satisfying bloodless surgical field during operation.&#x0D; Objective: To evaluate and compare the effectiveness of (Remifentanil, Nitroglycerin, Esmolol, and Nitroglycerin + Esmolol) on hemodynamic parameters and the effectiveness of these drugs in providing a satisfactory bloodless surgical field during rhinoplasty surgery.&#x0D; Patients and Methods: 200 adults aged 20 to 45 years were randomly divided into four groups: Remifentanil (R), Nitroglycerin (N), Esmolol (E), Nitroglycerin + Esmolol (N+E). Systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate (SBP, DBP, MBP, and HR) were recorded before anesthesia induction until the operation's end. The bleeding score and the visibility of the surgical field were rated by the surgeon as follows: (0) No bleeding, (1) Mild bleeding - no aspiration required, (2) Mild bleeding - intermittent aspiration is required, (3) Moderate bleeding - frequent aspiration is required, (4) Severe bleeding-constant aspiration is required, (5) Severe bleeding, operation stopped because of surgical field invisibility.&#x0D; Results: As a result, during operation, decreased values of (SBP, DBP, and MBP) were statistically significant in all groups. At the same time, the value of HR showed a statistically significant decrease in the (E) and (R) groups, while there was a statistically significant increase in the (N) and (N+ E) groups. Patients in the (E) and (R) groups had a statistically significantly lower bleeding score than the patients in the (N) and (N + E) groups.&#x0D; Conclusion: Patients had better Hemodynamic stability and surgical field visibility after applying Esmolol and Remifentanil.

Experimental study of the effects of nitroglycerin, botulinum toxin A, and clopidogrel on bipedicled superficial inferior epigastric artery flap survival

Beneficial effects could be achieved by various agents such as nitroglycerin, botulinum toxin A (BoTA), and clopidogrel to improve skin flap ischaemia and venous congestion injuries. Eighty rats were subjected to either arterial ischaemia or venous congestion and applied to a bipedicled U-shaped superficial inferior epigastric artery (SIEA) flap with the administration of nitroglycerin, BoTA, or clopidogrel treatments. After 7 days, all rats were sacrificed for flap evaluation. Necrotic area percentage was significantly minimized in flaps treated with clopidogrel (24.49%) versus the ischemic flaps (34.78%); while nitroglycerin (19.22%) versus flaps with venous congestion (43.26%). With ischemia, light and electron microscopic assessments revealed that nitroglycerin produced degeneration of keratinocytes and disorganization of collagen fibers. At the same time, with clopidogrel administration, there was an improvement in the integrity of these structures. With venous congestion, nitroglycerin and BoTA treatments mitigated the epidermal and dermal injury; and clopidogrel caused coagulative necrosis. There was a significant increase in tissue gene expression and serum levels of vascular endothelial growth factor (VEGF) in ischemic flaps with BoTA and clopidogrel, nitroglycerin, and BoTA clopidogrel in flaps with venous congestion. With the 3 treatment agents, gene expression levels of tumor necrosis factor-α (TNF-α) were up-regulated in the flaps with ischemia and venous congestion. With all treatment modalities, its serum levels were significantly increased in flaps with venous congestion and significantly decreased in ischemic flaps. Our analyses suggest that the best treatment option for ischemic flaps is clopidogrel, while for flaps with venous congestion are nitroglycerin and BoTA.

Abstract 14195: The Effects of Pulmonary Capillary Wedge Pressure (PCWP) Reduction on Starling Mechanisms in Heart Failure With Preserved Ejection Fraction (HFpEF): Potential for Harm?

Introduction: Elevated left ventricular (LV) filling pressure during exercise is a pathognomonic characteristic of HFpEF. Multiple therapies aiming to reduce filling pressures in HFpEF patients have failed to improve exercise capacity and in some studies, decreased activity levels. The Dynamic Starling Mechanism (DSM) quantifies beat-by-beat modulation of stroke volume (SV) by respiratory-mediated changes in LV filling and provides insight into the efficiency with which changes in LV filling pressure are converted to SV. Low DSM gain reflects inefficient conversion of LV pressures (input) into stroke volume (output). In this study, we examined the effect of sublingual nitroglycerin (NTG; 400μg given q15 minutes) to lower PCWP compared to placebo on DSM. Methods: HFpEF patients (n=11, 7 women; age 73 ± 7 years) were studied seated upright at rest following sublingual administration of placebo or NTG. DSM was quantified by transfer function analyses of beat-by-beat changes in pulmonary artery diastolic pressure (PAD, right heart catheterization as index for PCWP) and SV (Modelflow from radial arterial line waveform, normalized to direct Fick-derived SV) at the prevailing respiratory frequency. Direct Fick SV was calculated as VO2/a-vO2 difference divided by heart rate. Results: Compared to placebo, NTG decreased both SV (Placebo: 53 ml vs NTG: 43 ml, p=0.004) and PAD (Placebo: 15.0 mmHg vs NTG: 13.9 mmHg, p=0.026). The DSM gain was decreased with NTG compared to placebo (0.57 vs 0.82 ml/mmHg, p&lt;0.0001) suggesting a smaller change in SV for a change in filling pressure. Conclusions: Lowering cardiac filling pressures in the seated upright position decreased efficiency of the beat-by-beat Starling mechanism. The results may provide insight into how reducing LV filling pressures impacts stroke volume regulation, potentially leading to decreased exercise tolerance in HFpEF patients.

Comparative study between the effect of oral sildenafil citrate versus oral nitroglycerin on intrauterine growth restriction in normotensive pregnant women.

Comparative study between the effect of oral sildenafil citrate versus oral nitroglycerin on intrauterine growth restriction in normotensive pregnant women.

Intracoronary injection of nitroglycerine can prevent unnecessary percutaneous coronary intervention

BackgroundDespite the recommendation of the current guidelines, intracoronary administration of nitroglycerine during coronary angiography is often neglected. We investigated the effect of intra-coronary nitroglycerin on the relief of coronary artery stenosis in the candidates for percutaneous coronary intervention (PCI).MethodsWe included patients with angina pectoris or myocardial infarction who were candidates for PCI. In the coronary angiography, the culprit vessel involved was evaluated, and bolus nitroglycerin at a dose of 25–200 mcg was injected into the affected coronary artery. A significant change in the percentage of coronary artery stenosis was considered a positive response, and these patients were then compared with patients who did not have a substantial change in the percentage of stenosis at the same time. Univariate analysis and then multivariate logistic regression analysis was performed to determine the predictors of response to intracoronary nitroglycerin.ResultsAmong 360 patients, 27 (7.5%) responded to nitroglycerine, and 333 (92.5%) were non-responsive. The mean age of patients was 60.2 ± 11.6 years, ranging from 23 to 93 years, and 265 (73.6%) were men. The study groups were not significantly different in the baseline demographic characteristics. The presence of multivessel disease (Odds ratio (OR) = 16.26, 95% confidence interval (CI):2.07–127.6; P = 0.008) and stenosis in the left circumflex artery (OR = 3.62, 95% CI: 1.03–12.70; P = 0.044) were the independent predictors for nonresponse to nitroglycerine, leading to PCI.ConclusionIn some cases, especially those without multivessel diseases, intracoronary nitroglycerine administration can efficiently relieve coronary stenosis and prevent unnecessary PCI.

Evaluation of the effect of intravenous nitroglycerine on short-term survival of patients with acute heart failure according to congestion and perfusion status at emergency department arrival.

We investigated if the phenotypic classification of acute heart failure (AHF) based on the number of signs/symptoms of congestion and hypoperfusion at emergency department (ED) arrival identifies subgroups in which intravenous (IV) nitroglycerine (NTG) use improves short-term survival. We included consecutive AHF patients diagnosed in 45 Spanish EDs, who were grouped according to phenotype severity. The main outcome was 30-day all-cause death. Propensity scores (PS) for NTG use were generated using variables associated with death. Analysis of interaction was performed in subgroups of patients based on congestion, hypoperfusion, age, sex, coronary artery disease (CAD), left ventricular ejection fraction (LVEF) and SBP. We analyzed 16 437 AHF patients (median = 83 years; women = 56%); 1882 received NTG (11.4%). In the whole cohort, the cumulative 30-day mortality in patients receiving NTG was higher (11.5% vs. 9.6%; unadjusted HR, 1.19; 95% CI, 1.04-1.36), but not in the PS-matched cohorts (1698 pairs of patients; 11.5% vs. 10.5%; HR, 1.10; 95% CI, 0.90-1.35). Mortality was increased in NTG-treated patients with mild congestion (HR, 2.09; 95% CI, 1.19-3.67), especially in those without hypoperfusion (HR, 2.51; 95% CI, 1.24-5.10). Interaction analysis of the PS-matched cohorts confirmed detrimental effects of NTG use in less congested patients, whereas beneficial effects were only observed in patients with decreased LVEF (<50% subgroup: HR, 0.59; 95% CI, 0.37-0.92; ≥50% subgroup: HR, 1.30; 95% CI, 0.66-2.56; P = 0.002). Phenotypical classification of AHF based on congestion/hypoperfusion at ED arrival does not identify subgroups of patients in whom IV-NTG would decrease mortality, although it could potentially be beneficial in those with LVEF of less than 50%. This hypothesis will have to be confirmed in the future. Conversely, our results suggest that IV-NTG may be harmful in patients with only mild clinical congestion.

Is Glyceryl Trinitrate, a Nitric Oxide Donor Responsible for Ameliorating the Chemical-Induced Tissue Injury In Vivo?

Oxidative stress induced by well-known toxins including ferric nitrilotriacetate (Fe-NTA), carbon tetrachloride (CCl4) and thioacetamide (TAA) has been attributed to causing tissue injury in the liver and kidney. In this study, the effect of glyceryl trinitrate (GTN), a donor of nitric oxide and NG-nitroarginine methyl ester (l-NAME), a nitric oxide inhibitor on TAA-induced hepatic oxidative stress, GSH and GSH-dependent enzymes, serum transaminases and tumor promotion markers such as ornithine decarboxylase (ODC) activity and [3H]-thymidine incorporation in rats were examined. The animals were divided into seven groups consisting of six healthy rats per group. The six rats were injected intraperitoneally with TAA to evaluate its toxic effect, improvement in its toxic effect if any, or worsening in its toxic effect if any, when given in combination with GTN or l-NAME. The single necrogenic dose of TAA administration caused a significant change in the levels of both hepatic and serum enzymes such as glutathione S-transferase (GST), glutathione reductase (GR), glutathione peroxidase (GPx), γ-glutamyl transpeptidase (GGT), glucose 6-phosphate dehydrogenase (G6PD), alanine aminotransferase (AST) and aspartate aminotransferase (ALT). In addition, treatment with TAA also augmented malondialdehyde (MDA), ornithine decarboxylase (ODC) activity and [3H]-thymidine incorporation in rats liver. Concomitantly, TAA treatment depleted the levels of GSH. However, most of these changes were alleviated by the treatment of animals with GTN dose-dependently. The protective effect of GTN against TAA was also confirmed histopathologically. The present data confirmed our earlier findings with other oxidants including Fe-NTA and CCl4. The GTN showed no change whatsoever when administered alone, however when it was given along with TAA then it showed protection thereby contributing towards defending the role against oxidants-induced organ toxicity. Overall, GTN may contribute to protection against TAA-induced oxidative stress, toxicity, and proliferative response in the liver, according to our findings.

Nitroglycerin Use in the Emergency Department: Current Perspectives.

Nitroglycerin, a fast-acting vasodilator, is commonly used as a first-line agent for angina in the emergency department and to manage chest pain due to acute coronary syndromes. It is also a treatment option for other disease states such as acute heart failure, pulmonary edema, and aortic dissection. Nitroglycerin is converted to nitric oxide, a potent vasodilator, in the body, leading to venodilation at lower dosages and arteriodilation at higher dosages that results in both preload and afterload reduction, respectively. Although nitroglycerin has historically been administered as a sublingual tablet and/or spray, it is often given intravenously in the emergency department as this enables titration to effect with predictable pharmacokinetics. In this review article, we outline the indications, mechanism of action, contraindications, and adverse effects of nitroglycerin as well as review relevant literature and make general recommendations regarding the use of nitroglycerin in the emergency department.

Effects of nitroglycerin combined with continuous regional arterial infusion on severe acute pancreatitis, triglyceride, inflammatory factors and prognosis

Abstract Background: To evaluate the effects of nitroglycerin combined with continuous regional arterial infusion (CRAI) on severe acute pancreatitis (SAP), triglyceride (TG), inflammatory factors and prognosis. Methods: SAP patients were randomly divided into control and observation groups (n=169). The control group was treated with intravenous infusion of nitroglycerin once daily for 2 d, while the observation group was treated with nitroglycerin combined with CRAI for 7 d. Their hospitalization time, abdominal pain relief time, abdominal distension relief time and intestinal function recovery time were recorded. The levels of inflammatory factors, and TG were measured. Their liver and kidney functions, hemorheological indices, prognosis, and adverse reactions were evaluated. Results: The observation group had significantly shorter hospitalization time, abdominal pain relief time, abdominal distension relief time, and intestinal function recovery time than those of the control group (P&lt;0.05). After treatment, the levels of interleukin-6, tumor necrosis factor-alpha, endothelin, thromboxane A2 and TG significantly decreased in contrast with those before treatment in both groups, especially in the observation group (P&lt;0.05). The hemorheological indices were significantly improved after treatment compared with those before treatment in both groups, and the observation group had better indices (P&lt;0.05). The Acute Physiology and Chronic Health Evaluation-II score declined significantly in both groups after treatment, and the observation group had a more obvious decrease (P&lt;0.05). During follow-up, similar incidence rates of adverse reactions were observed for both groups (P&gt;0.05). Conclusion: Nitroglycerin combined with CRAI is prominently effective for treating SAP, which can facilitate the health recovery and reduce the incidence of microcirculation disturbance-induced adverse events such as organ failure.

WHAT DRUGS YOU CAN PREFER IN CARDIOGENIC SHOCK?

Abstract: Relevance. The use of nitroglycerin (NG) in cardiogenic shock (СS) helps to normalize blood pressure, reduce the risk of death and improve prognosis. Aim. To study the effect of vasopressors, inotropic drugs and nitroglycerin on hemodynamics and reducing the risk of death in patients with cardiogenic shock. Material and methods. A comparative assessment of the effectiveness of treatment of СS in myocardial infarction with nitroglycerin and traditional approaches to therapy was carried out. In the control group of patients with СS (17 people), dopamine or norepinephrine was administered in the traditional way. In the main group of patients with СS (22 people), large doses of nitroglycerin were administered. After the stabilization of the state of health, the drip injection of NG continued in the usual doses. Results. In 20 of 22 patients of the main group, immediately after the jet injection of nitroglycerin, blood pressure began to be determined or significantly increased, 14 of them survived (63.6%). In 9 cases, blood pressure did not decrease anymore, vasopressors were not administered, nitroglycerin was administered by drop for another 2-3 days, the treatment ended with discharge in a satisfactory state. In another 2 cases, it was necessary to administer vasopressors in parallel with the drip administration of nitroglycerin, after its jet administration. In the control group, the only patient survived (5.9%). Conclusions. Analysis of literature data indicates that in conditions of maximum depletion of reserves and a decrease in myocardial contractility in patients with cardiogenic shock, the use of vasopressors and inotropic drugs accelerates the decompensation of insufficient blood supply and increases the risk of death. The main way to combat СS is still urgent myocardial revascularization, however, the restoration of the functional activity of hibernated cardiomyocytes will be more successful and safer with their gradual activation. This problem can be successfully solved using the methods of mechanical support of blood circulation or with the help of nitroglycerin. It will be possible to verify the validity of this assumption only on the basis of the results of randomized clinical trials.

The effect of low-dose nitroglycerin on oxidative stress in patients with hypertension undergoing laparoscopic gynecological surgery

The effect of low-dose nitroglycerin on oxidative stress in patients with hypertension undergoing laparoscopic gynecological surgery

Effects of nitroglycerin and flunixin meglumine on circulating inflammatory, cardiovascular and hepatorenal biomarkers of ovine experimental endotoxemia model

Owing to the importance of endotoxemia and its risks, several studies have been conducted to better understand the pathophysiological processes of this disease, and many treatments have been suggested. Nitroglycerin is one of the drugs recommended for the treatment of endotoxemia and its therapeutic effects in some researches have been evaluated in human and animal models. However, there are no comprehensive studies on the effects of nitroglycerin on different circulating inflammatory, cardiovascular and hepatorenal biomarkers following endotoxemia in sheep; therefore, the present experiment was conducted to evaluate the anti-inflammatory effects of two different doses of nitroglycerin compared to the standard dose of flunixin meglumine in the treatment of endotoxemia in sheep. Hence, 25 clinically healthy 1-year old Iranian fat-tailed ewes were randomly divided into 5 equal groups, comprising NTG 0.2, NTG 0.4, Flnx, Ctrl+, and Ctrl-. Lipopolysaccharide from Escherichia coli serotype O55:B5 at 0.4 μg/kg was intravenously administered to the ewes. Flunixin meglumine (at 2.2 mg/kg) and nitroglycerin (at 0.2 and 0.4 μg/kg) were administrated to Flnx, NTG 0.2 and NTG 0.4 groups, respectively. All the ewes were clinically evaluated before and 1.5, 3, 3.5, 4, 4.5, 6 and 24 h after lipopolysaccharide injection, and blood samplings were also performed at those hours. Serum concentrations of haptoglobin, serum amyloid A, tumor necrosis factor-alpha, interferon-gamma, total antioxidant status, malondialdehyde, superoxide dismutase, glutathione peroxidase, creatine kinase-MB, cardiac lactate dehydrogenase, cardiac troponin-I, homocysteine, total bilirubin, aspartate aminotransferase, alanine transaminase, and creatinine were measured. Serum concentrations of acute phase proteins, inflammatory cytokines, oxidative stress, cardiovascular, hepatic and renal biomarkers, and clinical parameters were significantly increased following the induction of endotoxemia in the groups receiving lipopolysaccharide. The results indicated that nitroglycerin at both 0.2 and 0.4 μg/kg did not play an effective role in reducing inflammatory biomarkers and could not reduce circulating hepatic biomarkers following endotoxemia. However, nitroglycerin at 0.4 μg/kg significantly reduced circulating cardiac and renal biomarkers compared to 0.2 μg/kg and flunixin meglumine at 2.2 mg/kg. Clinical evaluations also demonstrated that nitroglycerin could not reduce the heart rate and body temperature compared to flunixin meglumine but significantly reduced respiratory rates at 0.4 μg/kg. In conclusion, nitroglycerin at 0.2 and 0.4 μg/kg could not alleviate inflammatory processes and oxidative stress. Nitroglycerin at 0.2 and 0.4 μg/kg also had suitable effects on reducing the serum concentration of cardiovascular and renal biomarkers, but it was not effective on circulating hepatic indices. Therefore, nitroglycerin at the doses used in this study could not be suggested as an effective drug in reducing inflammatory and hepatic biomarkers which were elevated during endotoxemia in sheep.

Bolus versus continuous infusion of nitroglycerin for the treatment of acute hypertensive heart failure

Background: The use of intravenous nitroglycerin by intermittent bolus doses in hypertensive acute heart failure patients (AHF) is still unclear. Aim and Objectives: This study aimed to determine intermittent bolus nitroglycerin's effect on the use of resources, admissions to intensive care unit (ICU), hospital length of stay (LOS), and safety. Patients and Methods: This prospective, randomized, parallel, single-blind clinical study, which included patients diagnosed with hypertensive AHF, was conducted from May 2019 to October 2020 at Benha University Hospital. Two hundred patients were recruited and randomly allocated into two groups, each composed of 100 patients. Results: The prevalence of hypertension and chronic obstructive pulmonary disease patients was significantly higher in patients given intermittent boluses of nitroglycerin than in standard therapy (88.0 vs. 77.0%, P = 0.041) and (27.0 vs. 15.0%, P = 0.037), respectively. Dyslipidemia was significantly lower in patients on intermittent doses of nitroglycerin than those on standard infusion therapy (30 vs. 66%, P < 0.001). The median initial troponin was significantly higher in group I compared to group II (0.145 vs. 0.065 ng/ml, P < 0.001). Conclusion: Nitroglycerin intravenous boluses were associated with fewer ICU admissions and a shorter LOS in the hospital as opposed to ordinarily infusion therapy. In addition, the mean mechanical ventilation duration was slightly shorter. Finally, continuous nitroglycerin infusion use in AHF management is being questioned.