Nitroglycerin Group Research Articles

Modulation of Novel Cardiorenal and Inflammatory Biomarkers by Intravenous Nitroglycerin and Nesiritide in Acute Decompensated Heart Failure

Background— Modulation of novel cardiorenal and inflammatory markers may provide insight into the disease process and outcomes of patients with acute decompensated heart failure. Methods and Results— In this open-labeled, prospective, randomized study, 89 patients received either nesiritide (NES) or nitroglycerin (NTG) infusion by standard protocol. The serum or plasma concentrations of cystatin-C and inflammatory markers (high-sensitivity C-reactive protein, tumor necrosis factor-α, transforming growth factor-β1, and interleukin-6) were measured in 66 patients with acute decompensated heart failure at baseline and during drug infusion. Mean baseline values for demographics were not significantly different between NTG and NES groups; however, baseline inflammatory markers were elevated on admission. In NES compared with NTG groups, lower cystatin-C (1449 versus 2739 ng/mL, P <0.05) and IL-6 (25 versus 50 pg/mL, P <0.05) were observed. There were no significant differences in concentrations of high-sensitivity C-reactive protein, tumor necrosis factor-α, and transforming growth factor-β1 between groups over time. Conclusions— The differential modulation effects of cystatin-C and interleukin-6 but not other inflammatory markers, in response to NES compared with NTG therapy, may provide important implications for vasodilator therapy. Further studies are warranted to confirm these findings. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00842023.

Is Nitroglycerin a Novel and Inexpensive Treatment for Osteoporosis?

Is Nitroglycerin a Novel and Inexpensive Treatment for Osteoporosis?

A Randomized Controlled Trial of Valdecoxib and Glyceryl Trinitrate for the Prevention of Post-ERCP Pancreatitis

Efforts to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis have been largely unsuccessful. Cyclo-oxygenase-2 enzyme-mediated inflammatory pathway has been suggested in the pathophysiology of acute pancreatitis. Glyceryl trinitrate (GTN) might prevent post-ERCP pancreatitis by relaxing the sphincter of Oddi. To evaluate the efficacy of valdecoxib, a cyclo-oxygenase-2 inhibitor, and GTN transdermal patch for the prevention of post-ERCP pancreatitis. Patients undergoing first ERCP procedure from October 2003 to August 2005 were randomized to receive either 20 mg intravenous valdecoxib or GTN patch (10 mg/h) at the start of ERCP, or assigned to control group. The study followed CONSORT guidelines. Primary outcome measure was frequency of post-ERCP pancreatitis in the 3 groups. A total of 380 patients were randomized; 121 patients in valdecoxib (group 1), 124 in GTN (group 2), and 126 in the control arm (group 3) were analyzed. There was no difference in the frequency of post-ERCP pancreatitis between the groups (12 each in groups 1 and 2, and 13 in group 3; P=0.986). None of the patients had severe pancreatitis. The frequency of post-ERCP pain and amylase levels were also similar in the 3 groups (P=0.769 and P=0.947, respectively). Pancreatic duct cannulation, cholecystectomy, difficult cannulation, and pre-cut were risk factors for pancreatitis on univariate analysis. On multivariate analysis, pancreatic duct cannulation was the only independent risk factor for pancreatitis (P≤0.001; odds ratio 5.67; 95% confidence interval: 2.76-11.63). Valdecoxib and GTN were not effective for the prevention of post-ERCP pancreatitis.

The analgesic effect of three different doses of nitroglycerine when added to lidocaine for intravenous regional anesthesia in trauma patients

Nitroglycerine (NTG) has analgesic properties. The aim of the present study was to assess the analgesic effect of three different doses of NTG (200 µg, 300 µg and 400 µg) when added to lidocaine in intravenous regional anesthesia (IVRA) in trauma patients. One hundred patients undergoing hand surgery were randomly allocated to four groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL in the control group (Group LS, n = 25) or 200, 300, 400 µg NTG plus 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL in the NTG group (Groups LN1, LN2, LN3 respectively; n = 25 in each group). Before and after the tourniquet application, hemodynamic variables, tourniquet pain, sedation, and analgesic use were recorded. Sensory and motor block onset times were significantly shorter in the LN3 group compared with Groups LN1, LN2, and LS (p<0.05). Sensory and motor block recovery times were statistically prolonged in the LN3 group when compared with Groups LN1 and LS (p<0.05). Postoperative visual analogue scale (VAS) scores were significantly lower at 2, 4, 8, 12, and 24 hours after tourniquet release in Group LN3 compared with Group LS (p<0.05). The addition of 400 µg NTG to lidocaine in IVRA shortens the onset of sensory and motor block in trauma patients and improves the quality of anesthesia and perioperative analgesia better than the addition of 200 µg or 300 µg NTG, without causing side effects.

The Antioxidative Property of Nitroglycerin Enhances Lornoxicam’s Antiinflammatory Effect

Background and objectives: The aim of the study is to evaluate the effect of combination of nitroglycerin and lornoxicam on nociception and antioxidative system in rats. Methods: Thirty-nine Wistar male rats were divided into five groups; control group (Group C, n=7), isotonic group (0.09 sodium chloride, Group ISO, n=8 ), lornoxicam group (lornoxicam 1.3 mg kg-1, Group L, n=8), nitroglycerin group (nitroglycerin 1 mg kg-1, Group N, n=8), and lornoxicam-nitroglycerin combination group (1.3 mg kg-1 lornoxicam+1 mg kg-1 nitroglycerin Group L+N, n=8). Hot plate test was applied in all groups before and at 30, 60, 90 minutes after drug injections by intraperitoneal route. Malondialdehyde, nitric oxide, glutathione, and catalase concentrations were measured before and after 90 minutes of drug injection in all blood samples. Results: The latency response of hot plate test was increased in Group L+N at 30 minutes, and Group L and Group L+N at 60 and 90 minutes (p<0.05). Malondialdehyde levels were decreased, while catalase and glutathion levels were increased in N and L+N groups (p<0.05). Conclusion: Nitroglycerin enhances the antioxidative effects of lornoxicam for antinociception but different mechanisms might also play a role on antinociception. Further studies must be carried out with experimental models and different drug doses to reach an ultimate conclusion.

Transdermal nitroglycerine potentiates the analgesic effect of patient controlled epidural analgesia after lower abdominal surgery

BackgroundThis study was designed to evaluate the effect of pre-emptive use of transdermal nitroglycerine (NTG) patch as an adjuvant to combined general epidural anesthesia (CGEA) in patients undergoing lower abdominal surgery.MethodForty patients (ASA I or II) were randomly allocated to two equal groups; control group (group C) and nitroglycerine group (group NG). Nitroderm patch, 5 mg, was applied to patients in group NG, 2 h before surgery. All patients received epidural bolus of 18 ml of 0.25% bupivacaine with fentanyl 2 μg/ml followed by continuous infusion at the rate of 5 ml/h combined with general anesthesia. Patients used patient controlled analgesia (PCA) device to receive bolus dose of 5 ml of patient controlled epidural analgesia (PCEA) solution containing bupivacaine 0.125% and fentanyl 2 μg/ml after surgery. Perioperative mean arterial blood pressure (MAP) and heart rate (HR), time to first rescue analgesic, postoperative bupivacaine and fentanyl consumption, and VAS pain scores were measured for 24 h postoperatively. Patient satisfaction score was also recorded.ResultsPostoperative MAP and HR increased significantly to both baseline and the other group at 2 h in group C and at 4 h in group NG (p < 0.05). The time to first rescue analgesic was significantly longer in group NG (238.62 ± 54.3 min) than in group C (126.75 ± 35.1 min) (p < 0.05). Pain scores were significantly higher compared to the other group at 2 h in group C and at 4 h in group NG (p < 0.05). Postoperative bupivacaine and fentanyl consumption were significantly lower in group NG (74.91 ± 26.34 mg and 121.83 ± 32.5 μg, respectively) than in group C (118.68 ± 29.4 mg and 194.21 ± 45.31 μg, respectively). Patient satisfaction was significantly better in group NG than in group C (p < 0.05).ConclusionPre-emptive application of 5 mg transdermal nitroglycerine patch as adjuvant to CGEA provided significant prolongation of the postoperative analgesia and reduction of the postoperative bupivacaine and fentanyl consumption.

Comparative Effects of Verapamil, Nicardipine, and Nitroglycerin on Myocardial Ischemia/Reperfusion Injury

The aim of this experiment was to establish whether verapamil, nicardipine, and nitroglycerin have (1) infarct size-limiting effects and (2) antiarrhythmic effects in in vivo rabbit hearts during ischemia/reperfusion. Rabbits received regional ischemia by 30 min of left anterior descending coronary artery occlusion followed by 3 hours of reperfusion under ketamine and xylazine anesthesia. The animals were randomly assigned to the following 4 treatment groups: a control group, a verapamil group, a nicardipine group, and a nitroglycerin group. A continuous infusion of verapamil, nicardipine, or nitroglycerin was initiated 5 min prior to ischemia. Infarct size/area at risk decreased in verapamil, and nitroglycerin. The incidence of ischemia-induced arrhythmia decreased in nicardipine, verapamil and nitroglycerin. The incidence of reperfusion-induced arrhythmias decreased in verapamil and nitroglycerin. From the present experimental results, verapamil and nitroglycerin rather than nicardipine did afford significant protection to the heart subjected to ischemia and reperfusion in a rabbit model.

E0651 Evaluation on acute haemodynamic effects of intravenous rhBNP in acute myocardial infarction patients with heart failure by continuous Swan-Ganz catheter monitoring

ObjectivesTo compared and evaluated the acute haemodynamic effects and safety of intravenous rhBNP versus nitroglycerin (NIT) in AMI patients with ADHF by Swan-Ganz catheter (6F, ARROW, Inc USA) monitoring through...

Experimental study on the option of antispasmodic drugs for radial artery in elderly patients with coronary atherosclerotic heart disease

To compare the relief effect of diltiazem, papaverine and nitroglycerin on radial artery spasm in elderly patients with coronary atherosclerotic heart disease. Sixty patients aged beyond 70 years underwent coronary artery bypass grafting (CABG) with autologous radial artery from July 2009 to March 2010. Redundant radial artery was collected and the relief function of different drugs was evaluated through "organ bath" technique in vitro. All the patients were randomly divided into 3 groups based on different antispasmodic drugs: diltiazem, papaverine and nitroglycerin. Thirty seconds free blood flow of radial artery and hemodynamic parameters (heart rate, mean arterial pressure and central venous pressure) were assessed before and after intra-radial administration of diltiazem, papaverine and nitroglycerin in vivo. All three drugs could relieve radial artery spasm in different levels and the eventual relief rate was over 80%. Only nitroglycerin could relax radial artery completely, the relief capacity of nitroglycerin, diltiazem and papaverine decreased in order. There was no significant difference in the hemodynamic parameters before and after the injection. Blood flow of radial artery increased in nitroglycerin group [(42 ± 10) ml/30 s vs. (28 ± 7) ml/30 s, P < 0.05] while there was no significant difference in diltiazem [(23 ± 10) ml/30 s vs. (25 ± 8) ml/30 s, P > 0.05] and papaverine group [(25 ± 10) ml/30 s vs. (24 ± 9), P > 0.05]. Nitroglycerin could relieve vasospasm of radial artery effectively and increased blood flow. Nitroglycerin is the suitable antispasmodic drug for radial artery in the elderly patients with coronary atherosclerotic heart disease compare with diltiazem and papaverine.

A meta-analysis for the effect of prophylactic GTN on the incidence of post-ERCP pancreatitis and on the successful rate of cannulation of bile ducts

BackgroundGlyceryl trinitrate (GTN) has been shown to be able to relax the sphincter of Oddi (SO) both in animals and humans. Theoretically, the use of these compounds during and after endoscopic retrograde cholangiopancreatgraphy (ERCP) could relax the biliary and pancreatic sphincters, facilitating cannulation of common bile duct (CBD) during the procedure, or minimizing potential pancreatic outflow obstruction after the procedure. However, clinical trials evaluating the protective effect of GTN on the post-endoscopic retrograde cholangiopancreatgraphy pancreatitis (PEP) have yielded inconclusive results. This meta-analysis is to systematically assess the effect of prophylactic administration of glyceryl trinitrate (GTN) on the prevention of PEP and the effect on the cannulation of bile ducts.MethodsBy searching PubMed (1966 to September 2009), CENTRAL (Cochrane Controlled trials Register; issue 3, 2009) and EMBASE.com (1984 to September 2009), two independent reviewers systematically identified prospective randomized controlled trials (RCTs) detecting the effect of prophylactic GTN on the incidence of PEP and on the cannulation of bile ducts. A meta-analysis of these clinical trials was then performed.ResultsThere are 55/899(6.1%) patients suffering PEP in the treatment group versus 95/915(10.4%) patients in the placebo group. The overall pooled risk of PEP was significantly lower in the GTN group than in the placebo group (OR 0.56, 95% CI: 0.40 to 0.79, p = 0.001). Subgroup analyses suggested that GTN administered by the sublingual form (OR 0.34,95% CI:0.16 to 0.75, p = 0.007) is more effective than transdermal route(OR 0.64,95% CI:0.40 to 1.01, p = 0.05), and the protective effect of GTN was far more obvious in the centers with high incidence of PEP (OR 0.40, 95% CI:0.24 to 0.67, p = 0.0006) than those centers with a low incidence of PEP (OR 0.75, 95% CI: 0.47 to 1.20, p = 0.22). Additionally, the meta-analysis suggests that GTN was not helpful for the cannulation of bile ducts.ConclusionWe concluded that prophylactic administration of GTN may significantly reduce the incidence of PEP and not be helpful for the cannulation of bile ducts.

Efficacy of Milrinone versus Nitroglycerin in Controlling Pulmonary Arterial Hypertension Induced by Intravenous Injections of Absolute Ethanol in Anesthetized Dogs

To compare the attenuating effects of milrinone versus nitroglycerin on pulmonary artery pressure (PAP) increase caused by repeat intravenous bolus injection of absolute ethanol in anesthetized dogs. Twenty-four dogs were randomly distributed into three groups: a control group (group C), a nitroglycerin group (treated with a continuous infusion of nitroglycerin at 5.0 microg/kg/min; group N), and a milrinone group (treated with a continuous infusion of milrinone at 3.0 microg/kg/min after an initial bolus dose of 100 microg/kg; group M). Absolute ethanol (0.1 mL/kg) was injected at 10-minute intervals via a 5-F angiographic catheter advanced into the proximal portion of the inferior vena cava. Immediately before and after each intravenous injection of absolute ethanol, hemodynamic values were obtained through a pulmonary arterial catheter. Group M showed more stable hemodynamic values of systolic, mean, and diastolic PAP and pulmonary vascular resistance (PVR) compared with groups C and N. In addition, group M showed significantly higher values of cardiac output versus group C at 10 minutes after the 10th bolus of ethanol. After restoration of spontaneous breathing, group M also showed the least hemodynamic changes in systolic, mean, and diastolic PAPs and PVR among the groups. Although a continuous infusion of nitroglycerin or milrinone effectively prevented cardiovascular deterioration, milrinone was superior to nitroglycerin in managing the acute hemodynamic changes that resulted from repeated intravenous bolus injections of absolute ethanol (0.1 mL/kg) in healthy anesthetized dogs.

PRETERM LABOUR

Objective: To compare the efficacy of Glyecryl trinitrate patch for prolonging gestation for more than 48 hours, 7 days or upto 37 weeks of gestation with Salbutamol in preterm labour. Study Design: Compartive descriptive study. Setting: Fatima Memorial HospitalLahore. Period: Dec 2003 to Jan 2005. Patients &amp; Methods: The study was carried out on 60 pregnant patients admitted in hospital with thesymptoms and signs of preterm labour. The results were statistically analyzed using SPSS version 8.0. Results: Two groups (TransdermalGlyceryl Trinitrate group and Salbutamol) comprising 30 patients each were made. In Glyceryl Trinitrate group, transdermal patch was appliedand in Salbutamol group,. Intravenous infusion titrated according to frequency, duration and intensity of uterine contractions. All the patientsin each group were evaluated for prolongation of gestation for 48 hours till 37th week of gestation. The mean prolongation of pregnancy was26 days in GTN group and 32 days in Salbutamol group. The decrease in frequency of uterine contractions by 67.51 ± 7.74% in first 48 hoursof applying transdermal Glyceryl Trinitrate patch and by 80.14 ± 8.43 % in Salbutamol group which was statistically significant. Conclusion:Trinitrate appears to be a safe, well tolerated and non-invasive but less effectives method of suppressing uterine contraction in preterm labouras compared to Salbutamol.

The effects of intravenous nitroglycerine and norepinephrine on gastric microvascular perfusion in an experimental model of gastric tube reconstruction

Esophagectomy with gastric tube reconstruction is the surgical treatment for cancer of the esophagus. Perfusion of the anastomotic site of the tube depends exclusively on microcirculation, making it susceptible to hypoperfusion. It is unknown whether vasodilatation is superior to increased perfusion pressure to improve gastric tissue perfusion of the anastomosis. We performed a gastric tube reconstruction in 12 pigs, mean body weight 32 +/- 2 kg. Besides systemic hemodynamic parameters, gastric microvascular blood flow (MBF) was assessed with laser Doppler flowmetry and gastric microvascular HbO(2) saturation (microHbSO(2)) and Hb concentration (microHbcon) with spectrophotometry. Animals were randomized over 2 groups: with and without intravenous nitroglycerin (NTG). In both groups, mean arterial pressure (MAP) was increased from 50 to 110 mmHg with infusion of norepinephrine; in the NTG group, central venous pressure was maintained below 10 mmHg throughout the experiment with NTG. Except for central venous and pulmonary capillary wedge pressures, all hemodynamic parameters were similar in both groups. Especially in corpus and fundus, MBF decreased following surgery. However, overall MBF was significantly higher in the NTG group. Increasing MAP had no effect on fundus MBF. Gastric microHbSO(2) and microHbcon were not different between groups and did not change at higher MAP levels. In our experimental model of gastric tube reconstruction, tissue perfusion is severely compromised; this effect is aggravated by systemic hypotension independent from cardiac output. Impaired venous outflow might contribute to this effect and can be counteracted with infusion of nitroglycerine.

Effects of nitroglycerin on sublingual microcirculatory blood flow in patients with severe sepsis/septic shock after a strict resuscitation protocol: A double-blind randomized placebo controlled trial

Microcirculatory alterations have been associated with morbidity and mortality in human sepsis. Such alterations occur despite pressure-guided resuscitation. Earlier data suggested that impaired microcirculatory blood flow could be corrected with intravenous nitroglycerin in these patients. We tested this concept after fulfillment of preset systemic hemodynamic resuscitation end points in the early phase of sepsis. Prospective, single center, randomized, placebo-controlled, double-blind clinical trial. Closed-format 22-bed mixed intensive care unit in a tertiary teaching hospital. Patients > or =18 yrs with sepsis, according to international criteria, and at least one early sign of organ dysfunction, as the principal reason for intensive care unit admission, were eligible for enrollment. Patients were randomly assigned to receive nitroglycerin (n = 35) or placebo (n = 35) after fulfillment of protocol-driven resuscitation end points. This trial is registered with ClinicalTrials.gov as NCT00493415. Primary outcome was sublingual microcirculatory blood flow of small vessels, as assessed by side-stream dark field imaging. After protocolized resuscitation, we observed recruitment of sublingual microcirculation in both groups, as indicated by a significant improvement in the microcirculatory flow index after 24 hrs, in comparison to baseline. However, no difference in the sublingual microvascular flow index was observed between groups. The median microvascular flow index in sublingual small-sized vessels was 2.71 (1.85-3) in the nitroglycerin group and 2.71 (1.27-3), p = .80, in the placebo group. In medium-sized vessels, the respective values were 3 (2.75-3) vs. 2.86 (2.19-3), p = .21, and in large-sized vessels, 3 (3-3) vs. 3 (2.89-3), p = .06. In-hospital mortality, as a secondary outcome, was 34.3% in the nitroglycerin group and 14.2% in the placebo group, p = .09. In the context of a strict resuscitation protocol, based upon fulfillment of systemic hemodynamic end points in patients with early-phase severe sepsis or septic shock, we conclude that intravenous nitroglycerin does not promote sublingual microcirculatory blood flow.

Five year prospective comparison study of topical glyceryl trinitrate treatment of chronic lateral epicondylosis at the elbow

Background Topical glyceryl trinitrate (GTN) treatment has previously demonstrated short-term effi cacy in the treatment of lateral epicondylosis. No long-term follow-up has been performed. Hypothesis Benefi ts from topical GTN persist 5 years after the cessation of therapy. Study design A prospective comparative study. Methods A follow-up study of 58 patients treated with 6 months of topical GTN or placebo, combined with a tendon rehabilitation programme, was performed 5 years after discontinuation of therapy. Assessment included patient-rated pain scores, clinically assessed lateral epicondylar and proximal common extensor tendon tenderness, hand-held dynamometer measurement of resisted third fi nger metacarpophalangeal extension with a fully extended elbow (Maudsley’s test) and wrist extensor tendon mean peak force using a modifi ed chair pick-up test (the Orthopaedic Research Institute— tennis elbow testing system). Results Patients in both the GTN group and those in the placebo group had signifi cant improvements in symptoms, clinical signs and provocative functional tests compared with baseline week 0 measures. GTN did not offer any additional clinical benefi t over a standard tendon rehabilitation programme at 5 years. Conclusion While GTN appears to offer short-term benefi ts up to 6 months in the treatment of lateral epicondylosis, at 5 years there does not appear to be signifi cant clinical benefi ts when compared with patients undertaking a standard tendon rehabilitation programme alone. This is in contrast to fiof continued benefi ts at long-term follow-up described in the literature for patients with Achilles tendinopathy treated with GTN.

Transdermal nitroglycerine enhances postoperative analgesia of intrathecal neostigmine following abdominal hysterectomies.

This study was carried out to assess the effect of nitroglycerine (transdermal) on intrathecal neostigmine with bupivacaine on postoperative analgesia and note the incidence of adverse effects, if any. After taking informed consent, 120 patients of ASA Grade I and II were systematically randomised into four groups of 30 each. Patients were premedicated with midazolam 0.05 mg/kg intravenously and hydration with Ringer's lactate solution 10ml/kg preoperatively in the holding room. Group I patients received Intrathecal injection of 15 mg bupivacaine with 1ml of normal saline and transdermal placebo patch. Group II patients received Intrathecal injection of 15 mg bupivacaine with 5 mcg of neostigmine and transdermal placebo patch. Group III patients received Intrathecal injection of 15 mg bupivacaine with 1ml of normal saline with transdermal nitroglycerine patch (5 mg/24 hours). Group IV patients received Intrathecal injection of 15 mg bupivacaine with 5mcg of neostigmine and transdermal nitroglycerine patch (5 mg/24 hours), applied on a non anaesthetised area after 20 minutes. Groups were demographically similar and did not differ in intraoperative characteristics like sensory block, motor block, haemodynamic parameters and SpO2. The mean duration of analgesia was 202.17 minutes, 407.20 minutes, 207.53 minutes and 581.63 minutes in control group (I), neostigmine group (II), nitroglycerine group (III) and nitroglycerine neostigmine group (IV) respectively (P<0.01). To conclude, our results show that transdermal nitroglycerine itself does not show any analgesic potential but it enhances the analgesic potential of intrathecal neostigmine.

Nimodipine Prevents Memory Impairment Caused by Nitroglycerin-Induced Hypotension in Adult Mice

Hypotension and a resultant decrease in cerebral blood flow have been implicated in the development of cognitive dysfunction. We tested the hypothesis that nimodipine (NIMO) administered at the onset of nitroglycerin (NTG)-induced hypotension would preserve long-term associative memory. The passive avoidance (PA) paradigm was used to assess memory retention. For PA training, latencies (seconds) were recorded for entry from a suspended platform into a Plexiglas tube where a shock was automatically delivered. Latencies were recorded 48 h later for a testing trial. Ninety-six Swiss-Webster mice (30-35 g, 6-8 wk), were randomized into 6 groups 1) saline (control), 2) NTG immediately after learning, 3) NTG 3 h after learning, 4) NTG and NIMO, 5) vehicle, and 6) NIMO alone. The extent of hypotension and changes in brain tissue oxygenation (PbtO(2)) and in cerebral blood flow were studied in a separate group of animals. All groups exhibited similar training latencies (17.0 +/- 4.6 s). Mice subjected to hypotensive episodes showed a significant decrease in latency time (178 +/- 156 s) compared with those injected with saline, NTG + NIMO, or delayed NTG (580 +/- 81 s, 557 +/- 67 s, and 493 +/- 146 s, respectively). A Kruskal-Wallis 1-way analysis of variance indicated a significant difference among the 4 treatment groups (H = 15.34; P < 0.001). In a separate group of mice not subjected to behavioral studies, the same dose of NTG (n = 3) and NTG + NIMO (n = 3) caused mean arterial blood pressure to decrease from 85.9 +/- 3.8 mm Hg sem to 31.6 +/- 0.8 mm Hg sem and from 86.2 +/- 3.7 mm Hg sem to 32.6 +/- 0.2 mm Hg sem, respectively. Mean arterial blood pressure in mice treated with NIMO alone decreased from 88.1 +/- 3.8 mm Hg to 80.0 +/- 2.9 mm Hg. The intergroup difference was statistically significant (P < 0.05). PbtO(2) decreased from 51.7 +/- 4.5 mm Hg sem to 33.8 +/- 5.2 mm Hg sem in the NTG group and from 38.6 +/- 6.1 mm Hg sem to 25.4 +/- 2.0 mm Hg sem in the NTG + NIMO groups, respectively. There were no significant differences among groups. In a PA retention paradigm, the injection of NTG immediately after learning produced a significant impairment of long-term associative memory in mice, whereas delayed induced hypotension had no effect. NIMO attenuated the disruption in consolidation of long-term memory caused by NTG but did not improve latency in the absence of hypotension. The observed effect of NIMO may have been attributable to the preservation of calcium homeostasis during hypotension, because there were no differences in the PbtO(2) indices among groups.

Effect assessment of controlled hypotension of remifentanil in endoscopic sinus surgery

Objective To investigate the effects,safety,controlling of controlled hypotension induced by remifentanil during endoscopic sinus surgery.Methods Forty patients with ASA grade Ⅰ～Ⅱ undergoing selective endoscopic sinus surgery,were randomly assigned into remifentanil group(A group)and nitroglycerin group(B group).After routine inducing,controlled hypotension was induced before the main procedure of surgery.A group was given remifentanil(1μg/kg)by intravenous injection,then remifentanil(0.3～0.8μg·kg~(-1)·min~(-1))was used in group A to keep mean arterial pressure between(MAP)60 and 80 mm Hg.B group was given fentanyl(0.03～0.08 μg·kg~(-1)·min~(-1))and nitroglycerin(2～5 μg·kg~(-1)·min~(-1))to keep mean arterial pressure(MAP)between 60 to 80 mm Hg till the main procedure of surgery was finished.Observing MAP and HR change before controlled hypotension,during controlled hypoteusion and after stopping controlled hypotension.Observing the time of opening-eyes,remove-tracheal tube and surgical field quality.Results The two groups were comparable with regard to the surgical field rating(P＞0.05).MAP in two groups during controlled hypotension were lower than those before controlled hypotension(P＜0.05),in A group,MAP were comparable with those in B group during controlled hypotension(P＞0.05).In B group there was rellexible tachycardia during controlled hypotension.HR in A group during controlled hypotension was lower than those before controlled hypotension(P＜0.05).HR during controlled hypotension in A group was lower than those in B group(P＜0.01).The time of opening-eyes,remove-tracheal tube in A group was less than those in B group(P＜0.01).ConclusionRemifentanil cound induce and sustain controlled hypoteusion.It was safe and feasible.It was better than nitroglycerin group for controlled hypotension in endoscopic sinus surgery. Key words: fentanil; hypotension controlled

The effect of verapamil and nitroglycerin on the coronary slow flow phenomenon

Objective: The aim of this study was to assess the effect of nitroglycerin and verapamil on the coronary flow in patients with the coronary slow flow (CSF) phenomenon (CSFP). Design and methods: Sixty-four patients with CSF and no stenotic lesions during diagnostic coronary angiography were enrolled and divided into the nitroglycerin group (n=35) and verapamil group (n=29), and 29 patients with normal coronary flow were selected as normal. CSFP was defined as it required 4 or more beats for the contrast media to opacify the distal vasculature. Intracoronary injection of 100–400 μg nitroglycerin or verapamil was not given in patients with CSFP until the coronary flow improved. The coronary blood flow was evaluated by Thrombolysis in Myocardial Infarction frame count (TFC) method in this study. Results: There was no difference regarding the clinical characteristics among the three groups. The basic TFCs of the left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) were 78.28±19.40, 57.24±14.58, and 56.87±12.47 in the verapamil group, and were 70.84±21.66, 55.33±12.52, and 51.05± 15.35 in the nitroglycerin group, respectively, which were significantly higher than those in the normal controls (LAD 29.15±4.42, LCX 23.14± 3.48 and RCA 19.72±1.75, respectively). After the administration of drugs, the TFCs of LAD, LCX and RCA were 42.32±8.88, 36.65±6.78, and 30.32±5.94, respectively (vs. base, all P<0.05) in nitroglycerin group and 37.68±9.31, 31.50±11.30, and 24.58±4.40 respectively (vs. base, all P<0.05) in the verapamil group. The TFCs in both the two groups after the administration of drugs were still higher than that in normal controls (all P<0.05). The TFCs in the verapamil group had a larger decrease than those in the nitroglycerin group (P<0.05). Conclusions: Intracoronary administration of verapamil could result in more improvement of the coronary flow in patients with CSFP than after the administration of nitroglycerin, although the coronary flow was still slower than normal.

Effects of different concentrations of nitroglycerin on ischemia-reperfusion injury in isolated rat hearts

Objective To investigate the effects of different concentrations of nitroglycerin on ischemia-reperfusion (IR) injury in the isolated rat hearts. Methods Healthy adult male SD rats 7 weeks old weighing 220-330 g were anesthetized with intraperitoneal pentobarbital 50 mg/kg. Their hearts were excised and perfused in a Langendorff apparatus. Thirty isolated hearts were randomly divided into 3 groups (n = 10 each) : group 1R, low-concentration nitroglycerin group (group LN) and high-concentration nitroglycerin group (group HN). The hearts in group IR were perfnsed with plain modified K-H solution. The hearts in group LN were perfused with K-H solution containing nitroglycerin 2.5 μg/L. The hearts in group HN were perfnsed with K-H solution containing nitroglycerin 25 μg/L. After 15 min of post-preparation equilibration, IR was induced by 20 min suspension of perfusion followed by 60 min reperfusion. HR, left ventricular end-diastolic pressure (LVEDP), coronary flow (CF), left ventricular developed pressure (LVDP), + dp/dtmax, and - dp/dtmax were measured at 10, 20, 30, 40, 50 and 60 min of reperfusion. To determine the activities of myocardial lactate dehydrogenase (LDH) and creatine kinase (CK), 1.5 ml of coronary effluent was collected at the end of equilibration, and at 5, 30 and 60 min of reperfusion. At 60 min of reperfusion, myocardial tissues were obtained to determine myocardial infarct size (IS) (by Trc staining) and assess the apoptosis rate (by TUNAL technique) .Results Compared with group IR, HR, CF, LVDP, + dp/dtmax and - dp/dtmax were significantly increased in group LN, while significantly decreased in group HN, and LVEDP, activities of CK and LDH in the coronary effluent, myocardial IS and apoptosis rate were significantly decreased in group LN, while significantly increased in group HN (P < 0.05). Compared with group LN, HR, CF, LVDP, + dp/dtmax and - dp/dtmax were significantly decreased, and LVEDP, activities of CK and LDH in the coronary effluent, myocardial IS and apoptosis rate significantly increased in group HN (P < 0. 05). Conclusion Low-concentration nitroglycerin can attenuate myocardial IR injury in isolated rat hearts, but high-concentration nitroglycerin can exacerbate the injury. Key words: Nitroglycerin; Myocardial reperfusion injury