Nitroglycerin Spray Research Articles

Bariatric surgery and HIV: Joint venture between family, primary care, and HIV physicians

ABSTRACT We report a case of a 49-year-old female with a history of HIV infection for 12 years. The patient had excellent compliance with antiretroviral medications, raltegravir 400 mg twice daily and truvada once daily for HIV. Over the years, she maintained an undetectable viral load with a CD4+ count >200 cells/μL. She has a history of type II diabetes, hypertension, bipolar manic depression, endometriosis, recurrent herpes simplex attacks, arthritis in both shoulders, irritable bowel syndrome (IBS), and nonalcoholic fatty liver disease (NAFLD). She weighed 148 kg with a body mass index (BMI) of 52.08 kg/m2. Her medication included diltiazem 60 mg once a day, glyceryl trinitrate (GTN) spray, metformin 1 g twice daily, and linagliptin 500 mg once daily for her type II diabetes with glycated hemoglobin (HbA1c) of 8.4%. She has full capacity and elected to have bariatric surgery; 4 months postprocedure, she lost 28 kg with a reduced BMI of 38.62 kg/m2 with no postoperative complications. Her diabetes control improved, and she no longer required linagliptin and metformin. Following the procedure, she was given supplements including ferrous sulfate, vitamin B12, vitamin D, and calcium. She was also prescribed lansoprazole. The case illustrates that bariatric surgery is an effective and safe operation for people living with HIV. Due to complex needs and the need for regular follow-up; primary care, family, and HIV physicians can all collaborate in the care of individuals living with HIV and who underwent bariatric surgery.

INav-based, Automated Coronary Magnetic Resonance Angiography for the Detection of Coronary Artery Stenosis (iNav-AUTO CMRA)

BackgroundCoronary computed tomography angiography (CCTA) is recommended as the first line diagnostic imaging modality in low to intermediate risk individuals suspected of stable coronary artery disease (CAD). However, CCTA exposes patients to ionising radiation and potentially nephrotoxic contrast agents. Invasive coronary angiography (ICA) is the gold-standard investigation to guide coronary revascularisation strategy, however, invasive procedures incur an inherent risk to the patient. Coronary magnetic resonance angiography (Coronary MRA) avoids these issues. Nevertheless, clinical implementation is currently limited due to extended scanning durations, inconsistent image quality, and consequent lack of diagnostic accuracy. Several technical Coronary MRA innovations including advanced respiratory motion correction with 100% scan efficiency (no data rejection), fast image acquisition with motion-corrected undersampled image reconstruction and deep-learning (DL)-based automated planning have been implemented and now await clinical validation in multi-centre trials. MethodsThe objective of the iNav-AUTO CMRA prospective multi-centre study is to evaluate the diagnostic accuracy of a newly developed, state-of-the-art, standardised, and automated Coronary MRA framework compared to CCTA in 230 patients undergoing clinical investigation for CAD. The study protocol mandates the administration of oral beta-blockers to decrease heart rate to below 60bpm and the use of sublingual nitroglycerine spray to induce vasodilation. Additionally, the study incorporates the utilisation of standardised postprocessing with sliding-thin-slab multiplanar reformatting, in combination with evaluation of the source images, to optimize the visualisation of coronary artery stenosis. DiscussionIf proven effective, Coronary MRA could provide a non-invasive, needle-free, yet also clinically viable, alternative to CCTA. Trial RegistrationThis study is registered at clinicaltrials.gov (NCT05473117).

Effects of Co-administration of Fentanyl and Nitroglycerin on Hemodynamic Responses During Intubation and Extubation: A Randomized Clinical Trial

PurposeThis study was conducted with the aim of investigating the effects of simultaneous administration of fentanyl and nitroglycerine on hemodynamic responses. DesignThis randomized controlled trial was conducted with 50 patients undergoing elective inguinal hernia surgery. MethodsPatients were randomly divided into two groups. In one group, fentanyl (F) was administered 5 minutes before intubation and extubation. In the other group, in addition to F, sublingual nitroglycerine spray was administered 2 minutes before intubation and extubation. Systolic, diastolic, and mean blood pressure and heart rate were measured before, immediately after, and at 1, 3, and 5 minutes after both procedures. FindingsSystolic, diastolic, and mean blood pressure and heart rate were significantly lower in the group receiving fentanyl and nitroglycerine than in the group receiving fentanyl alone. In both groups, a reduction in hemodynamic variables was observed immediately after both procedures, up to 5 minutes later, but it was significantly reduced in the group receiving simultaneous administration of the two drugs. ConclusionsCo-administration of nitroglycerine and fentanyl significantly weakened the hemodynamic responses and reflexes induced by intubation and extubation during the anesthesia process. Preventing these unwanted complications can lead to safer anesthesia for susceptible patients.

Sublingual Nitroglycerine Spray Facilitates Efficient Submucosal Tunneling during Per Oral Endoscopic Myotomy—A Nonrandomized Trial

Abstract Introduction In the last one decade, per oral endoscopic myotomy (POEM) has been found to be an effective minimally invasive approach for the treatment of esophageal achalasia cardia and was lately shown to be noninferior to laparoscopic Heller's myotomy in a randomized controlled trial.Here we describe a new method of using sublingual nitroglycerine spray during submucosal tunneling to facilitate the procedure. Materials and Methods This study includes a cohort of 50 patients who were diagnosed with achalasia cardia on high-resolution esophageal manometry. Out of the 50 patients, 27 patients were administered two metered doses of sublingual nitroglycerine spray during submucosal tunneling across the gastroesophageal junction (GEJ), and 23 patients were not administered nitroglycerine. This process was nonrandomized; patients were assigned sublingual nitroglycerine using alternating sequence enrollment number. Results All the procedures were technically feasible and successful without any major complications. Eckhardt's scores of all patients normalized after the procedure. The mean submucosal tunneling time and mean time across GEJ were 36.8 ± 7.9, 14.2 ± 2.9 in intervention group (sublingual nitroglycerine), and 50.2 ± 8.9 and 23.0 ± 3.6 minutes in nonintervention group, respectively. Time for each procedure was significantly less (p < 0.05) in patients who were given sublingual nitroglycerine. Mucosal injury and bleeding during procedure were not significantly different in the two groups. Conclusion This POEM technique with the use of sublingual nitroglycerine spray is simple and renders POEM easier and less time consuming.

Efficacy of Transmucosal Nitroglycerin Spray versus Intravenous Lignocaine for the Attenuation of Hemodynamic Responses to Intubation

Abstract Background and Aims: Intravenous (IV) lignocaine and sublingual nitroglycerin (NTG) obtund intubation responses. We aimed to compare heart rate (HR) and mean arterial pressure (MAP) changes following direct laryngoscopy and intubation after transmucosal NTG spray versus IV lignocaine. Methods: Sixty participants were randomized equally into two groups. Group A patients received IV lignocaine 1.5 mg/kg, 90 s before intubation. Oropharynx of Group B patients was sprayed with 800 μg of NTG oral spray just before induction. General anesthesia regimen for induction, intubation, and maintenance was similar for all patients. HR and MAP at predefined time points and incidence of intraoperative hypotension were noted. Results: Intergroup analysis showed comparable HR in both the groups till 10 min. There was no significant difference in baseline MAP in both the groups. MAP was significantly higher in Group A till 10 min after intubation. Intragroup analysis of HR in Group A showed no significant difference from baseline after induction, 1, 3, and 5 min after intubation. HR at different time points was comparable with baseline during the study period in Group B. A significant fall in MAP from baseline was noted in Group A except at 1 min after intubation. In Group B, a significant fall in MAP from baseline was noted till 15 min after intubation. The incidence of intraoperative hypotension was significantly higher in Group B compared with Group A (40% vs. 3.3%). Conclusion: Both IV lignocaine and transmucosal NTG spray attenuated hemodynamic responses to intubation. However, considering a significantly lesser fall in MAP, IV lignocaine 1.5 mg/kg can be considered superior to 800 μg of transmucosal NTG spray for safely attenuating hemodynamic response to intubation.

Investigating the Effects of Fentanyl and Nitroglycerin on Hemodynamic Changes During Laryngoscopy: A Randomized Trial

Background: Laryngoscopy is the required procedures in general anesthesia that can cause cardiovascular disorders for the patient. Various pharmacological methods are used to reduce unwanted laryngoscopy responses. Objectives: The present study aimed to compare the effects of fentanyl and nitroglycerin spray on hemodynamic responses during laryngoscopy. Methods: In a clinical trial study, 40 patients were divided into two groups. In one group of patients, intravenous fentanyl (2 µg/kg) was given and in the other group, 2 puffs sublingually nitroglycerin spray was given in addition to receiving fentanyl. Hemodynamic variables were measured at one minute before and after laryngoscopy. The data was analyzed using SPSS version 19 software. Results: The study data showed that there is no statistically significant difference between the study groups in terms of demographics. Systolic and diastolic blood pressure, as well as heart rate decreased significantly in the group of receiving simultaneous fentanyl and nitroglycerin in comparison to the group receiving fentanyl alone. Conclusions: The results of our study showed that the administration of nitroglycerin spray with fentanyl more weakened the cardiovascular responses induced by laryngoscopy.

Pill or pump? Nitroglycerin 0.5 mg tablet vs 0.8 mg spray: Effect on proximal vessel diameters at Coronary CT Angiography (CCTA)

IntroductionThe administration of sublingual Nitroglycerin (NTG) prior to CT coronary angiography (CCTA) can be perfomed using pump spray or tablets. Choice of method seems to be based on local preference, rather than published guidelines. This retrospective analysis tested whether proximal coronary diameters differed dependent on the sublingual administration of 0.5 mg Nitroglycerin (NTG) tablets or 0.8 mg NTG spray. Methods287 ECG-gated CCTA studies with optimal image quality and Agatston scores<400 were included in this retrospective analysis. 143 of the patients were dosed with NTG tablets at a dose of 0.5 mg prior to CCTA. 144 patients received 2 puffs of 0.4 mg NTG spray for a total dose of 8 mg.All were scanned on a second-generation Dual Source CT. Diameters of proximal segments of Left Main (LM), Right (RCA), Left Anterior (LAD) and circumflex (CX) coronary arteries were measured using semi-automatic electronic callipers by two blinded readers. Results were summarised as the mean of maximum and minimum diameters. Sex-specific analysis of diameters was carried out using repeated-measures ANOVA for each vessel. Agreement between readers was examined with Bland-Altman analysis and intra-class-correlation coefficient (ICC). ResultsNo significant differences in coronary diameters were found except in the RCA for women and LM for men. In both cases, diameters were smaller in the spray group (11 and 9%, respectively). Reader agreement was excellent, with ICC>0.96 for all vessels, and no significant bias, except in CX (0.03 mm). ConclusionsWe found no evidence for the systematic superiority of either administration method in proximal coronary vessels. Implications for practiceChoosing between tablet or spray NTG prior to CCTA can be guided by practical, economical and hygienic considerations alone.

Tell me what you want, what you really really want: Estimands in observational pharmacoepidemiologic comparative effectiveness and safety studies.

Ideally, the objectives of a pharmacoepidemiologic comparative effectiveness or safety study should dictate its design and data analysis. This paper discusses how defining an estimand is instrumental to this process. We applied the ICH-E9 (Statistical Principles for Clinical Trials) R1 addendum on estimands - which originally focused on randomized trials - to three examples of observational pharmacoepidemiologic comparative effectiveness and safety studies. Five key elements specify the estimand: the population, contrasted treatments, endpoint, intercurrent events, and population-level summary measure. Different estimands were defined for case studies representing three types of pharmacological treatments: (1) single-dose treatments using a case study about the effect of influenza vaccination versus no vaccination on mortality risk in an adult population of ≥60 years of age; (2) sustained-treatments using a case study about the effect of dipeptidyl peptidase 4 inhibitor versus glucagon-like peptide-1 agonist on hypoglycemia risk in treatment of uncontrolled diabetes; and (3) as needed treatments using a case study on the effect of nitroglycerin spray as-needed versus no nitroglycerin on syncope risk in treatment of stabile angina pectoris. The case studies illustrated that a seemingly clear research question can still be open to multiple interpretations. Defining an estimand ensures that the study targets a treatment effect that aligns with the treatment decision the study aims to inform. Estimand definitions further help to inform choices regarding study design and data-analysis and clarify how to interpret study findings.

EFFICACY OF INTRAVENOUS ESMOLOL WITH INTRANASAL NITROGLYCERINE SPRAY GIVEN BEFORE ENDOTRACHEAL EXTUBATION ON THE ATTENUATION OF PRESSOR RESPONSE: A COMPARATIVE STUDY

Aims and Objectives: The aim of the study was to compare the effects of intravenous esmolol and intranasal nitroglycerine spray on attenuation of extubation pressor response in terms of hemodynamic parameters and to compare the adverse effects, if any, of either drug. Methods: This was a randomized comparative study conducted in a tertiary care medical college in which 64 patients of ASA Grade I with age between 18 and 60 years, including both males and females undergoing elective non cardiac surgeries under general anesthesia with orotracheal intubation were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were divided into two groups (Depending on whether they received Intravenous Esmolol or NTG spray) of 32 patients each. Attenuation of extubation pressor response in terms of hemodynamic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], heart rate, and rate pressure product) were recorded and compared before induction, during surgery and postoperatively up to 10 min after surgery. Results: The gender distribution was comparable in both the groups. The mean age of patients in Group A and Group B was found to be 36.90±10.12 and 35.20±11.32 years, respectively. The mean age of both the groups was found to be comparable with no statistically significant difference. Both the study groups were comparable in base line parameters with no significant difference seen in mean age, mean heart rate, mean SBP and DBP, MAP, anesthesia time, and surgery time. Both drugs controlled the blood pressure changes effectively; however, NTG group had a better control of systolic as well as DBP. Heart rate was better controlled in esmolol group. Conclusion: Intranasal nitro-glycerine and intravenous esmolol before tracheal extubation in ASA Grade I patients are simple, effective, and practical methods of blunting cardiovascular responses to tracheal extubation.

Abstract 13676: Sublingual Nitroglycerin Lowers Aortic Augmentation Pressure at Rest and During Exercise in Patients With HFpEF

Infusion or inhalation of organic nitrates lower ascending aortic pressures, and reduce mid-late systolic afterload via a reduction in augmentation pressure (aAP, the difference between the first [aP1] and second [aP2] peaks of the aortic pressure waveform) at rest and during exercise in patients with heart failure and preserved ejection fraction (HFpEF). Sublingual nitroglycerin (NTG) is more accessible for patients as compared to the infusion or inhalation of nitrates. It is unknown whether NTG spray (400μg) elicits these same effects as organic nitrates on aortic hemodynamics at rest and during exercise. Therefore, in 15 patients with HFpEF (age, 71 ± 6 years; 10 women; BMI 39.2 ± 6.2 kg/m 2 ), as part of our ongoing clinical trial, we measured beat-by-beat radial artery blood pressure and estimated aortic pressure in real-time via a generalized inverse transfer function (SphygmoCor). Data were collected in the seated upright position at rest and throughout six-minutes of cycling at 20 Watts during either a placebo or NTG condition (randomized order). Stroke volume (SV) was calculated from cardiac output (Qc, acetylene rebreathe) and heart rate (ECG). NTG lowered stroke volume at rest, but not during exercise (Table); however, SV responses to exercise were similar (Placebo: Δ22 ± 19 vs NTG: Δ25 ± 18 ml, P = 0.1991). Aortic diastolic pressure was not different at rest with NTG compared to placebo (Table). aP1 and aP2 were lower at rest with NTG, with greater reductions in aP2 (Table). NTG lowered aAP during rest (Placebo: 11 ± 11 vs NTG: 0 ± 14 mmHg, P = 0.0002) and exercise (Placebo: 12 ± 11 vs NTG: 4 ± 12 mmHg, P &lt; 0.0001). These results suggest patients with HFpEF do not augment SV responses to exercise despite a lower aAP contribution to (mid-late) systolic afterload with NTG. The inability to take advantage of a lower aAP during exercise may reflect impairments in contractile function and end-systolic reserve.

Successful management of ulceration associated with diffuse dermal angiomatosis of the breasts with topical glyceryl trinitrate spray.

We report the successful use of topical glyceryl trinitrate spray in managing ulceration associated with diffuse dermal angiomatosis of the breasts.

Assessment of the effect of two different doses of intranasal nitroglycerine spray on attenuation of haemodynamic stress response to pneumoperitoneum in laparoscopic surgeries: A randomised, double-blinded study.

Background and Aims:The stress response to pneumoperitoneum can be deleterious due to its effects on haemodynamics, thereby increasing the morbidity. We intended to compare different doses of nitroglycerine nasal spray to obtund these responses and to look for any side effects.Methods:After ethical committee clearance and clinical trials registration, 70 patients scheduled for laparoscopic cholecystectomy were recruited. Random allocation was done into two groups by a computer generated randomisation table. Group N4 (n = 35) received 400 μg nitroglycerine and group N8 (n = 35) received 800 μg nitroglycerine with an intranasal spray 2 min prior to pneumoperitoneum. All the haemodynamic parameters were monitored at regular intervals.Results:The heart rate was comparable between the groups except at 6 and 10 min of pneumoperitoneum but showed significant increase from baseline within the groups. Mean arterial pressure (MAP) was statistically significant between the groups, being higher in group N4. Within group N4, MAP was significantly low only at 2 min, 4 min of pneumoperitoneum (101.69 ± 12.34 at baseline versus 93.31 ± 8.07 at 2 min and 97.54 ± 9.07 mm Hg at 4 min) and increased significantly at 30 min of pneumoperitoneum (101.69 ± 12.34 at baseline versus 105.66 ± 12.35 mm Hg) and hence, MAP was observed to be around baseline throughout the rest of intraoperative period. Within group N8, there was a significant decrease in mean, systolic and diastolic blood pressure from baseline at most of the time intervals.Conclusion:800 μg of intranasal nitroglycerine effectively obtunds the hypertensive response associated with pneumoperitoneum as compared to 400 μg without significant side effects.

WALANT – Wide Awake Local Anaesthesia No Tourniquet: Komplikationen bei elektiven und akut-traumatologischen handchirurgischen Eingriffen

The WALANT (Wide Awake Local Anaesthesia No Tourniquet) technique has rapidly gained popularity. The advantages are often described, whereas information about complications is rare. Therefore, we followed up on our own patients regarding complications.Patients and Method Between January 2013 und June 2017, the complications experienced by one single surgeon were evaluated. The study included all elective (n = 195) and acute (n = 90) surgical procedures performed in WALANT. Minimum age of the patients was 18 years. All patients received Articaine 1 % and Suprarenine (1:200.000). Different volumes were injected with a minimum delay to surgery of 30 minutes. Complications were identified retrospectively by evaluation of patient files and a survey via telephone using a standardised questionnaire. Mean follow-up was 73 weeks. In 285 patients, there were 13 (4.6 %) complications. After injection of 16 ml of Articaine/Suprarenine, one patient had coronary symptoms, which ceased when two puffs of nitroglycerin spray were given. In one patient with a neurovascular injury in the palm, a bloodless field could not be obtained. A short tourniquet time was necessary for exploration. In one patient undergoing flexor tendon tenolysis, there was a need to convert to general anaesthesia with tourniquet because there was insufficient vasoconstriction due to marked scar tissue. One patient had an erythema around the injection site for a prolonged time, two had extensive erythema on the dorsum of the hand and seven patients reported swelling of the hand that lasted more than one week. The WALANT method is safe. Perioperative complications are rare. Nevertheless, there are some disadvantages that should be considered.Vascular injuries, especially in fingers, are to be monitored closely regarding perfusion, and the off-label use should be remembered. Also, caution should be exercised in patients with cardiac disease. Larger injuries may need a short tourniquet time. Tissue that was operated on before does not always seem to be suitable for the technique as diffusion may be compromised. In rare cases, patients may suffer from prolonged erythema or swelling. Generally, patients should be evaluated for suitability to an operation in local anaesthesia.

A neonate with spontaneous arterial limb ischemia and an aneurysm of the oval foramen: a\xa0case report

BackgroundIn this case report, we describe a very rare case of severe limb ischemia due to an arterial embolus caused by an aneurysm of the oval foramen in a term-born infant that occurred in the first few hours after birth.Case presentationA newborn male Caucasian patient presented on the maternity ward with ischemia of the right foot. Ischemia was treated with nitroglycerin spray and low-molecular-weight heparin in therapeutic dosage. An aneurysm of the oval foramen was found during postnatal echocardiography screening. This was thought to be the source of an embolus causing limb ischemia. At birth and upon follow-up, no clotting disorders were found. A large part of the right forefoot was ischemic, leading to loss of digits 1, 2, and 3. No significant loss of function was found in the first year of life.ConclusionSevere limb ischemia can be caused by an embolus arising from an aneurysm of the oval foramen and can be treated with heparin.

Comparison of MAP between sublingual Nitroglycerin spray and normal saline spray in attenuating pressor response to extubation

Various methods have been tried to decrease this stressor response to extubation such as non pharmacological methods like using laryngeal mask airway or extubation in deeper planes of anaesthesia and pharmacological methods such as pre-treatment with beta blocker), fentany remifentanil, magnesium sulphate or nitroglycerin. Participants in the study aged 18-60 years, of either gender, belonging to ASA grade I and II, undergoing elective surgery in supine position under general anesthesia with tracheal intubation in tertiary hospital. Mean MAP at the time of reversal (TR) was 95.20+5.68 and at the time of administration of NTG spray (T0) was 96.27+7.48. The MAP increased till 3 minutes when the maximum mean BP was 99.29+4.15. This MAP subsequently reduced gradually till 10 minutes (T10) with the mean being 84.80+2.60. The mean MAP at the time of reversal (TR) was 95.43+3.06 and at the time of administration of saline spray (T0) was 98.1 +3.60. The MAP increased till 4 minutes (T4) when the maximum mean BP was 120.98+2.80. This MAP remained high till 10minutes. This increase in MAP when compared was statistically highly significant with p value of <0.0001.

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

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.

Sublingual Nitroglycerin spray versus normal saline spray in attenuating pressor response to extubation: Changes in heart rate

The sympathetic response involves polysynaptic pathway with Glossopharyngeal and Vagus nerve forming afferent arc to the sympathetic nervous system via brain stem and spinal cord. This causes firing of adrenergic mediators such as norepinephrine and epinephrine which leads to increase in HR and blood pressure. Parasympathetic reflex is monosynaptic and is more common in children. Approval from ethical committee and written informed consent was obtained. A total of 60 patients undergoing surgery under general anaesthesia with endotracheal intubation were included in the study. After having met inclusion and exclusion criteria and having obtained informed consent, patients were randomized based on computer generated randomization table into one of the two groups. Hemodynamic response to extubation increases HR, BP which in turn increases myocardial oxygen demand. Activation of sympathetic nervous system during extubation causes coronary vasoconstriction which in turn reduces coronary blood flow. NTG dilates coronary vessels thereby increases blood flow of coronaries and thus improving oxygen delivery to myocardium which is an added advantage.

Successful use of nitroglycerin spray to treat a neonate with ischemic injury

Successful use of nitroglycerin spray to treat a neonate with ischemic injury

Prevention of impending scalp necrosis by topical nitroglycerine in hair transplant surgery.

Recipient site necrosis is a rare but potentially devastating complication of hair restoration surgery. Appropriate case selection and procedure performed by expert surgical team are although mandatory but not enough to prevent such event, particularly in megasessions. Timely recognition of impending necrosis is very important to consider preventive measures. We aim to evaluate the use of topical nitroglycerine in preventing the incidence of impending necrosis in hair restoration surgery. A retrospective observational study was designed to determine the efficacy of nitroglycerine spray in consecutive cases of hair transplant troubled with dusky skin vulnerable to necrosis. 1580 cases that underwent hair transplant were enrolled and topical nitroglycerine was used in 88 patients vulnerable to necrosis. A management algorithm was also proposed from clinical observations and literature review to avoid vascular injury that may lead to necrosis. 83 cases (94.32%) were rescued by topical nitroglycerine and five developed necrosis eventually. Five cases who had considerable black hue and treated successfully with above treatment were reported in detail. Our experience with the use of nitroglycerine spray on the cyanotic area aided in the prevention of impending necrosis due to its vasodilatory effects on arterioles.

A Comparative Study of the Effects of Intravenous Esmolol and Sublingual Nitroglycerine Spray on Hemodynamic Response Following Tracheal Extubation

A Comparative Study of the Effects of Intravenous Esmolol and Sublingual Nitroglycerine Spray on Hemodynamic Response Following Tracheal Extubation