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Nitrates and calcium channel blockers are frequently administered during cardiac surgery. We simultaneously measured femoral arterial pressure and radial arterial pressure to investigate whether nitrates, in conjunction with calcium channel blockers, would influence the central-to-peripheral arterial pressure gradient. Combined nitroglycerin and nicardipine infusion during cardiac surgery involving coronary artery bypass grafting or valve replacement resulted in a significant increase above baseline levels in the femoral-to-radial arterial pressure gradient at 60 min after cardiopulmonary bypass. In control patients there was no significant increase in the femoral-to-radial arterial pressure gradient at 60 min after completion of cardiopulmonary bypass. A subsequent study in patients given nitroglycerin and nicardipine identified that the difference in the systolic arterial pressure between femoral and radial arteries was observed 15, 60, and 120 min after completion of cardiopulmonary bypass. However, there was no difference in the mean arterial pressure between femoral and radial arteries throughout the same period. We conclude that combined infusion of nitroglycerin and nicardipine, a new calcium channel blocker, intensifies the magnitude and duration of the femoral-to-radial arterial pressure gradient after cardiopulmonary bypass.

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The authors evaluated the prophylactic protocols with unfractionated heparin (UFH) and warfarin in Japanese patients who underwent total knee arthroplasty (TKA) for osteoarthritis knee in regard to bleeding complications. Fifty-six patients who underwent TKA for osteoarthritis knee with the use of methylmethacrylate were included. Subcutaneous UFH and warfarin were administered for thromboprophylaxis to the first group of 26 patients. The second group of 30 patients did not receive any pharmacological thromboprophylaxis and were used as controls. No significant differences were found between the 2 groups for operative and postoperative blood loss. There were no cases with major bleeding as a complication, but for 2 cases, the international normalized ratio high value exceeded the remedy limits, and temporary dosage discontinuance was required. There were no clinically important bleeding events in the 2 groups. No heparin-induced thrombocytopenia or warfarin-induced skin necrosis occurred. The authors conclude that the protocol with UFH and warfarin is safe for thromboprophylaxis against deep venous thrombosis and pulmonary embolism after TKA in Japanese patients, but its efficacy can only be resolved with further studies.