Nitroprusside‐ and nitroglycerin‐induced hypotension: Effects on hemodynamics and on the microcirculation

Hauß, J.; Schönleben, K.; Spiegel, H. U.; Themann, H

doi:10.1007/bf01654701

Cited by 15 publications

(5 citation statements)

References 36 publications

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“…Hauss et al (6) found that SNP-induced hypotension (4 pg kg-I min-') in dogs caused a reduced oxygenation in skeletal muscle, which was claimed to be due to a reduced oxygen supply. It was also stated that the changes in skeletal muscle oxygen pressure distribution could be due to a redistribution of blood flow to a higher perfusion in "high flow capillaries".…”

Section: Discussionmentioning

confidence: 99%

Effects on skeletal muscle oxygenation and capillary blood flow by adenosine‐, sodium nitroprusside‐ and acetylcholine‐induced hypotension

Gustafsson

Sollevi

Sirsjö³

et al. 1996

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 99%

Effects on skeletal muscle oxygenation and capillary blood flow by adenosine‐, sodium nitroprusside‐ and acetylcholine‐induced hypotension

Gustafsson

Sollevi

Sirsjö³

et al. 1996

Acta Anaesthesiol Scand

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“…No patient in group E suffered from clinically significant bradycardia <50/min, These findings are comparable with the finding of E Ornstein et al [8] with mean heart rate of 67+ 10 in esmolol group in which they compared isoflurane with esmolol and sodium nitroprusside in patients with Arterio-venous malformations.The mean heart rate in group N as per table no 1 is consistent with the fact that nitroglycerine causes either no change or slight tachycardia during continuous infusion as slight increase in heart rate is reflex phenomenon, baroreceptor response secondary to hypotension produced. [9] The mean arterial pressure MAP preoperatively in group E was 88.48+4.28 whereas in group N it was 87.76+4.62 mmHg which were statistically comparable (p>0.05). At 5 th minute the mean MAP in group E was 69.96+2.24 and in group N was 67.28+1.33 mmHg which was statistically significant, (P<0.05).…”

Section: Haemodynamic Variabilitymentioning

confidence: 74%

The efficacy of esmolol and nitroglycerine in creating dry operative field by producing controlled hypotension in spinal surgeries.

Dongre¹

2012

iosrphr

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Introduction: Laminectomy and Spine Surgeries are associated with increased blood loss due to bleeding from the extensive epidural venous plexuses. Controlled hypotension is a time tested technique utilized for reducing blood loss and creating a blood less operative field. Esmolol and Nitroglycerine(NTG) are reportedly used in various surgeries for this purpose. As dry operative field is a fundamental component of spine surgeries this study intended to compare the dry operative field created by esmolol with NTG. Material and Methods: This single blinded randomized controlled trial was carried out on 50 adult patients undergoing spine surgeries and divided into two groups of 25 each. Group-E received Esmolol infusion while the Group-N received NTG infusion.Dosages were titrated to achieve controlled hypotension and optimum bloodless operative field. Results: Systoloic, Diastolic and Mean arterial pressures were comparable in both the groups.Pulse rates in group-E were significantly lower(P<0.05) as compared to that in group-N.Mean scores for quality of surgical field were comparable in both the groups however group E required lower blood pressures to achieve it compared to group-N. Esmolol infusion required significantly higher cost than NTG for the above trial. Conclusion: Both Esmolol and NTG can be used as a sole agent to create dry operative field in spine surgeries by way of controlled hypotension with comparable efficacy however NTG is more economical than esmolol for this purpose. Also dry operative field with NTG can be achieved at higher mean blood pressure values compared with use of esmolol.

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“…On the other hand, NTG causes either no change or slight tachycardia which is a reflex phenomenon, produced secondary to hypotension. [5] None of our patients in Group N had reflex tachycardia (HR >120 beats/min). This could be because we maintained the MAP within the desired range by titrating the dose of NTG, thereby not allowing hypotension to occur further and produce reflex tachycardia.…”

Section: Discussionmentioning

confidence: 89%

Randomized open-labeled comparative evaluation of the efficacy of nitroglycerine, esmolol, and dexmedetomidine in producing controlled hypotension in spine surgeries

et al. 2019

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Aim:This study was designed to evaluate the efficacy of nitroglycerine (NTG), esmolol, and dexmedetomidine (DEX) as hypotensive agents in decreasing intraoperative blood loss by producing controlled hypotension in posterior spine surgeries.Materials and Methods:Sixty patients aged 18–60 years, the American Society of Anesthesiologists physical status Classes I and II of either gender, were randomly assigned into three groups to receive either: NTG (0.01%) at the rate of 3–10 μg.kg-1.min-1 after positioning without a prior loading dose in Group N, esmolol 500 μg.kg-1 loading dose over 1 min before induction of anesthesia followed by 50–300 μg.kg-1.min-1 infusion in Group E, and DEX 1 μg.kg-1 over 10 min before induction followed by 0.2–0.7 μg.kg-1.h-1. infusion in Group D to maintain mean arterial blood pressure (MAP) between 60 and 65 mmHg. The three groups were compared for the achievement of target MAP, intraoperative blood loss, reversibility of hypotensive state, quality of surgical field, emergence time, and postextubation sedation score.Statistical Analysis:Analysis of variance was used for intergroup analysis, and for multiple comparisons, Bonferroni post hoc test was applied. P < 0.05 was considered statistically significant.Results:Patients in Group D and Group E achieved the target MAP with better heart rate control as compared to Group N. The intraoperative blood loss was significantly lesser in Group D (P < 0.001). The time to hypotension reversal and emergence time was prolonged in Group D (P < 0.001). The mean quality of surgical field score was statistically insignificant among the three groups. The mean Ramsay Sedation Scores were significantly higher in Group D compared to Groups N and E at 20th and 40th min postextubation (P < 0.001) with no significant intergroup difference at 60th min postextubation (P = 0.130).Conclusion:Continuous infusion of DEX is an effective and safe method of producing controlled hypotension by achieving the target MAP, minimizing blood loss, and maintaining superior hemodynamics in comparison with NTG and esmolol in posterior spine surgeries.

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Nitroprusside‐ and nitroglycerin‐induced hypotension: Effects on hemodynamics and on the microcirculation

Cited by 15 publications

References 36 publications

Effects on skeletal muscle oxygenation and capillary blood flow by adenosine‐, sodium nitroprusside‐ and acetylcholine‐induced hypotension

Effects on skeletal muscle oxygenation and capillary blood flow by adenosine‐, sodium nitroprusside‐ and acetylcholine‐induced hypotension

The efficacy of esmolol and nitroglycerine in creating dry operative field by producing controlled hypotension in spinal surgeries.

Randomized open-labeled comparative evaluation of the efficacy of nitroglycerine, esmolol, and dexmedetomidine in producing controlled hypotension in spine surgeries

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