PMID- 1536439
OWN - NLM
STAT- MEDLINE
DCOM- 19920326
LR  - 20131121
IS  - 0003-2417 (Print)
IS  - 0003-2417 (Linking)
VI  - 41
IP  - 1
DP  - 1992 Jan
TI  - [Nifedipine versus nitroglycerin in aortocoronary bypass surgery. The effect on 
      hemodynamics, kidney function and homologous blood requirement].
PG  - 39-46
AB  - Even during adequate general anesthesia, hypertension is a common phenomenon in 
      patients undergoing aortocoronary bypass grafting (CABG). In such cases 
      application of vasodilators is recommended in order to decrease myocardial oxygen 
      consumption. This study was performed to compare two commonly used substances, 
      i.e., nitrates and nifedipine, with regard to their influence on hemodynamics, 
      renal blood flow, kidney function, and the requirement for homologous blood 
      transfusions. METHODS. Forty-four patients gave their informed consent to the 
      study. They were randomly divided into 2 groups: group 1 received nitroglycerin 
      (3.0 micrograms/kg.min), group 2 nifedipine (Adalat, 0.5 microgram/kg.min) in 
      order to prevent hypertension in the phase before onset of cardiopulmonary bypass 
      (CPB). Anesthesia was induced by etomidate and succinylcholine and maintained as 
      a modified neuroleptanalgesia with fentanyl (up to 50 micrograms/kg), midazolam 
      (0.3 mg/kg.h), and pancuronium (0.1 mg/kg). Systolic blood pressure was kept 
      within the range of 120-160 mm Hg; in case of higher values boluses of either 
      0.25 mg nitroglycerin or 0.5 mg nifedipine were administered. Cardiac index, 
      stroke volume index, rate-pressure product, intrapulmonary shunt, and pulmonary 
      and total peripheral resistances were evaluated at five predefined points: (1) 
      after induction of anesthesia; (2) before incision; (3) before cannulating the 
      aorta; (4) after decannulating the aorta; and (5) at the end of operation. 
      Creatinine and free-water clearances as well as sodium and potassium excretion 
      were calculated for three phases of the operation: (A) induction of 
      anesthesia--onset of CPB; (B) during CPB; and (C) end of CPB--end of operation. 
      CPB was performed using a membrane oxygenator (Sorin 51) and a nonpulsatile blood 
      flow of 2.5 1/min.m2, which was reduced during mild hypothermia of 30-32 degrees 
      C to 1.7 l/min.m2. Mean arterial pressure in both groups was kept at 
      approximately 70 mm Hg. In case of lower pressures norepinephrine (50-100 
      micrograms/bolus) was administered; higher pressures were treated as described 
      above. Volume substitution was performed initially by 500 ml hydroxyethyl starch 
      and continued, if necessary, by homologous blood or 5% human albumin in order to 
      keep the hematocrit greater than 30 in the phases before and after CPB. RESULTS. 
      Group 2 showed significantly higher values of cardiac index and stroke volume 
      index at point 3 while the rate-pressure product was clearly lower, indicating 
      better myocardial performance and lower oxygen consumption than in group 1. 
      Creatinine and free-water clearances in all three phases did not differ. However, 
      sodium excretion during CPB was significantly higher in the nifedipine group 
      while potassium excretion showed no differences. The average requirement for 
      blood and blood substitutes was lower in group 2, but the difference could not be 
      confirmed statistically because of the large dispersion of values. Nevertheless, 
      4 patients in the nifedipine group but no patient in group 1 did not need 
      homologous blood transfusion. CONCLUSION. In comparison to nitrates, nifedipine 
      showed some advantages in the treatment of hypertension during CABG: (1) it 
      provided better myocardial performance; (2) it had a more reliable but not too 
      long-lasting effect on elevated total peripherial resistance, leading to better 
      hemodynamic stability; and (3) by not affecting the capacitance vessels it may 
      necessitate fewer homologous blood transfusions.
FAU - Petry, A
AU  - Petry A
AD  - Klinik fur Anaesthesie und Operative Intensivmedizin, Universitat Kiel.
FAU - Wulf, H
AU  - Wulf H
FAU - Blomer, U
AU  - Blomer U
FAU - Wawersik, J
AU  - Wawersik J
LA  - ger
PT  - Clinical Trial
PT  - Comparative Study
PT  - English Abstract
PT  - Journal Article
PT  - Randomized Controlled Trial
TT  - Nifedipin versus Nitrat bei aorto-koronaren Bypassoperationen. Einfluss auf 
      Hamodynamik, Nierenfunktion und Fremdblutbedarf.
PL  - Germany
TA  - Anaesthesist
JT  - Der Anaesthesist
JID - 0370525
RN  - G59M7S0WS3 (Nitroglycerin)
RN  - I9ZF7L6G2L (Nifedipine)
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Blood Transfusion
MH  - *Coronary Artery Bypass
MH  - Female
MH  - Hemodynamics/*drug effects
MH  - Humans
MH  - Hypertension/*prevention & control
MH  - Intraoperative Complications/prevention & control
MH  - Male
MH  - Middle Aged
MH  - Nifedipine/*therapeutic use
MH  - Nitroglycerin/*therapeutic use
MH  - Renal Circulation/*drug effects
EDAT- 1992/01/01 00:00
MHDA- 1992/01/01 00:01
CRDT- 1992/01/01 00:00
PHST- 1992/01/01 00:00 [pubmed]
PHST- 1992/01/01 00:01 [medline]
PHST- 1992/01/01 00:00 [entrez]
PST - ppublish
SO  - Anaesthesist. 1992 Jan;41(1):39-46.