Hiroshi Hoshijima1, Yohei Denawa2, Takahiro Mihara3, Risa Takeuchi4, Norifumi Kuratani5, Tsutomu Mieda4, Yoshinori Iwase4, Toshiya Shiga6, Zen'ichiro Wajima7, Hiroshi Nagasaka4. 1. Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan. Electronic address: hhoshi@saitama-med.ac.jp. 2. Department of Anesthesiology, Allegheny Health Network, PA, USA. 3. Departments of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 4. Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan. 5. Department of Anesthesiology, Saitama Children's Medical Center, Saitama, Japan. 6. Department of Anesthesia, Chemotherapy Research Institute, Kaken Hospital, International University of Health and Welfare, Chiba, Japan. 7. Department of Anesthesiology, International University of Health and Welfare Shioya Hospital, Tochigi, Japan and Department of Anesthesiology, International University of Health and Welfare Hospital, Tochigi, Japan.
Abstract
STUDY OBJECTIVE: To evaluate the efficacy of intravenous nitroglycerin (TNG) in preventing intraoperative myocardial ischemia (MI) under general anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate (HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure (PCWP) associated with TNG administration both before and after the induction of anesthesia. DESIGN: Meta-analysis. SETTING: Operating room, cardiac surgery or non-cardiac surgery, all surgeries were elective measurements. We performed a computerized search of articles on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Meta-analysis was performed using Review Manager. The data from the individual trials were combined using a random-effects model to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) with 95% confidence interval (CI). We conducted trial sequential analysis (TSA). The primary outcome was the incidence of MI and the secondary outcomes were hemodynamic changes (HR, MBP, and PCWP). MAIN RESULTS: Using electronic databases, we selected 10 trials with a total of 353 patients for our review. Prophylactic intravenous TNG did not significantly decrease the incidence of MI (RR=0.61; CI, 0.33 to 1.13; P=0.12; I2=55). TSA corrected the CI to 0.05 to 7.39 and showed that 9.5% of the required information size was achieved. In terms of hemodynamic changes, intravenous TNG significantly reduced MBP in comparison with the placebo (MBP pre-induction: WMD=-7.27; 95% CI -14.2 to -0.33; P=0.04; I2=97%; MBP post-induction: WMD=-5.13; 95% CI -9.17 to -1.09; P=0.01; I2=73%). CONCLUSIONS: Our analyses showed that prophylactic intravenous TNG does not reduce the incidence of intraoperative MI. Moreover, TSA suggests that further studies are necessary to confirm the results (GRADE: very low). Prophylactic doses of intravenous TNG significantly reduced the MBP both pre and post anesthesia induction (GRADE: very low).
STUDY OBJECTIVE: To evaluate the efficacy of intravenous nitroglycerin (TNG) in preventing intraoperative myocardial ischemia (MI) under general anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate (HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure (PCWP) associated with TNG administration both before and after the induction of anesthesia. DESIGN: Meta-analysis. SETTING: Operating room, cardiac surgery or non-cardiac surgery, all surgeries were elective measurements. We performed a computerized search of articles on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Meta-analysis was performed using Review Manager. The data from the individual trials were combined using a random-effects model to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) with 95% confidence interval (CI). We conducted trial sequential analysis (TSA). The primary outcome was the incidence of MI and the secondary outcomes were hemodynamic changes (HR, MBP, and PCWP). MAIN RESULTS: Using electronic databases, we selected 10 trials with a total of 353 patients for our review. Prophylactic intravenous TNG did not significantly decrease the incidence of MI (RR=0.61; CI, 0.33 to 1.13; P=0.12; I2=55). TSA corrected the CI to 0.05 to 7.39 and showed that 9.5% of the required information size was achieved. In terms of hemodynamic changes, intravenous TNG significantly reduced MBP in comparison with the placebo (MBP pre-induction: WMD=-7.27; 95% CI -14.2 to -0.33; P=0.04; I2=97%; MBP post-induction: WMD=-5.13; 95% CI -9.17 to -1.09; P=0.01; I2=73%). CONCLUSIONS: Our analyses showed that prophylactic intravenous TNG does not reduce the incidence of intraoperative MI. Moreover, TSA suggests that further studies are necessary to confirm the results (GRADE: very low). Prophylactic doses of intravenous TNG significantly reduced the MBP both pre and post anesthesia induction (GRADE: very low).
Authors: Ashraf Hamarneh; Andrew Fu Wah Ho; Derek M Yellon; Derek J Hausenloy; Heerajnarain Bulluck; Vivek Sivaraman; Federico Ricciardi; Jennifer Nicholas; Hilary Shanahan; Elizabeth A Hardman; Peter Wicks; Manish Ramlall; Robin Chung; John McGowan; Roger Cordery; David Lawrence; Tim Clayton; Bonnie Kyle; Maria Xenou; Cono Ariti Journal: Basic Res Cardiol Date: 2022-06-21 Impact factor: 12.416
Authors: S S Nethra; Malarvizhi Rajendran; Swathi Nagaraja; K Sudheesh; Devikarani Duggappa; Bhargavi Sanket Journal: Indian J Anaesth Date: 2022-08-12