Korean J Anesthesiol.  2011 Nov;61(5):388-393. 10.4097/kjae.2011.61.5.388.

The effect of nitroglycerin on hemodynamic changes during laparoscopic low anterior resection

• Moon HS
• Lee SK
• Choi YS
• In CB
• Choi EJ

• KMID: 2092320
• DOI: http://doi.org/10.4097/kjae.2011.61.5.388

Abstract

BACKGROUND
More laparoscopic low anterior resections (LAR) are being performed in recent years. There has been controversy around the hemodynamic changes affected by the Trendelenburg position and pneumoperitoneum during LAR. The goal of this study was to analyze the effect of nitroglycerin (NTG) on hemodynamic changes during LAR.
METHODS
Forty ASA physical status I-II patients undergoing LAR were randomized into two groups: the NTG infused group (N group, n = 20) and the control group (C group, n = 20). Anesthesia was maintained with sevoflurane at 1-3 vol%, air/oxygen (50%/50%) and continuous infusion with remifentanil. The N group patients were given 0.5 microg/kg/min of NTG during anesthesia. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), cardiac index (CI), stroke volume (SV) and systemic vascular resistance (SVR) were assessed 10 min after induction (T1), 5 min after pneumoperitoneum in the supine position (T2), 10 min after pneumoperitoneum in the Trendelenburg position (T3), 30 min after pneumoperitoneum in the Trendelenburg position (T4), 1 hr after pneumoperitoneum in the Trendelenburg position (T5) in addition to 5 (T6), 10 (T7) and 30 min (T8) after removal of the pneumoperitoneum in the supine position.
RESULTS
The increases of MAP were milder in the N group (22.6-7.3%) than the C group (32.3-17.7%) during pneumoperitoneum and while in the Trendelenburg position. The significant decreases of HR were maintained in the C group, but the changes in HR were not significant in N group during the operation. The increases in CVP were less in N group than C group. The increases of SVR were milder in N group (19.4-1.4%) than C group (41.7-16.6%) during pneumoperitoneum in the Trendelenburg position.
CONCLUSIONS
Intraoperative NTG infusions were effective to some degree in reducing the hemodynamic changes during pneumoperitoneum with Trendelenburg positioning for LAR.

Keyword

Hemodynamic change; Nitroglycerin; Pneumoperitoneum; Trendelenburg position

MeSH Terms

Anesthesia
Arterial Pressure
Central Venous Pressure
Head-Down Tilt
Heart Rate
Hemodynamics
Humans
Methyl Ethers
Nitroglycerin
Piperidines
Pneumoperitoneum
Stroke Volume
Supine Position
Vascular Resistance
Methyl Ethers
Nitroglycerin
Piperidines