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Anesth Analg 1986; 65:617-624
© 1986 International Anesthesia Research Society
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Roles of Fentanyl and Nitroglycerin in Prevention of Myocardial Ischemia Associated with Laryngoscopy and Tracheal Intubation in Patients Undergoing Operations of Short Duration

J. Fusciardi, MD, G. Godet, MD, J. M. Bernard, MD, M. Bertrand, MD, E. Kieffer, MD, and P. Viars, MD

Received from the Département d'Anesthésie-Réanimation, Groupe Hospitalier Pitie-Salpêtriere, Paris, France.

Abstract

The purpose of this study was to evaluate intravenous nitroglycerin given during induction of anesthesia as a means for prevention of myocardial ischemia and hemodynamic changes associated with induction, laryngoscopy, and intubation, in patients with stable angina scheduled for vascular operations of moderate duration. Forty-six patients were randomly assigned to receive either fentanyl, 3 µg/kg (group 1, n = 6), fentanyl, 8 µg/kg (group 2, n = 20), or fentanyl 3 µg/kg plus a continuous intravenous nitroglycerin infusion, 0.9 µg·kg–1·min–1 (group 3, n = 20), in addition to thiopental-pancuronium anesthetic induction, prior to laryngoscopy and intubation. The criteria for recognizing myocardial ischemia were the following: horizontal or downsloping ST segment depression equal to or greater than 1 mV, and/or ventricular arrhythmia, on CMS recording. In group 1, myocardial ischemia occurred during laryngoscopy and intubation in four patients, and mean blood pressure (MBP), heart rate, and mean pulmonary wedge pressure (PCWP) increased significantly (P < 0.05). Despite greater stability in MBP and heart rate in group 2, myocardial ischemia still occurred in four patients (not significantly different from group 1). Nitroglycerin added to low-dose fentanyl (group 3) produced significant reduction in myocardial ischemia (1/20) when compared with group 1 (P < 0.01), and significantly greater stability in PCWP during laryngoscopy and intubation in comparison to groups 1 and 2. In patients with stable angina undergoing operations of short duration, the use of nitroglycerin infusion and low-dose fentanyl significantly decreases the incidence of myocardial ischemia associated with induction of anesthesia and tracheal intubation.

Key Words: INDUCTION—anesthesia • HEART—ischemia • INTUBATION, TRACHEAL




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1986 by the International Anesthesia Research Society.