Hemodynamic effects of inhaled nitroglycerin in patients with pulmonary hypertension undergoing mitral valve replacement surgery

There has been a renewed interest in nitric oxide donor drugs such as nitroglycerin, delivered by the inhalational route for treatment of pulmonary arterial hypertension [PHT], since the presence of [PHT] affects the prognosis of the patients. Aim of this study was to investigate the postoperative hemodynamic effects of nitroglycerin inhalation on patients with [PHT] undergoing mitral valve replacement surgery. Twenty-two patients who diagnosed as having pulmonary hypertension [mean pulmonary artery pressures >25 mmHg] and underwent mitral valve replacement surgery were included in the study. Basal systemic and pulmonary hemodynamics were recorded in postoperative period at [T0] before inhalation of nitroglycerin. Then 2.5 microg/kg/min nitroglycerin liquid nebulized by 2 l/min gas flow of 40% oxygen and air mixture were given to the patients. Thereafter, the same parameters were measured at the first [T1], second [T2], and fourth [T3] hours after the beginning of nitroglycerin inhalation and one hour after the end of treatment [T4]. With respect to heart rate, mean arterial pressure, systemic vascular resistance, cardiac index, mixed venous oxygen saturation and arterial carbon dioxide tension, there were no statistically significant differences at T0, T1, T2, T3, or T4. On the other hand, the mean pulmonary artery pressure, pulmonary vascular resistance and intrapulmonary shunt fraction decreased significantly, whenever the PaO2/FiO2 ratio increased significantly at T1, T2 and T3 when compared to that of T0 and T4. The results of the present study suggest that nitroglycerin inhalation causes a significant decrease in both mean pulmonary artery pressure and pulmonary vascular resistance in patients with pulmonary hypertension undergoing mitral valve replacement surgery without decreasing mean arterial pressure and systemic vascular resistance thus can be used as a therapeutic modality during postoperative course

Effect of rocuronium compared with succinylcholine on intraocular pressure and intubating conditions during rapid sequence induction of anesthesia

Rapid sequence intubation is developed to secure the airway rapidly and safely. Succinylcholine provides excellent intubating conditions and thus remains the muscle relaxant of choice in emergency situation. The aim of this study was to compare the effects of rocuronium and succuinylcholine on intraocular pressure [IOP] during rapid sequence induction of anesthesia using propofol and fintanyl. In addition assessment of intubating conditions after administration of both succinylcholine and rocuronium. In a randomized, double-blind study we studied 40 adult patients, randomly allocated to one of two groups. Anesthesia was induced with fentanyl 2 microg/kg and propofol 2 mg/kg. This was followed by succinylcholine 1.5 mg/kg [group S; n=20] or rocuronium 0.6 mg/kg [group R; n=20]. Laryngoscopy and tracheal intubation were performed 60 seconds later. IOP, mean arterial blood pressure [MAP] and heart rate [HR] were measured before induction, immediately before intubation and every minute after intubation for 5 minutes. Tonopen tonometer was used to measure IOP and the mean of three consequative readings obtained in the right eye at each measurement time was recorded. Simple scoring system was used to evaluate intubating conditions. In the succinylcholine group, IOP was significantly greater than that in rocuronium group mean 23.7 +/- [SEM 1.6] vs mean 14.2 +/- [SEM 0.9] mm Hg; p<0.001. Intubating conditions were similar in both groups. Rocuronium 0.6 mg/kg when used with propofol and fentanyl during rapid sequence induction of anesthesia does not cause a rise in IOP. Thus, it may be a suitable alternative to succinylcholine, especially in cases of penetrating eye injury