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PEEP reverses nitroglycerin‐induced hypoxemia following coronary artery bypass surgery
Author(s) -
Berthelsen P.,
Haxholdt O. St.,
Husum B.,
Rasmussen J. P.
Publication year - 1986
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1986.tb02405.x
Subject(s) - medicine , oxygenation , anesthesia , hypoxemia , artery , hemodynamics , cardiac output , pulmonary artery , shunting , cardiology , nitroglycerin (drug) , blood pressure
Intravenous nitroglycerin is increasingly used during and after cardiac surgery to control blood pressure and improve subendocardial and peripheral circulation. A dramatic decrease in arterial oxygenation has, however, been reported in a number of poorly controlled clinical trials. In the present investigation 16 patients were studied 2–4 h after coronary artery bypass procedures. All were treated with a continuous infusion of nitroglycerin (lμg · kg ‐1 min ‐1 ). Utilizing an on‐off‐on drug design, it was clearly established that nitroglycerin depresses arterial oxygenation by increasing the pulmonary venous admixture. Three possible underlying mechanisms are discussed, but at the present time no firm conclusion can be drawn as to the nature of the changes. Eight patients were ventilated with 1 kPa (10 cmH 2 O) positive end‐expiratory pressure (PEEP) during the nitroglycerin infusion. PEEP‐ventilation reversed nitroglycerin‐induced changes in arterial oxygenation and pulmonary shunting without adversely affecting hemodynamic stability.