O. Muikku et al., PULMONARY VASCULAR EFFECTS OF TRINITROGLYCERIN AND ISOSORBIDE DINITRATE AFTER CARDIOPULMONARY BYPASS, British Journal of Anaesthesia, 71(5), 1993, pp. 720-724
We have compared the systemic and right ventricular haemodynamic effec
ts of trinitroglycerin (TNG) and isosorbide dinitrate (ISDN) in patien
ts recovering from coronary artery bypass grafting. Each of the 16 pat
ients was given increasing iv. doses of the two nitrates in a random o
rder and double blind fashion until the target of a 25% decrease in me
an pulmonary artery pressure (MPAP) was achieved. Total doses of TNG 9
(6-12) mug kg-1 (mean, 95% confidence interval) and ISDN 148 (76-220)
mug kg-1 were given during infusions of 22 (18-25) min and 34 (28-41)
min duration, respectively. The target decrease in MPAP was produced
with infusion rates of TNG 0.5 (0.4-0.7) mug kg-1 min-1 and ISDN 5.8 (
4.1-7.5) mug kg-1 min-1. These doses produced similar acute decreases
in MPAP and similar effects on pulmonary and systemic vascular resista
nces and systemic and right ventricular haemodynamic variables. We con
clude that TNG is more than 10 times as potent as ISDN in its acute ha
emodynamic effects in cardiac surgical patients in the immediate posto
perative period. Both nitrates have relatively greater effect on the p
ulmonary than the systemic vasculature.