The Effect of Intranasally Administered Nitroglycerin on Hemodynamic Response to Laryngoscopy and Intubation Among Patients Undergoing Coronary Artery Bypass Grafting (CABG) Surgery

Numerous preventive medications have been used to lessen the cardiovascular response to laryngoscopy and intubation. Though some advantages have been noted, most of these treatments have not been found to be completely satisfying. However, nitroglycerin is the most widely utilized medicine due to its fast effect, short half-life, and absence of sedative qualities.

Study Overview

• Status: Completed
• Conditions: Coronary Artery Bypass Grafting
• Intervention / Treatment: Drug: Nitroglycerin (NTG)

Detailed Description

The circulatory system under compromise is less resilient to the effects of general anaesthesia. Inducing anaesthesia is a crucial step for cardiac patients because their impaired circulatory systems are less tolerant to depression. During coronary artery bypass grafting surgery, the primary objective of general anesthesia is to reduce sympathetic response to uncomfortable stimuli, including laryngoscopy, intubation, skin incision, sternal splitting, and spreading. A rise in blood pressure is one of the hemodynamic reactions that is typically associated with tracheal intubation and laryngoscopy. The impact of intra nasally delivered nitroglycerin on blood pressure response to laryngoscopy and intubation in patients having non-cardiac surgery is currently contentious; however, this study focus on coronary artery bypass grafting surgery patients.

• Study Type: Interventional
• Enrollment (Actual): 58
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Lahore, Punjab, Pakistan
      • Department of Anesthesia, Rashid Latif Medical College

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Both genders
• Patients undergoing coronary artery bypass grafting surgery.
• Patients aged 35-60 years.
• Ejection Fraction between 50-60%.
• American Society of Anesthesiologists Classification 3-4.

Exclusion Criteria:

• Known hypersensitivity to nitroglycerin.
• Anticipated difficult airway.
• Emergency surgery.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: NTG; Received a mg nitroglycerin intranasally two minutes prior to laryngoscopy and intubation	Drug: Nitroglycerin (NTG); Received 1 mg of nitroglycerin intranasally two minutes prior to laryngoscopy and intubation
No Intervention: Control; Control group did not receive nitroglycerine prior to laryngoscopy and intubation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean aterial pressure	Mean arterial pressure was measured prior to and after intubation	5 minutes post intubation
Heart rate	Heart rate was measure prior to and after intubation	5 minutes post intubation
Systolic blood pressure	Systolic blood pressure was measure prior to and after itubation	5 minutes post intubation
Diastolic blood pressure	Diastolic blood pressure was measure prior to and after intubation	5 minutes post intubation

Collaborators and Investigators

• Sponsor: Muhammad Aamir Latif
• Investigators: Principal Investigator: Shehryar Ahmed, MS, Department of anesthesia Rashid Latif Medical college, Lahore, Pakistan; Principal Investigator: Syed Shakeel Ahmed, FCPS, Department of Anesthesia, Shahida Islam Teaching Hospital, Lodhran, Pakistan

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Actual): June 30, 2024
• Study Completion (Actual): June 30, 2024

Study Registration Dates

• First Submitted: October 7, 2024
• First Submitted That Met QC Criteria: October 9, 2024
• First Posted (Actual): October 15, 2024

Study Record Updates

• Last Update Posted (Actual): October 15, 2024
• Last Update Submitted That Met QC Criteria: October 9, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Keywords: Intranasal; intubation; coronary artery bypass grafting; nitroglycerin; hemodynamic response; larayngoscopy
• Additional Relevant MeSH Terms: Vasodilator Agents; Nitroglycerin
• Other Study ID Numbers: PIC_Lahore

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No