TY - JOUR
T1 - Efficacy of prophylactic doses of intravenous nitroglycerin in preventing myocardial ischemia under general anesthesia
T2 - A systematic review and meta-analysis with trial sequential analysis
AU - Hoshijima, Hiroshi
AU - Denawa, Yohei
AU - Mihara, Takahiro
AU - Takeuchi, Risa
AU - Kuratani, Norifumi
AU - Mieda, Tsutomu
AU - Iwase, Yoshinori
AU - Shiga, Toshiya
AU - Wajima, Zen'ichiro
AU - Nagasaka, Hiroshi
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Study Objective To evaluate the efficacy of intravenous nitroglycerin (TNG) in preventing intraoperative myocardial ischemia (MI) under general anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate (HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure (PCWP) associated with TNG administration both before and after the induction of anesthesia. Design Meta-analysis. Setting Operating room, cardiac surgery or non-cardiac surgery, all surgeries were elective measurements. We performed a computerized search of articles on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Meta-analysis was performed using Review Manager. The data from the individual trials were combined using a random-effects model to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) with 95% confidence interval (CI). We conducted trial sequential analysis (TSA). The primary outcome was the incidence of MI and the secondary outcomes were hemodynamic changes (HR, MBP, and PCWP). Main Results Using electronic databases, we selected 10 trials with a total of 353 patients for our review. Prophylactic intravenous TNG did not significantly decrease the incidence of MI (RR = 0.61; CI, 0.33 to 1.13; P = 0.12; I2 = 55). TSA corrected the CI to 0.05 to 7.39 and showed that 9.5% of the required information size was achieved. In terms of hemodynamic changes, intravenous TNG significantly reduced MBP in comparison with the placebo (MBP pre-induction: WMD = − 7.27; 95% CI − 14.2 to − 0.33; P = 0.04; I2 = 97%; MBP post-induction: WMD = − 5.13; 95% CI − 9.17 to − 1.09; P = 0.01; I2 = 73%). Conclusions Our analyses showed that prophylactic intravenous TNG does not reduce the incidence of intraoperative MI. Moreover, TSA suggests that further studies are necessary to confirm the results (GRADE: very low). Prophylactic doses of intravenous TNG significantly reduced the MBP both pre and post anesthesia induction (GRADE: very low).
AB - Study Objective To evaluate the efficacy of intravenous nitroglycerin (TNG) in preventing intraoperative myocardial ischemia (MI) under general anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate (HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure (PCWP) associated with TNG administration both before and after the induction of anesthesia. Design Meta-analysis. Setting Operating room, cardiac surgery or non-cardiac surgery, all surgeries were elective measurements. We performed a computerized search of articles on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Meta-analysis was performed using Review Manager. The data from the individual trials were combined using a random-effects model to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) with 95% confidence interval (CI). We conducted trial sequential analysis (TSA). The primary outcome was the incidence of MI and the secondary outcomes were hemodynamic changes (HR, MBP, and PCWP). Main Results Using electronic databases, we selected 10 trials with a total of 353 patients for our review. Prophylactic intravenous TNG did not significantly decrease the incidence of MI (RR = 0.61; CI, 0.33 to 1.13; P = 0.12; I2 = 55). TSA corrected the CI to 0.05 to 7.39 and showed that 9.5% of the required information size was achieved. In terms of hemodynamic changes, intravenous TNG significantly reduced MBP in comparison with the placebo (MBP pre-induction: WMD = − 7.27; 95% CI − 14.2 to − 0.33; P = 0.04; I2 = 97%; MBP post-induction: WMD = − 5.13; 95% CI − 9.17 to − 1.09; P = 0.01; I2 = 73%). Conclusions Our analyses showed that prophylactic intravenous TNG does not reduce the incidence of intraoperative MI. Moreover, TSA suggests that further studies are necessary to confirm the results (GRADE: very low). Prophylactic doses of intravenous TNG significantly reduced the MBP both pre and post anesthesia induction (GRADE: very low).
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U2 - 10.1016/j.jclinane.2017.03.040
DO - 10.1016/j.jclinane.2017.03.040
M3 - Review article
C2 - 28625438
AN - SCOPUS:85017462910
VL - 40
SP - 16
EP - 22
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
SN - 0952-8180
ER -