The effectiveness of the use of nitroglycerin for the correction of arterial hypertension in ophthalmic surgery: a single-center prospective study.

Published: 27 February 2023| Version 1 | DOI: 10.17632/9gfc6vdbjt.1
Alexandr Romanov,


Introduction. Anesthesiological aid adult patients with cataract surgery are mainly carried out by intravenous sedation. A significant part of the patients operated on for cataracts are aged 50 and over, with concomitant diseases of the cardiovascular system, diabetes mellitus, kidney diseases and overweight. The most common concomitant diagnosis in ophthalmology is arterial hypertension (AH). During the operation or in the postoperative period, blood pressure (BP) increases in 25% of hypertensive patients. High, uncontrolled hypertension during surgery poses a threat to the development of operational complications (increased intraocular pressure (IOP) against a background of highly systemic blood pressure), as well as cardiovascular complications. Objectives. To compare the effectiveness of hypotensive therapy with nitroglycerin, magnesium sulfate and droperidol during ophthalmic surgery. Materials and methods. 261 patients participated in the study. The patients were randomized into 3 groups. Exclusion criteria: angle-closure glaucoma. Patients with an average blood pressure above 113 mm Hg underwent hypotensive therapy: group 1 Nitroglycerin (1-2 doses under the tongue); group 2 intravenously magnesium sulfate (5 ml 250 mg/ml); group 3 intravenously 1.0 ml droperidol (2.5 mg/ ml). The effectiveness of antihypertensive therapy was assessed by the level of mean blood pressure (cf. BP) and heart rate (HR) during and after surgery, as well as the dynamics of IOP after surgery. Results. After hypotensive therapy with nitroglycerin, blood pressure was lower compared to other groups during surgery (p≤0.005) and after (p=0.0004). Heart rate was significantly lower in the droperidol group (p<0.05). There was a tendency to a slight increase in IOP in patients in the nitroglycerin group. However, there was no significant difference between the IOP values of OD (p=0.065) and OS (p=0.269). Conclusion(s). The use of nitroglycerin in the form of a spray (1-2 doses) quickly and effectively allows you to stabilize a high blood pressure level during ophthalmic surgery (except for patients with angle-closure glaucoma) can serve as a prevention of acute coronary syndrome. In our study, nitroglycerin did not have a negative effect on the hydrodynamics of the eye. IOP before and after surgery remained at a stable level.


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A single-center prospective study comparing the effectiveness and safety of antihypertensive therapy regimens in the operating room was conducted on the basis of the Krasnodar branch of the Academician S.N. Fedorov Eye Microsurgery. 261 patients participated in the study. The patients were randomized into 3 groups. The groups were homogeneous by gender (130 men and 131 women), age (from 50 to 75 years), duration of surgery and concomitant pathology. (Table.1) Selection criteria for the groups: cataract surgery, arterial hypertension of the 1st and 2nd degrees. Exclusion criteria: angle-closure glaucoma, a history of hemorrhagic stroke and/or intracranial hypertension. Hemodynamic parameters (HR, cf. BP) were studied in preparation for the operation, during and at the end of the operation. Cp. AD was calculated by the formula: cf. AD = DAD + (SAD-DAD)/3. Where SAD is systolic blood pressure, and DAD is diastolic blood pressure. Intraocular pressure (IOP) was measured by pneumotonometry before and after surgery. The indication for hypotensive therapy in the operating room was an increase in blood pressure above 113 mmHg (160/90 mmHg) at the stage of preparation for surgery. In the first group (N = 87 people), hypotensive therapy with nitrospray (aerosol form of nitroglycerin) was performed. Nitrospray was administered according to the instructions: sublingually, in a sitting position, against the background of breath retention, 1-2 doses containing 0.4–0.8 mg of nitroglycerin. In the second group (N = 87 people), hypotensive therapy was performed with intravenous slow administration of magnesium sulfate 5 ml 250 mg/ml. Patients of group 3 (N = 87 people) underwent hypotensive therapy with intravenous administration of neuroleptic droperidol 1 ml 2.5 mg/ml. In all three groups, premedication was performed with gabapentin 300 mg 2 hours before surgery, analgosedation was performed with intravenous tramadol 100 mg (slowly 10 minutes before surgery). If there was insufficient analgesia during the operation, ketorolac 30 mg or fentanyl 25 mcg was injected as indicated.


Mezotraslevoj naucno-tehniceskij kompleks Mikrohirurgia glaza imeni Akademika S N Fedorova


Anesthesiology, Ophthalmology