Intranasal Versus Intravenous Nitroglycerin for Attenuation of Pneumoperitoneum-Induced Hemodynamic Stress Response during Laparoscopic Cholecystectomy: A Randomized Controlled Trial
Shruti Panda, Laba Kumar Nayak, Ayesha Pattnaik, Shreyasi Mallick, Abhishek DashAbstract
Background:
Carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy provokes a sympathetically mediated increase in arterial pressure and heart rate (HR). Nitroglycerin attenuates this response, but its intranasal and intravenous routes have not been directly compared in this setting. This trial compared intranasal nitroglycerin with an intravenous bolus for attenuating the pneumoperitoneum pressor response.
Materials and Methods:
In this prospective, double-blind, randomized controlled trial, 111 patients (American Society of Anesthesiologists physical status I–II, aged 18–60 years) scheduled for elective laparoscopic cholecystectomy were allocated to intranasal nitroglycerin 400 µg (Group A), intranasal nitroglycerin 800 µg (Group B), or intravenous nitroglycerin 2 µg/kg (Group C), given 3 min before pneumoperitoneum. The primary outcome was mean arterial pressure (MAP) 2 min after insufflation; the secondary outcomes were systolic and diastolic pressure, HR, oxygen saturation, and adverse effects.
Results:
Groups were comparable at baseline. Group B produced the greatest early reduction in MAP, systolic and diastolic pressure, from 1 min before insufflation through the early intraoperative period (
Conclusion:
Intranasal nitroglycerin 800 µg provided an effective, noninvasive attenuation of the pneumoperitoneum-induced rise in arterial pressure, whereas the intravenous bolus afforded better HR stability. Intranasal 800 µg is a feasible alternative for perioperative hemodynamic control when titrated intravenous therapy is impractical.