British Journal of Anaesthesia, 2001, Vol. 86, No. 3 332-337
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia
Dose-dependent prophylactic effect of nicorandil, an ATP-sensitive potassium channel opener, on intra-operative myocardial ischaemia in patients undergoing major abdominal surgery
1Department of Anesthesiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-0034, Japan. 2Department of Anesthesia, Tokyo Metropolitan Fuchu Hospital, Tokyo, Japan*Corresponding author
Nicorandil, a nicotinamide nitrate derivative, relaxes vascular smooth muscle and reduces cardiac muscle contractility by increasing membrane potassium conductance, probably by activating ATP-sensitive potassium channels. In this prospective, randomized, double-blind, placebo-controlled clinical study, we examined the dose-dependent prophylactic effect of nicorandil on intra-operative myocardial ischaemia in 248 patients who had pre-operative risk factors for ischaemic heart disease and were undergoing major abdominal surgery. Patients in group HD (n=81) received a bolus dose of nicorandil 0.08 mg kg–1 and a continuous infusion of 0.08 mg kg–1 h–1. Patients in group LD (n=87) received nicorandil 0.04 mg kg–1 and 0.04 mg kg–1 h–1. Patients in the placebo (P) group (n=80) received the same volumes of saline. The patients were monitored with a three-lead clinical ECG monitor with an ST trending device from arrival in the operating theatre to the end of anaesthesia. Intra-operative myocardial ischaemia occurred significantly less frequently in the HD group (one patient, 1.2%) than in the LD (11 patients, 12.6%) and P groups (21 patients, 26.3%) (P<0.01), and in group LD significantly less than in group P (P<0.05). Administration of nicorandil had little effect on the patients’ heart rate or arterial pressure. Three patients in group P and none in either treatment group developed myocardial infarction after surgery.
Br J Anaesth 2001; 86: 332–7
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