Journal Article

Dose‐dependent prophylactic effect of nicorandil, an ATP‐sensitive potassium channel opener, on intra‐operative myocardial ischaemia in patients undergoing major abdominal surgery

T. Kaneko, Y. Saito, Y. Hikawa, K. Yasuda and K. Makita

in BJA: British Journal of Anaesthesia

Published on behalf of the British Journal of Anaesthesia

Volume 86, issue 3, pages 332-337
Published in print March 2001 | ISSN: 0007-0912
Published online March 2001 | e-ISSN: 1471-6771 | DOI: https://dx.doi.org/10.1093/bja/86.3.332
Dose‐dependent prophylactic effect of nicorandil, an ATP‐sensitive potassium channel opener, on intra‐operative myocardial ischaemia in patients undergoing major abdominal surgery

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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

Keywords: Keywords: metabolism, ATP; metabolism, nicorandil; complications, myocardial ischaemia; surgery, abdominal

Journal Article.  3226 words.  Illustrated.

Subjects: Anaesthetics

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