Effect of intra-arterial nitroglycerin and verapamil administration during radial artery access on systemic blood pressure and its correlation with timing of moderate sedation administration.

Presented During:

Tue, 3/31/2020: 3:00 PM  - 3:09 PM 
Washington State Convention Center  
Room: Room 201  

Final ID:

182 

Poster Type:

Scientific Session 

Authors:

H Swanson1, N Tabori2, S Sabri2, K Horton2, A Khan2, G Sivananthan2

Institutions:

1Medstar Georgetown University Hospital, Washington, DC, 2Medstar Washington Hospital Center, Washington, DC

First Author:

Haley Swanson, MD  
Medstar Georgetown University Hospital
Washington, DC

Co-Author(s):

Nora E. Tabori, MD  
Medstar Washington Hospital Center
Washington, DC
Saher S. Sabri, MD, FSIR  
Medstar Washington Hospital Center
Washington, DC
Keith M. Horton, MD, FSIR  
Medstar Washington Hospital Center
Washington, DC
Arshad Ahmed Khan, MD, FSIR  
Medstar Washington Hospital Center
Washington, DC
Gajan Sivananthan, MD  
Medstar Washington Hospital Center
Washington, DC

Presenting Author:

Haley Swanson, MD  
Medstar Georgetown University Hospital
Arlington, VA

Purpose:

Transradial (TR) access for endovascular interventions is steadily increasing. Propensity for spasm has lead to the use of "radial artery cocktails" (RC). At present, the systemic effects of RC administration have not been studied. Our study evaluates the hemodynamic effects of administration of 2.5 mg Verapamil and 200 ug Nitroglycerine to the radial artery following access and its correlation with timing of moderate sedation administration.

Materials:

All data was prospectively collected in the EMR and retrospectively reviewed. IRB exemption was granted. All patients who underwent left TR interventions from 4/2018 to 4/2019 were identified. Patients lacking documentation of all medication administration, or pre and post administration blood pressures were excluded. Hypotensive complications were recorded. Decrease in systolic blood pressure (SBP) is expressed as means with standard deviation. Patients who received sedation and RC within 5 minutes of each other were compared to those in whom the interval was greater than 5 minutes using t-test. Multivariate regression analysis was performed with SBP as the dependent variable.

Results:

From 4/2018 to 4/2019, 107 patients underwent TR interventions. 86 patients met inclusion criteria and had an overall mean decrease in SBP of 14.8mmHg +/- 12.0 mmHg. No hypotensive complications were seen.

55 patients received sedation at an interval greater than 5 minutes from the RC. Of these patients, 12 had no decrease in SBP; 43 demonstrated a mean decrease in SBP of 11.8 mmHg +/- 11.2 mmHg. 31 patients received sedation within 5 minutes of RC infusion. Of these patients, 4 had no decrease in SBP; 27 had a mean decrease in SBP of 19.5 mmHg +/- 11.9 mmHg. Patients receiving sedation and RC within 5 minutes of each other had a significantly greater SBP drop then those in whom the interval was greater than 5 minutes; -7.6+/- 2.5 (CI -12.7 - -2.5, p = 0.0039).

Conclusions:

Patients undergoing TR interventional procedures can safely be administered Verapamil and Nitroglycerine for prevention of radial artery spasm. Blood pressure variations can be tempered by staggering RC and sedation administration at an interval of five minutes or greater.

Abstract Categories:

Arterial Interventions: Other

Keywords:

Radial artery
Transradial Access
Vascular access