Pharmacological protocol for prevention of radial artery spasm

In the Department of Cardiovascular Surgery of the FSBI “RI Cardiology” SB RAMS, the pharmacological antispasmoic protocol for the prevention of the radial artery spasm was developed and implemented. The protocol is based on the systemic administration of calcium channel antagonists of the dihydropyridine group. According to the protocol, nifedipine in a dose of 5 mg per day was administered orally for 3 to 5 days prior to surgery. After exposure of the radial artery, the vessel was incubated in the nifedipine (adalat) solution for 15 min. After completion of the main stage of the operation, after the aortic clamp release, the intraoperative intravenous infusion of nifedipine in a dose of 0.63 mg/h began under control of arterial blood pressure. In the postoperative period, while the patient stayed in the intensive care unit, the infusion of nifedipine continued for 6 h. Then, patients were recommended to take nifedipine according to the same regime (orally in a dose of 5 mg daily) after the discharge from the hospital for one year. Follow-up examinations at 3±0.8 years after surgery showed that the use of this protocol resulted in the low occurrence rates of the recurrent myocardial infarctions (1.75%) and cardiac angina (7%). Ultrasound examination of the heart showed that end systolic volume (ESV) gradually decreased after the operation and reached 59±9 mL at 3±0.8 years after surgery which was less than the initial ESV by 13.2%. This contributed to the gradual increase in left ventricular ejection fraction by 21.6% (from 47±8% to 60+7%) 3±0.8 years after surgery. Control angiography showed that the radial artery patency was high in 27 of 56 patients where radial artery was used as a aortocoronary bypass (87.5%) and as a composite bypass (94.7%).