Using sorbitol - a cheap and easy-to-find material in Vietnam, the authors built a relative optimal and complete protocol to synthesize isosorbide and isosorbide dinitrate (productivity of 64%). Test purity isosorbide dinitrate and solution of 25% isosorbide dinitrate. With purity isosorbite dinitrate: qualitative analysis by IR and test by HPLC method were conducted; isosorbide dinitrate solution was test according to USP 24 and checked by this standard. All products meet USP 24 standard
Isosorbide Dinitrate ; Sorbitol

No abstract available.
Common Bile Duct* ; Isosorbide Dinitrate* ; Isosorbide*

BACKGROUND: Coronary perfusion pressure(CPP) is the most important factor for the success of cardiopulmonary resuscitation(CPR). Therefore, CPP must be optimized during the resuscitation. The purpose of this study is to investigate the effects of isosorbide dinitrate(Isoket(R)) on CPP during CPR. METHODS: 10 Korean dogs were divided into two groups: Group I(N=5) was resuscitated with infusion of isosorbide dinitrate(1 microgram /kg/min) and Group II(N=5) was resuscitated without using isosorbide dinitrate. Following CPR, the heart rate(HR), blood pressure(BP), pulmonary capillary wedge pressure, cardiac output(CO), CPP and endocardial viability ratio(EVR) were measured repeatedly. RESULTS: The changes in HR were not significantly different between the two groups but systolic and diastolic BP, CO, CPP and EVR were well maintained in group 1. CONCLUSIONS: These results suggest that the usual dosage of isosorbide dinitrate is effective in improving CPP and EVR on CPR after impending cardiac arrest.
Animals ; Cardiopulmonary Resuscitation* ; Dogs ; Heart ; Heart Arrest ; Isosorbide Dinitrate ; Isosorbide* ; Perfusion* ; Pulmonary Wedge Pressure ; Resuscitation

In a placebo-controlled trial, we have studied the vasodilator properties of bolus dose of nitroglycerin, isosorbide dinitrate and chlorpromazine in 38 patients during cardiopulmonary bypass with a constant pump flow. Mean arterial pressure and blood volume of the venous reservoir were recorded for 10 min after drug administration to detect changes in arteriolar resistance and venous capacitance, respectively. Nitroglycerin, 2.5 ug/kg, decreased arterial pressure, but the effect lasted for 3 minutes. Chlorpromazine, 0.1 mg/kg, decreased arterial pressure for 9 minutes. Isosorbide dinitrate, 20 ug/kg, had no significant change on arterial pressure. The venous capacitance-increasing effects of nitroglycerin and chlorpromazine were significant for 4 minutes after the bolus. Thereafter the effect of nitroglycerin began to decline, while that of chlorpromazine significantly continued. Isosorbide dinitrate had no significant change on venous reservoir level. The SVR reduction effects of nitroglycerin was significant for 3 minutes, chlorpromazine decreased SVR for over 10 minutes. In conclusion chlorpromazine effect on arterial pressure and venous capacitance was more potent and longer than nitroglycerin and isosorbide dinitrate. Nitroglycerin and chlorpromazine effect on preload and afterload were significant after bolus dose.
Arterial Pressure ; Blood Volume ; Cardiopulmonary Bypass ; Chlorpromazine* ; Humans ; Isosorbide Dinitrate* ; Isosorbide* ; Nitroglycerin* ; Vascular Access Devices

We have studied the vasodilating effect of bolus doses of sodium nitroprusside (SNP), nitro- glycerin (NTG), and isosorbide dinitrate (ISDN) in 40 patients during cardiopulmonary bypass with a constant pump flow. Blood volume of the venous reservoir and mean arterial pressure were recorded for 10 minutes after drug administration to detect changes in venous capacitance and arteriolar resistance. SNP 500 ug decreased mean blood pressure significantly more than NTG and ISDN compared with placebo. NTG 500 ug decreased mean blood pressure transiently at 1-4 min but significantly reduced reservoir blood volume. ISDN 500 ug increased mean blood pressure after drug administration, decreased reservoir blood volume less than NTG. We could conclude that SNP was more effective arteriolar vasodilator than NTG and ISDN, but NTG and ISDN were effective as a venodilator during cardiopulmonary bypass.
Arterial Pressure ; Blood Pressure ; Blood Volume ; Cardiopulmonary Bypass* ; Glycerol ; Humans ; Isosorbide Dinitrate* ; Isosorbide* ; Nitroglycerin* ; Nitroprusside* ; Sodium* ; Vascular Access Devices

BACKGROUND AND OBJECTIVES: The head-up tilt test (HUT) is widely used for the diagnosis of vasovagal syncope. To improve the sensitivity of the test, provocation with isoproterenol is frequently used. The aim of this study was to evaluate the values of isosorbide dinitrate spray as a provocation drug in the HUT. SUBJECTS AND METHODS: Two hundred patients, undergoing baseline HUT (60 degrees for 20 minutes) for suspected vasovagal syncope or presyncope and unexplained dizziness, were enrolled. If the baseline HUT was negative, isosorbide dinitrate (2.5 mg) spray was applied sublingually (group I, n=93), or isoproterenol (3 microgram/min) infused (group II, n=93), in a randomized fashion. The values of isosorbide dinitrate and isoproterenol were compared in those patients that developed a positive vasovagal response or who completed the drug-provocative HUT. RESULTS: Syncope was similarly reproduced in both groups (47.7 vs. 41.9%, p>0.05). Type I responses were most common in both groups, and types I and II responses were more common in group I than group II (78.0 vs. 55.6% and 12.2 vs. 5.6%, p<0.05, respectively). The average time to a positive response was longer in group I than group II (8.5+/-3.4 vs. 6.1+/-3.6 minutes, p<0.01). The sensitivity and specificity of the drug-provocative HUT were significantly higher in group I than group II (73.5 and 87.5% vs. 58.5 and 71.1%; respectively, p<0.01). The incidence of minor adverse effects were similar in both groups, but serious cardiac side effects were significantly more common in group II than group I (4.3 vs. 0%, p<0.05). CONCLUSION: Sublingual isosorbide dinitrate spray may be used as a simple, effective and well tolerated provocative drug during HUT.
Diagnosis ; Dizziness ; Humans ; Incidence ; Isoproterenol* ; Isosorbide Dinitrate ; Sensitivity and Specificity ; Syncope ; Syncope, Vasovagal ; Tilt-Table Test

In the mid 1980's, the ITA(internal thoracic artery) graft was clearly recognized to be superior to the sapheonous vein graft in respect to long term patency. Therefore, there has been growing interest in the arterial conduit with the possibility of improving the long term result. We have been performing CABG with GEA since 1998 with the same purpose. For mid-term and long-term follow up, we have been performing postoperative coronary angiography. In this paper, a case of GEA spasm, a purported drawback of this conduit, during postoperative coronary anigiography and relieved by direct infusion of 200 microgram isoket into the GEA is reported. The current case which exemplifies the spastic nature of RGEA is accompanied with coronary angiography.
Coronary Angiography* ; Follow-Up Studies ; Gastroepiploic Artery* ; Isosorbide Dinitrate ; Muscle Spasticity ; Spasm* ; Transplants ; Veins

BACKGROUND: Multi-vessel off-pump coronary bypass surgery (OPCAB) imposes cumulative myocardial ischemia/reperfusion injury, which may be attenuated by continuous infusion of nitrate. However, nitrate infusion and consequent decrease in preload may be hazardous during heart displacement which causes restrictive filling of the ventricles. Therefore, we evaluated the effect of nitrate infusion on myocardial protection and hemodynamics in patients undergoing OPCAB, in a prospective, randomized and controlled trial. METHODS: Fifty patients with stable angina and left ventricular ejection fraction >40% undergoing elective, isolated, multivessel OPCAB were enrolled. Patients were randomized equally to either continuous infusion of isosorbide dinitrate 0.5microg/kg/min or same amount of normal saline during the surgery. Operative data including hemodynamic variables, intraoperative ST segment changes and postoperative cardiac enzyme release (creatine kinase-MB, troponin T) were compared. RESULTS: Patients characteristic and operative data including ST segment changes and use of vasopressors were similar between the groups except the total amount of infused crystalloid during the surgery which was significantly higher in the nitrate group. Postoperative variables including cardiac enzyme release were also similar between the groups. CONCLUSIONS: Prophylactic continuous infusion of nitrate during OPCAB exerted no additional benefit in terms of myocardial protection. It also, was not associated with accentuated decrease in cardiac output during heart displacement, and the decrease in preload seems to have been nullified by modest increase in fluid therapy.
Angina, Stable ; Cardiac Output ; Displacement (Psychology) ; Fluid Therapy ; Heart ; Hemodynamics ; Humans ; Isosorbide ; Isosorbide Dinitrate ; Isotonic Solutions ; Myocardial Ischemia ; Prospective Studies ; Stroke Volume ; Troponin

BACKGROUND: Cardiopulmonary bypass (CPB) may produce lung injury with decreased PaO2/FiO2 ratio in patients undergoing CABG surgery. We examined PaO2/FiO2 ratio and incidence of PaO2/FiO2 < 300 or 150 to determine the differences in oxygenation with the use of amrinone-dopamine (DP) or isosorbide dinitrate (IDN)-DP in patients undergoing CABG. METHODS: Twenty patients undergoing elective CABG were divided into two groups according to drug used on separation from CPB: IDN-DP (Group 1, n = 10) or amrinone-DP (Group 2, n = 10). Anesthesia was induced and maintained with propofol, fentanyl and vecuronium. IDN infusion (1.0microgram/kg/min) was started preoperatively in both groups. Mild hypothermic CPB was applied with a roller pump and nonpulsatile flow maintained a mean arterial pressure of 60-80 mmHg. In Group 2, amrinone was administered (0.75 mg/kg + 10microgram/kg/min) instead of IDN at the time of CPB separation. DP infusion (3microgram/kg/min) was started at a rectal temperature more than 35.5oC and adjusted to maintain acceptable hemodynamics. IDN-DP or amrinone-DP infusion, monitoring and sedation with propofol were continued in the intensive care unit (ICU). PaO2/FiO2 ratio under controlled ventilation with air/O2 mixture (FiO2 0.6) was checked immediately before CPB (pre-CPB), 30 mins (post-CPB30), 60 mins after CPB (post-CPB60) and 30 mins after admission to ICU (ICU30). RESULTS: There was no significant difference between the groups in the terms of the duration of arotic cross clamp, PaO2/FiO2 at pre-CPB, PaO2/FiO2 at post-CPB60, PaO2/FiO2 at ICU30 or in the incidence of PaO2/FiO2 < 150, PaO2/FiO2 < 300 at ICU30. But there was a significant difference in PaO2/FiO2 post CPB30 (263.3 +/- 105.5 in Group 1 vs. 381.7 +/- 69.5 in Group 2, P<0.05). CONCLUSIONS: Amrinone-DP provides more favorable oxygenation immediately after CPB in CABG surgery than IDN-DP.
Amrinone ; Anesthesia ; Arterial Pressure ; Cardiopulmonary Bypass* ; Coronary Artery Bypass* ; Coronary Vessels* ; Fentanyl ; Hemodynamics ; Humans ; Incidence ; Intensive Care Units ; Isosorbide Dinitrate ; Isosorbide* ; Lung Injury ; Oxygen* ; Propofol ; Vecuronium Bromide ; Ventilation

The coronary vasospasm has usually been readily reversible by sublingual, intravenous or intracoronary nitroglycerin. Relief of spasm, either spontaneous or following nitrate therapy, results in reperfusion. Occurence of ventricular tachyarrhythmia during release of coronary spasm is attractive as a possible cause of sudden death because of significant proportion of sudden death victims do not have acute myocardial infarction. Recently, we experienced a 36 year old man who developed spontaneous coronary vasospasm, and the patients suffered from repetitive reperfusion ventricular tachyarrhythmia, and died suddenly in spite of administration of isosorbide dinitrate, lidocaine and several trials of cardioversion and cardiopulmonary resuscitation, and we report.
Adult ; Cardiopulmonary Resuscitation ; Coronary Vasospasm ; Death, Sudden* ; Electric Countershock ; Humans ; Isosorbide Dinitrate ; Lidocaine ; Myocardial Infarction ; Nitroglycerin ; Reperfusion* ; Spasm ; Tachycardia*