Abstract
Eight-five patients who required vasodilator therapy in the postoperative period after cardiac surgery were studied to compare the haemodynamic effects of nitroglycerin and nitroprusside, to evaluate local and systemic toxicity, and to develop long-range dosage recommendations. Ninety-one per cent of the patients received the vasodilators for postoperative hypertension, while nine per cent had low output syndromes. Both drugs significantly decreased blood pressure and central venous pressure, and increased heart rate. Nitroglycerin decreased both right and left ventricular filling pressures more than nitroprusside. No local toxicity or methaemoglobinaemia was found with either drug. Elevated thiocyanate levels were detected in 44 per cent of the nitroprusside group; however, none of the patients developed progressive metabolic acidosis. For prolonged infusions we found that nitroprusside at 1 μg·kg-1·min-1 and nitroglycerin at 0.5 μg·kg-1· min-1 were without significant toxicity.
Résumé
Quatre-vingt-cinq patients ayant requis des vasodilatateurs dans la période post-opératoire, après chirurgie cardiaque, ont fait ľobjet ďune étude prospective dont les buts étaient de comparer les effects hémodynamiques de la nitroglycérine et du nitroprussiate de sodium, ďévaluer la toxicité locale et systémique de ces agents et ďétablir des politiques sur leur usage. Leur emploi a été motivé par une hypertension artérielle post-opératoire dans 91 pour cent des cas et par un syndrome de bas débit dans les autres cas. Les deux agents ont diminué (de façon significative) la pression artérielle et la pression veineuse avec une accélération de la fréquence cardiaque. La nitroglycérine diminuait les pressions de remplissage gauches et droites de façon plus marquée que le nitroprussiate. On n’a relevé aucune toxicité locale ou de méthémoglobinémie avec ľun ou ľautre agent. Des taux élevés de thiocyanate ont été relevés chez 44 pour cent des patients ayant reçu du nitroprussiate; cependant, aucun de ceux-ci n’a présenté ďacidose métabolique progressive. Nous avons trouvé que le nitroprussiate de sodium, à raison de 1 μg · kg-1 · min-1 et la nitroglycérine, à raison de 0.5 μg·kg-1 · min-1, ne présentaient pas de toxicité significative en administration prolongée.
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Kaplan, J.A., Finlayson, D.C. & Woodward, S. Vasodilator therapy after cardiac surgery: a review of the efficacy and toxicity of nitroglycerin and nitroprusside. Canad. Anaesth. Soc. J. 27, 254–259 (1980). https://doi.org/10.1007/BF03007436
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DOI: https://doi.org/10.1007/BF03007436