Isoflurane versus sodium nitroprusside for the control of proximal hypertension during thoracic aortic cross-clamping: Effects on spinal cord ischemia

Simpson, Joseph I.; Eide, Thomas R.; Schiff, Gerald A.; Clagnaz, John F.; Zisbrod, Zvi; Newman, Sheldon B.; Hossain, Imtiaz

doi:10.1016/s1053-0770(05)80129-6

Cited by 17 publications

(5 citation statements)

References 31 publications

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“…The use of isoflurane resulted in greater SCPP and was associated with a lower incidence of neurologic injury when compared with nitroprusside in a canine model of thoracic aortic occlusion. 48 Phlebotomy after aortic occlusion significantly decreased MAP, CVP, and CSF pressure, suggesting that cardiac preload may be an important determinant of CSF pressure. 49 Because there was concomitant hypotension with exsanguination, no change in SCPP was observed.…”

Section: Hemodynamic Changes Associated With Aortic Clamping and Unclampingmentioning

confidence: 92%

Anesthetic Consideration for Descending Thoracic Aortic Aneurysm Repair

Kahn

Stone

Moskowitz

2007

Semin Cardiothorac Vasc Anesth

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Anesthesia for surgery of the aorta poses some of the most difficult challenges for anesthesiologists. Major hemodynamic and physiologic stresses and sophisticated techniques of extracorporeal support are superimposed on patients with complex medical disease states. In this review, etiologies, natural history, and surgical techniques of thoracic aortic aneurysm are presented. Anesthetic considerations are discussed in detail, including the management of distal perfusion using partial cardiopulmonary bypass. Considerations of spinal cord protection, including management of proximal hypertension, cerebral spinal fluid drainage, and pharmacological therapies, are presented.

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Section: Hemodynamic Changes Associated With Aortic Clamping and Unclampingmentioning

confidence: 92%

Anesthetic Consideration for Descending Thoracic Aortic Aneurysm Repair

Kahn

Stone

Moskowitz

2007

Semin Cardiothorac Vasc Anesth

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“…Aggressive treatment with sodium nitroprusside during proximal aortic cross-clamping may be associated with a higher incidence of postoperative paraplegia [34]. Duration of cross-clamping is a key determinant of outcome and spinal cord protection is critical.…”

Section: Aortic Injuriesmentioning

confidence: 99%

Anesthetic management of thoracic trauma

Moloney

Fowler

Chang

2008

Current Opinion in Anaesthesiology

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“…Few studies directly compare nitroprusside with other intravenous antihypertensives and their effects on surgical outcomes in aortic surgery. Early animal studies showed SNP to be associated with a poorer response of multiple variables in the setting of cross-clamping when compared to other antihypertensive agents or controls, including increased cerebral spinal fluid pressure,[ 61 ] lower spinal cord perfusion pressure, and increased neurologic injury[ 62 63 64 ] and mortality. [ 65 ] In one of the few head to head comparisons of nitroprusside and another antihypertensive agent, fenoldopam, during cross-clamping, no differences were found in intraoperative hemodynamic variables or renal indices.…”

Section: Clinical Use Efficacy and Comparative Advantages Of Nitropmentioning

confidence: 99%

Sodium nitroprusside in 2014: A clinical concepts review

Hottinger

Beebe

Kozhimannil

et al. 2014

J Anaesthesiol Clin Pharmacol

163

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Sodium nitroprusside has been used in clinical practice as an arterial and venous vasodilator for 40 years. This prodrug reacts with physiologic sulfhydryl groups to release nitric oxide, causing rapid vasodilation, and acutely lowering blood pressure. It is used clinically in cardiac surgery, hypertensive crises, heart failure, vascular surgery, pediatric surgery, and other acute hemodynamic applications. In some practices, newer agents have replaced nitroprusside, either because they are more effective or because they have a more favorable side-effect profile. However, valid and adequately-powered efficacy studies are sparse and do not identify a superior agent for all indications. The cyanide anion release concurrent with nitroprusside administration is associated with potential cyanide accumulation and severe toxicity. Agents to ameliorate the untoward effects of cyanide are limited by various problems in their practicality and effectiveness. A new orally bioavailable antidote is sodium sulfanegen, which shows promise in reversing this toxicity. The unique effectiveness of nitroprusside as a titratable agent capable of rapid blood pressure control will likely maintain its utilization in clinical practice for the foreseeable future. Additional research will refine and perhaps expand indications for nitroprusside, while parallel investigation continues to develop effective antidotes for cyanide poisoning.

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Isoflurane versus sodium nitroprusside for the control of proximal hypertension during thoracic aortic cross-clamping: Effects on spinal cord ischemia

Cited by 17 publications

References 31 publications

Anesthetic Consideration for Descending Thoracic Aortic Aneurysm Repair

Anesthetic Consideration for Descending Thoracic Aortic Aneurysm Repair

Anesthetic management of thoracic trauma

Sodium nitroprusside in 2014: A clinical concepts review

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