The Renal Effects of Sodium Nitroprusside in Postoperative Cardiac Surgical Patients

Maseda, J; Hilberman, Mark; Derby, Geraldine C.; Spencer, R.R.; Stinson, Edward B.; Myers, Bryan D.

doi:10.1097/00000542-198104000-00005

Cited by 14 publications

(7 citation statements)

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“…SNP, an exogenous NO donor, is frequently used to control hypertension and/or to improve cardiac output following cardiac operations. It is able to antagonize vasoconstricting signals and increases end-organ perfusion [21], facilitates rewarming [22], decreases complement activation [23], decreases reperfusion injury, and increases renal blood flow by 20% [24]. The renal effects of SNP are considered to reduce renal vascular resistance and increase renal blood flow and furthermore, selective dilatation of the afferent arterioles increases the GFR.…”

Section: Discussionmentioning

confidence: 99%

The effect of sodium nitroprusside infusion on renal function during reperfusion period in patients undergoing coronary artery bypass grafting: a prospective randomized clinical trial

Kaya

Oğuz

Akar

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Section: Discussionmentioning

confidence: 99%

The effect of sodium nitroprusside infusion on renal function during reperfusion period in patients undergoing coronary artery bypass grafting: a prospective randomized clinical trial

Kaya

Oğuz

Akar

et al. 2007

European Journal of Cardio-Thoracic Surgery

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“…However in the ECLIPSE trial, rates of atrial fibrillation were similar between all treatment arms (clevidipine, nicardipine, nitroglycerin, and sodium nitroprusside). 13 In addition, a recent meta-analysis confirms that there is no difference in rates of atrial fibrillation between clevidipine and comparator arms in published studies. 27 While sodium nitroprusside improves rates of renal dysfunction after CABG compared to placebo, the rates of renal dysfunction were also similar between all treatment arms in the ECLIPSE trial.…”

Section: Discussionmentioning

confidence: 87%

“…12 AKI after cardiac surgery is caused by decreased renal perfusion, enhanced vasoconstriction due to sympathetic nervous system activation, the inflammatory response, and reperfusion injury. 13 Avoiding AKI in CABG patients receiving sodium nitroprusside is crucial, as use of sodium nitroprusside in kidney impairment may result in accumulation of toxic metabolites. A randomized, blinded study investigated the impact of sodium nitroprusside versus placebo on renal function in 240 elective on-pump CABG patients with a left ventricular ejection fraction (LVEF) ≤50% and an estimated glomerular filtration rate (eGFR) >30 mL/min.…”

Section: Resultsmentioning

confidence: 99%

“…Adverse events including postoperative AF were similar between all treatment arms. 13 Based on the ECLIPSE trials, clevidipine and nicardipine may be preferred over sodium nitroprusside and nitroglycerin for managing postoperative hypertension. When selecting the most appropriate agent, clinicians should also consider pharmacokinetic differences between the 2 calcium channel blockers.…”

Section: Discussionmentioning

confidence: 99%

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Examining the Use of Sodium Nitroprusside in Coronary Artery Bypass Grafting: Is the Benefit Worth the Cost?

2017

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Sodium nitroprusside is a vasodilator frequently used in the coronary artery bypass grafting (CABG) setting. However, the price of a 50-mg vial of sodium nitroprusside increased from $5.00 in 2003 to up to $900 in 2016. The purpose of this review is to help health systems balance high-quality patient care with economic responsibility. A MEDLINE literature search was performed using the search terms "nitroprusside" and "coronary artery bypass." All English-language trials in human subjects assessing the use of sodium nitroprusside in the setting of CABG were evaluated. The references of these studies were also reviewed. In the setting of CABG, sodium nitroprusside attenuates conduit vasospasm and reduces the incidence of inflammation, atrial fibrillation, and acute kidney injury after surgery. However, other vasodilators are more effective at maintaining postoperative blood pressure at goal. Despite its cost, sodium nitroprusside may be an appropriate agent to use during CABG operations, but other agents should be considered for treatment of postoperative hypertension.

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“…Endotheliumindependent vasodilators like papaverine, 15 nitroglycerin, 13 isosorbide dinitrate, 14 or sodium nitroprusside 46 induce an effective increase in RBF, but even intrarenal injections are often limited by profound systemic effects that restrict interpretation of RBF or achieving maximal RFR. Among these, papaverine dilates the renal microcirculation and is more likely to achieve a substantial decrease in RVR and RFR than conduit vessel dilators.…”

Section: Choice Of Vasoactive Substancementioning

confidence: 99%

Functional Assessment of the Circulation of the Single Kidney

Lerman

Rodriguez-Porcel²

2001

Hypertension

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Abstract-Functional alterations in the renal circulation that can contribute to abnormal renal perfusion have been demonstrated in various models of renal injury. To detect impairments in renal vascular function, renal flow reserve can be determined by repeated measurements of renal blood flow (RBF) during pharmacological challenge with short-acting vasodilators that should increase RBF in kidneys that are not severely damaged structurally. Among the invasive techniques for such measurements, the most readily available is probably the intravascular Doppler, which can be employed during renal angiography for rapid evaluation of changes in RBF during intrarenal injections of vasoactive substances. High-resolution tomographic imaging techniques, like electron-beam x-ray computed tomography, further offer the potential for noninvasive measurements of renal parenchymal perfusion and function, in association with either intrarenal or systemic injections of vasoactive substances. Acetylcholine is a potent short-acting renal vasodilator that can be useful to assess the response of the renal microcirculation, define renal flow reserve, and examine the endothelium-dependent responses of RBF. Such assessments of the function of the renal circulation can assist in evaluation of patients with systemic or renal disease for early detection and monitoring of renovascular injury. Key Words: renal circulation Ⅲ renal blood flow Ⅲ computed tomography Ⅲ acetylcholine U nder normal conditions, basal renal vascular tone is well regulated by many vasoactive systems that keep renal blood flow (RBF) in equilibrium, 1 including the endothelium-derived relaxing factor NO, prostaglandins, and the reninangiotensin system. 2 Therefore, at an early stage of renal disease, RBF may be normal, and impaired renal vascular tone may become evident only as an attenuated response during stimulus with vasoactive substances or physiological challenges. The mechanisms of the attenuated response have been postulated to include decreased release of vasodilators (eg, NO, prostaglandins) and co-existing vasoconstrictors (eg, thromboxane, angiotensin II), which may be released or rendered unopposed during challenge. The altered functional response may precede structural renal damage and can serve as a marker for abnormal handling of daily challenges by the kidney. Such impairment has been demonstrated in various models of renal injury, like hypertension, hypercholesterolemia, renal artery stenosis, ischemia and reperfusion, acute renal failure, diabetes mellitus, and aging. Hence, utilization of vasodilators to examine renal flow reserve (RFR) can serve to disclose subtle functional vascular alterations 3 and may allow early detection and monitoring of renovascular injury. For example, residual responsiveness of the intrarenal circulation to challenge may also reflect renal viability and may conceivably predict success of subsequent therapy (eg, revascularization).Evaluation of the reactivity of the single-kidney circulation entails rapid and successive meas...

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The Renal Effects of Sodium Nitroprusside in Postoperative Cardiac Surgical Patients

Cited by 14 publications

References 0 publications

The effect of sodium nitroprusside infusion on renal function during reperfusion period in patients undergoing coronary artery bypass grafting: a prospective randomized clinical trial

The effect of sodium nitroprusside infusion on renal function during reperfusion period in patients undergoing coronary artery bypass grafting: a prospective randomized clinical trial

Examining the Use of Sodium Nitroprusside in Coronary Artery Bypass Grafting: Is the Benefit Worth the Cost?

Functional Assessment of the Circulation of the Single Kidney

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