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Cardiopulmonary bypass, hemolysis, and nitroprusside-induced cyanide production

Albert T Cheung1, Gonzalo E Cruz-Shiavone, Qing C Meng

  • 1Department of Anesthesiology, University of Pennsylvania, Philadelphia, PA 19104-4283. cheunga@uphs.upenn.edu

Anesthesia and Analgesia
|June 21, 2007
PubMed

Insights

Cardiac surgery patients may face higher cyanide toxicity risk from sodium nitroprusside due to hemolysis during cardiopulmonary bypass (CPB). Free hemoglobin released during CPB accelerates cyanide generation from this medication.

Area of Science:

  • Cardiovascular Surgery
  • Clinical Toxicology
  • Pharmacology

Background:

  • Sodium nitroprusside administration can lead to cyanide toxicity.
  • Cardiac surgery, particularly cardiopulmonary bypass (CPB), may elevate this risk.
  • Hemolysis during CPB can catalyze cyanide release from sodium nitroprusside.

Purpose of the Study:

  • To investigate the relationship between hemolysis during CPB and cyanide generation from sodium nitroprusside.
  • To assess the risk of cyanide toxicity in cardiac surgical patients undergoing CPB.

Main Methods:

  • Serial blood specimens were collected from 25 cardiac surgical patients during CPB.
  • Plasma samples were analyzed for free hemoglobin concentration.
  • The capacity of plasma to generate free cyanide anion upon exposure to sodium nitroprusside was measured.

Main Results:

  • Plasma-free hemoglobin concentration increased significantly over time during CPB.
  • The rate of hemolysis was measured at an average of 0.27 mg x dL(-1) x min(-1).
  • A direct correlation was observed between plasma-free hemoglobin levels and the concentration of free cyanide generated.

Conclusions:

  • CPB-associated hemolysis accelerates the release of free cyanide from sodium nitroprusside.
  • Elevated free hemoglobin levels in cardiac surgical patients increase the risk of cyanide toxicity.
  • These findings suggest a heightened risk of cyanide toxicity from perioperative sodium nitroprusside administration in patients undergoing cardiac surgery.
Abstract

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