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A probable case of nitroprusside intoxication.

G Nicoletta¹, M Cascelli, L Marchesini

¹Section of Anesthesia, Analgesia and Intensive Care, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy. giammichelenicoletta@hotmail.com

Minerva Anestesiologica

|July 31, 2007

Summary

A patient with type B aortic dissection experienced uncontrolled hypertension and renal failure. Standard treatments like sodium nitroprusside and urapidil were ineffective, necessitating general anesthesia for successful surgical repair.

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Area of Science:

Cardiovascular Medicine
Nephrology
Anesthesiology

Background:

Type B aortic dissection is a serious condition often requiring blood pressure management.
Effective blood pressure control is crucial during endovascular repair of aortic dissections.

Observation:

A patient with type B aortic dissection presented with severe hypertension (210/120 mmHg) and acute renal failure (BUN 108 mg/dL, Cr 4.00 mg/dL).
Initial management with sodium nitroprusside and subsequent attempts with urapidil and clonidine failed to control blood pressure during thoracic endoprosthesis insertion.
The patient exhibited psychomotor agitation, decreased oxygen saturation, and metabolic acidosis during attempted pharmacological management.

Findings:

Sodium nitroprusside infusion escalation up to 18 microg/kg/min was ineffective in controlling hypertension.
Multiple pharmacological agents including urapidil and clonidine failed to manage blood pressure surges during the procedure.
General anesthesia with sevoflurane ultimately enabled blood pressure reduction, facilitating the completion of the thoracic endoprosthesis procedure.

Implications:

This case highlights the challenges in managing refractory hypertension during endovascular aortic repair.
Alternative anesthetic and pharmacologic strategies may be necessary for patients with complex aortic dissections and resistant hypertension.
Further research into optimal anesthetic and pharmacologic protocols for these high-risk patients is warranted.