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Related Experiment Videos

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
PubMed
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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.

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.

Related Experiment Videos

  • 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.