Hepatic plasma flow during sodium nitroprusside-induced hypotension in humans

Changes in hepatic plasma flow (HPF) during sodium nitroprusside (SNP) induced hypotension were studied in 14 patients undergoing intracranial aneurysm surgery under neurolept anesthesia. Patients were monitored with the use of a radial artery catheter and a thermistor-tipped Swan-Ganz catheter. Hypotension was induced with incremental increases in the rate of SNP infusion until a stable mean arterial pressure (MAP) 35-55 mmHg had been achieved. In one group (Group A) of 10 patients, indocyanine green (ICG) clearance was determined simultaneously with hemodynamic variables, before and during SNP hypotension. In a second group (Group B) of four patients, a catheter was inserted into a hepatic vein to determine the ICG hepatic extraction (HE) coefficient. In Group A, MAP decreased from 73 +/- 10 (SD) to 41 +/- 9 mmHg, while cardiac index (CI) decreased in six patients and increased in four patients. However, the mean value of CI did not change significantly. The mean value of ICG clearance was not significantly affected by SNP hypotension. Nevertheless, a positive linear correlation existed between individual variation in CI and ICG clearance (r = 0.96). On the other hand, no correlation was noted between the change in MAP and ICG clearance. In Group B patients, the ICG HE coefficient remained unchanged during SNP hypotension, suggesting that ICG clearance varies only according to the variation in HPF. In conclusion, this study demonstrated that HPF did not decrease, despite a range of 20-60% decrease in blood pressure when CI is maintained during SNP hypotension.