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The haemodynamic effects of sodium nitroprusside following cardiopulmonary bypass: a clinical study
Insights
Sodium nitroprusside improved cardiac output and left ventricular function in patients undergoing coronary artery bypass grafting. This intervention maintained a higher cardiac index post-surgery compared to controls.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure.
- Postoperative cardiac function can be compromised following cardiopulmonary bypass.
- Maintaining adequate cardiac output is crucial for patient recovery.
Purpose of the Study:
- To evaluate the effect of sodium nitroprusside on cardiac index post-CABG.
- To assess the impact of sodium nitroprusside on left ventricular function after cardiopulmonary bypass.
- To compare cardiac performance between patients receiving and not receiving sodium nitroprusside.
Main Methods:
- 18 patients undergoing CABG for stable angina pectoris were studied.
- Patients were randomly assigned to receive sodium nitroprusside or serve as controls.
- Cardiac index and peripheral vascular resistance were measured preoperatively and up to 12 hours postoperatively.
Main Results:
- Both groups experienced a drop in cardiac index post-bypass, but the nitroprusside group maintained levels above preoperative values.
- The nitroprusside group showed a statistically significant higher cardiac index at 1.5 and 3 hours postoperatively.
- Nitroprusside treatment resulted in a more rapid increase in cardiac index and improved left ventricular function.
Conclusions:
- Sodium nitroprusside effectively increases cardiac output in the early postoperative period following cardiopulmonary bypass.
- Nitroprusside administration improves left ventricular function in patients after CABG.
- Continuous infusion of sodium nitroprusside is a beneficial adjunct in managing cardiac performance post-CABG.
Abstract:
Measurements of cardiac index were made in 18 patients (14 male and 4 female) preoperatively and thereafter during a 12-hour period immediately following coronary artery bypass grafting for stable angina pectoris. Patients with evidence of impaired left ventricular function were not included in the study. Individuals were allocated randomly to one of two groups. The first group received sodium nitroprusside as a constant, variable dose infusion during the post bypass study period (nitroprusside group). The second group received no nitroprusside (control group). The operative and postoperative management of these patients was otherwise identical. Following bypass, both groups showed a gradual drop in cardiac index with an associated increase in peripheral vascular resistance. In the control group, the mean cardiac index fell below the mean preoperative value. In the nitroprusside group, however, the mean cardiac index always remained above the mean preoperative level for the group, the differences between the groups being statistically highly significant at 1 1/2 hours postoperatively (p less than .005) and still significant at 3 hours postoperatively (p less than .05). The subsequent rise in cardiac index over the next 9 hours was more rapid in the nitroprusside treated patients and left ventricular function was better as demonstrated by a consistently higher mean cardiac index for any given left ventricular filling pressure. It is concluded that nitroprusside increases cardiac output and improves left ventricular function in the early postoperative period following cardiopulmonary bypass.