Document Detail


A comparison of nitroglycerin and nitroprusside for inducing hypotension in children: a double-blind study.
MedLine Citation:
PMID:  3090906     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Intravenous nitroglycerin (NTG) and sodium nitroprusside (SNP) were compared as hypotensive agents in anesthetized children and adolescents. The drugs were studied in a prospective, randomized, double-blind fashion in 14 patients anesthetized with nitrous oxide: oxygen, morphine, and thiopental. NTG in doses as high as 40 micrograms X kg-1 X min-1 was ineffective at decreasing mean arterial pressure (MAP) below 55 mmHg or causing a decrease in MAP greater than one-third of baseline values. SNP was uniformly successful at inducing hypotension in all patients, including those patients in whom NTG failed. The dose of SNP required to induce hypotension was 6-8 micrograms X kg-1 X min-1. Both NTG and SNP decreased systemic vascular resistance, although SNP did so to a much greater degree than NTG (64% vs. 29%; P less than 0.01). Only SNP increased cardiac index significantly (2.27 +/- 0.35 to 4.44 +/- 1.36; P less than 0.003). Both drugs reflexly increased heart rate, necessitating the use of intravenous propranolol (range from 1 to 3 mg) in all patients. Both drugs produced small decreases in arterial oxygen tension and increases in the average alveolar-arterial oxygen tension gradient (SNP, 44 +/- 13 vs. NTG, 41 +/- 6). SNP use was associated with a slight metabolic acidosis (pH = 7.38 +/- 0.01; base excess [BE] = -6 +/- 1). Neither drug produced any other untoward reaction. SNP appears to be the agent of choice for the reliable and sustained induction of deliberate hypotension in children and adolescents.
Authors:
M Yaster; R S Simmons; V T Tolo; J M Pepple; R C Wetzel; M C Rogers
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesiology     Volume:  65     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  1986 Aug 
Date Detail:
Created Date:  1986-09-17     Completed Date:  1986-09-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  175-9     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Anesthesia, Inhalation
Blood Gas Analysis
Child
Double-Blind Method
Evoked Potentials, Somatosensory / drug effects
Ferricyanides / therapeutic use*
Heart Rate / drug effects
Humans
Hypotension / chemically induced*
Nitroglycerin / therapeutic use*
Nitroprusside / therapeutic use*
Chemical
Reg. No./Substance:
0/Ferricyanides; 15078-28-1/Nitroprusside; 55-63-0/Nitroglycerin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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