Captopril reduces the dose requirement for sodium nitroprusside induced hypotension

J. Woodside, L. Garner, R. F. Bedford, M. D. Sussman, Edward Miller, D. E. Longnecker, R. M. Epstein

Research output: Contribution to journalArticle

Abstract

The authors studied 12 patients who required deliberate hypotension for spinal fusion operations in order to investigate the efficacy of captopril for reducing dose requirement for sodium nitroprusside (SNP). Six patients, selected at random, were pretreated with captopril, 3 mg/kg po, and the remaining six patients served as controls. All patients received a similar anesthetic technique, consisting of thiopental 3 mg/kg, pancuronium 0.1 mg/kg, morphine 0.5 mg/kg, plus nitrous oxide 70% in oxygen. SNP was used to maintain mean arterial pressure (MAP) at 50-55 mmHg during deliberate hypotension lasting 140 ± 13 minutes (mean ± SE). Patients who received captopril required less SNP than untreated patients both early during hypotension (1.4 ± 0.5 μg.kg-1.min-1 vs. 4.8 ± 0.8 μg.kg-1.min-1, P < 0.05), as well as late during hypotension (2.2 ± 0.2 μg.kg-1.min-1 vs. 5.6 ± 0.6 μg.kg-1.min-1, P < 0.05). Whole blood cyanide was significantly lower in the patients pretreated with captopril than the untreated controls both early in the hypotensive period (2.7 ± 0.6 μmol/l vs. 13 ± 4 μmol/l, P < 0.05) and also late in the hypotensive period (3.7 ± 0.8 μmol/l vs. 30 ± 10 μmol/l, P < 0.05). MAP was reduced by captopril pretreatment both following induction of anesthesia (64 ± 4 mmHg captopril vs. 80 ± 4 mmHg control, P < 0.05) and during surgery before deliberate hypotension (86 ± 5 mmHg captopril vs. 100 ± 4 control, P < 0.05). Cardiac output did not differ significantly between the groups, either awake or after anesthetic induction. The authors conclude that captopril pretreatment significantly reduces the dose of SNP required to produce deliberate hypotension and, therefore, reduces the potential for cyanide toxicity. No adverse hemodynamic consequences of combining captopril with thiopental, N2O, or morphine anesthesia were observed.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalAnesthesiology
Volume60
Issue number5
StatePublished - 1984
Externally publishedYes

Fingerprint

Controlled Hypotension
Captopril
Nitroprusside
Hypotension
Thiopental
Cyanides
Morphine
Anesthetics
Arterial Pressure
Anesthesia
Pancuronium
Spinal Fusion
Nitrous Oxide
Cardiac Output
Hemodynamics
Oxygen

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Woodside, J., Garner, L., Bedford, R. F., Sussman, M. D., Miller, E., Longnecker, D. E., & Epstein, R. M. (1984). Captopril reduces the dose requirement for sodium nitroprusside induced hypotension. Anesthesiology, 60(5), 413-417.

Captopril reduces the dose requirement for sodium nitroprusside induced hypotension. / Woodside, J.; Garner, L.; Bedford, R. F.; Sussman, M. D.; Miller, Edward; Longnecker, D. E.; Epstein, R. M.

In: Anesthesiology, Vol. 60, No. 5, 1984, p. 413-417.

Research output: Contribution to journalArticle

Woodside, J, Garner, L, Bedford, RF, Sussman, MD, Miller, E, Longnecker, DE & Epstein, RM 1984, 'Captopril reduces the dose requirement for sodium nitroprusside induced hypotension', Anesthesiology, vol. 60, no. 5, pp. 413-417.
Woodside J, Garner L, Bedford RF, Sussman MD, Miller E, Longnecker DE et al. Captopril reduces the dose requirement for sodium nitroprusside induced hypotension. Anesthesiology. 1984;60(5):413-417.
Woodside, J. ; Garner, L. ; Bedford, R. F. ; Sussman, M. D. ; Miller, Edward ; Longnecker, D. E. ; Epstein, R. M. / Captopril reduces the dose requirement for sodium nitroprusside induced hypotension. In: Anesthesiology. 1984 ; Vol. 60, No. 5. pp. 413-417.
@article{739353ffc5bb44128550a09f3d6d8775,
title = "Captopril reduces the dose requirement for sodium nitroprusside induced hypotension",
abstract = "The authors studied 12 patients who required deliberate hypotension for spinal fusion operations in order to investigate the efficacy of captopril for reducing dose requirement for sodium nitroprusside (SNP). Six patients, selected at random, were pretreated with captopril, 3 mg/kg po, and the remaining six patients served as controls. All patients received a similar anesthetic technique, consisting of thiopental 3 mg/kg, pancuronium 0.1 mg/kg, morphine 0.5 mg/kg, plus nitrous oxide 70{\%} in oxygen. SNP was used to maintain mean arterial pressure (MAP) at 50-55 mmHg during deliberate hypotension lasting 140 ± 13 minutes (mean ± SE). Patients who received captopril required less SNP than untreated patients both early during hypotension (1.4 ± 0.5 μg.kg-1.min-1 vs. 4.8 ± 0.8 μg.kg-1.min-1, P < 0.05), as well as late during hypotension (2.2 ± 0.2 μg.kg-1.min-1 vs. 5.6 ± 0.6 μg.kg-1.min-1, P < 0.05). Whole blood cyanide was significantly lower in the patients pretreated with captopril than the untreated controls both early in the hypotensive period (2.7 ± 0.6 μmol/l vs. 13 ± 4 μmol/l, P < 0.05) and also late in the hypotensive period (3.7 ± 0.8 μmol/l vs. 30 ± 10 μmol/l, P < 0.05). MAP was reduced by captopril pretreatment both following induction of anesthesia (64 ± 4 mmHg captopril vs. 80 ± 4 mmHg control, P < 0.05) and during surgery before deliberate hypotension (86 ± 5 mmHg captopril vs. 100 ± 4 control, P < 0.05). Cardiac output did not differ significantly between the groups, either awake or after anesthetic induction. The authors conclude that captopril pretreatment significantly reduces the dose of SNP required to produce deliberate hypotension and, therefore, reduces the potential for cyanide toxicity. No adverse hemodynamic consequences of combining captopril with thiopental, N2O, or morphine anesthesia were observed.",
author = "J. Woodside and L. Garner and Bedford, {R. F.} and Sussman, {M. D.} and Edward Miller and Longnecker, {D. E.} and Epstein, {R. M.}",
year = "1984",
language = "English (US)",
volume = "60",
pages = "413--417",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Captopril reduces the dose requirement for sodium nitroprusside induced hypotension

AU - Woodside, J.

AU - Garner, L.

AU - Bedford, R. F.

AU - Sussman, M. D.

AU - Miller, Edward

AU - Longnecker, D. E.

AU - Epstein, R. M.

PY - 1984

Y1 - 1984

N2 - The authors studied 12 patients who required deliberate hypotension for spinal fusion operations in order to investigate the efficacy of captopril for reducing dose requirement for sodium nitroprusside (SNP). Six patients, selected at random, were pretreated with captopril, 3 mg/kg po, and the remaining six patients served as controls. All patients received a similar anesthetic technique, consisting of thiopental 3 mg/kg, pancuronium 0.1 mg/kg, morphine 0.5 mg/kg, plus nitrous oxide 70% in oxygen. SNP was used to maintain mean arterial pressure (MAP) at 50-55 mmHg during deliberate hypotension lasting 140 ± 13 minutes (mean ± SE). Patients who received captopril required less SNP than untreated patients both early during hypotension (1.4 ± 0.5 μg.kg-1.min-1 vs. 4.8 ± 0.8 μg.kg-1.min-1, P < 0.05), as well as late during hypotension (2.2 ± 0.2 μg.kg-1.min-1 vs. 5.6 ± 0.6 μg.kg-1.min-1, P < 0.05). Whole blood cyanide was significantly lower in the patients pretreated with captopril than the untreated controls both early in the hypotensive period (2.7 ± 0.6 μmol/l vs. 13 ± 4 μmol/l, P < 0.05) and also late in the hypotensive period (3.7 ± 0.8 μmol/l vs. 30 ± 10 μmol/l, P < 0.05). MAP was reduced by captopril pretreatment both following induction of anesthesia (64 ± 4 mmHg captopril vs. 80 ± 4 mmHg control, P < 0.05) and during surgery before deliberate hypotension (86 ± 5 mmHg captopril vs. 100 ± 4 control, P < 0.05). Cardiac output did not differ significantly between the groups, either awake or after anesthetic induction. The authors conclude that captopril pretreatment significantly reduces the dose of SNP required to produce deliberate hypotension and, therefore, reduces the potential for cyanide toxicity. No adverse hemodynamic consequences of combining captopril with thiopental, N2O, or morphine anesthesia were observed.

AB - The authors studied 12 patients who required deliberate hypotension for spinal fusion operations in order to investigate the efficacy of captopril for reducing dose requirement for sodium nitroprusside (SNP). Six patients, selected at random, were pretreated with captopril, 3 mg/kg po, and the remaining six patients served as controls. All patients received a similar anesthetic technique, consisting of thiopental 3 mg/kg, pancuronium 0.1 mg/kg, morphine 0.5 mg/kg, plus nitrous oxide 70% in oxygen. SNP was used to maintain mean arterial pressure (MAP) at 50-55 mmHg during deliberate hypotension lasting 140 ± 13 minutes (mean ± SE). Patients who received captopril required less SNP than untreated patients both early during hypotension (1.4 ± 0.5 μg.kg-1.min-1 vs. 4.8 ± 0.8 μg.kg-1.min-1, P < 0.05), as well as late during hypotension (2.2 ± 0.2 μg.kg-1.min-1 vs. 5.6 ± 0.6 μg.kg-1.min-1, P < 0.05). Whole blood cyanide was significantly lower in the patients pretreated with captopril than the untreated controls both early in the hypotensive period (2.7 ± 0.6 μmol/l vs. 13 ± 4 μmol/l, P < 0.05) and also late in the hypotensive period (3.7 ± 0.8 μmol/l vs. 30 ± 10 μmol/l, P < 0.05). MAP was reduced by captopril pretreatment both following induction of anesthesia (64 ± 4 mmHg captopril vs. 80 ± 4 mmHg control, P < 0.05) and during surgery before deliberate hypotension (86 ± 5 mmHg captopril vs. 100 ± 4 control, P < 0.05). Cardiac output did not differ significantly between the groups, either awake or after anesthetic induction. The authors conclude that captopril pretreatment significantly reduces the dose of SNP required to produce deliberate hypotension and, therefore, reduces the potential for cyanide toxicity. No adverse hemodynamic consequences of combining captopril with thiopental, N2O, or morphine anesthesia were observed.

UR - http://www.scopus.com/inward/record.url?scp=0021337841&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0021337841&partnerID=8YFLogxK

M3 - Article

C2 - 6324616

AN - SCOPUS:0021337841

VL - 60

SP - 413

EP - 417

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 5

ER -