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Canadian Journal of Anesthesia, Vol 22, 553-560, Copyright © 1975 by Canadian Anesthesiologists' Society

Sodium Nitroprusside In Children: Observations on Metabolism During Normal and Abnormal Responses

D. W. DAVIES 1, LEILA GREISS 1, D. KADAR 1, and D. J. STEWARD 1

1 Departments of Anaesthesia and Pharmacology, University of Toronto, Toronto, Canada

Address reprints requests to: Dr. D.W. Davies, Department of Anaesthesia, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario. Canada M5G 1X8

Three different responses to sodium nitroprusside as a hypotensive agent during anaesthesia in children are described. A constant high dose (< 3 mg/Kg) response to, abnormal resistance to and tachyphylaxis to the drug are recognised and are dangerous and potentially lethal. They are probably related to abnormalities of cyanide-thiocyanate metabolism resulting in cyanide accumulation. The abnormal responses produce metabolic acidosis, an increase in mixed venous oxygen tension and a decrease in arterial-mixed venous oxygen content difference. Tachyphylaxis may be due to depletion of endogenous thiosulphate and was reversible by sodium thiosulphate therapy (150 mgm/Kg) in two cases in which it was used.






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Copyright © 1975 by the Canadian Anesthesiologists' Society.