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Anesth Analg 2007;105:29-33
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000264078.34514.32

CARDIOVASCULAR ANESTHESIOLOGY

Cardiopulmonary Bypass, Hemolysis, and Nitroprusside-Induced Cyanide Production

Albert T. Cheung, MD, Gonzalo E. Cruz-Shiavone, BA, Qing C. Meng, PhD, Alberto Pochettino, MD, John A. Augoustides, MD, Joseph E. Bavaria, MD, and E. Andrew Ochroch, MD, MSCE

From the Departments of Anesthesiology, Surgery, and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.

Address correspondence and reprint requests to Albert T. Cheung, MD, Department of Anesthesia and Critical Care Medicine, University of Pennsylvania, 3400 Spruce St., Dulles 680, Philadelphia, PA 19104-4283. Address e-mail to cheunga{at}uphs.upenn.edu.

Abstract

BACKGROUND: Cyanide toxicity is a complication of sodium nitroprusside administration. Cardiac surgery may increase the risk of cyanide toxicity, because hemolysis during cardiopulmonary bypass (CPB) may catalyze the release of free cyanide from sodium nitroprusside.

METHODS: We obtained serial blood specimens from 25 cardiac surgical patients during CPB. Plasma specimens were analyzed for free hemoglobin concentration and ability to generate free cyanide anion upon exposure to sodium nitroprusside.

RESULTS: Hemolysis based on plasma-free hemoglobin concentration increased over time during CPB at an average rate of 0.27 mg·dL–1·min–1 (P < 0.001). The concentration of free cyanide generated by the addition of sodium nitroprusside to the plasma samples was directly related to the plasma-free hemoglobin concentration (P < 0.001).

CONCLUSION: CPB-associated hemolysis and free hemoglobin release accelerated the immediate release of free cyanide from sodium nitroprusside. These in vitro findings suggest that cardiac surgical patients may be at increased risk of cyanide toxicity in response to the perioperative administration of sodium nitroprusside.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.