Chung Kum-Hee, Park Seo Min, Baek In Chan, Jang Junheum, Hong Yong-Woo, Ahn SoWoon
Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Korean J Anesthesiol. 2016 Apr;69(2):181-4. doi: 10.4097/kjae.2016.69.2.181. Epub 2016 Mar 30.
Sodium nitroprusside (SNP) is an anti-hypertensive drug, commonly used to decrease the systemic vascular resistance and lower the blood pressure. When the amount of cyanide generated by the SNP exceeds the metabolic capacity for detoxification, cyanide toxicity occurs. Under general anesthesia and cardiopulmonary bypass (CPB), it may be difficult to detect the development of cyanide toxicity. In cardiac surgical patients, hemolysis, hypothermia and decreased organ perfusion, which emphasize the risk of cyanide toxicity, may develop as a consequence of CPB. In particular, hemolysis during CPB may cause an unexpected overproduction of cyanide due to free hemoglobin release. We experienced a patient who demonstrated SNP tachyphylaxis and cyanide toxicity during CPB, even though the total amount of SNP administered was much lower than the recommended dose. We therefore report this case with a review of the relevant literature.
硝普钠（SNP）是一种抗高血压药物，常用于降低全身血管阻力和血压。当硝普钠产生的氰化物量超过解毒的代谢能力时，就会发生氰化物中毒。在全身麻醉和体外循环（CPB）下，可能难以检测到氰化物中毒的发生。在心脏手术患者中，体外循环可能导致溶血、体温过低和器官灌注减少，这些情况会增加氰化物中毒的风险。特别是，体外循环期间的溶血可能由于游离血红蛋白的释放而导致氰化物意外过量产生。我们遇到一名患者，在体外循环期间出现了硝普钠快速耐受性和氰化物中毒，尽管给予的硝普钠总量远低于推荐剂量。因此，我们报告此病例并复习相关文献。
