Journal of Anaesthesiology Clinical Pharmacology

REVIEW ARTICLE
Year
: 2014  |  Volume : 30  |  Issue : 4  |  Page : 462--471

Sodium nitroprusside in 2014: A clinical concepts review


Daniel G Hottinger, David S Beebe, Thomas Kozhimannil, Richard C Prielipp, Kumar G Belani 
 Department of Anesthesiology, University of Minnesota, Minneapolis, MN 55455, USA

Correspondence Address:
Kumar G Belani
Department of Anesthesiology, University of Minnesota, MMC 8294, 420 Delaware Street SE, Minneapolis, MN 55455
USA

Sodium nitroprusside has been used in clinical practice as an arterial and venous vasodilator for 40 years. This prodrug reacts with physiologic sulfhydryl groups to release nitric oxide, causing rapid vasodilation, and acutely lowering blood pressure. It is used clinically in cardiac surgery, hypertensive crises, heart failure, vascular surgery, pediatric surgery, and other acute hemodynamic applications. In some practices, newer agents have replaced nitroprusside, either because they are more effective or because they have a more favorable side-effect profile. However, valid and adequately-powered efficacy studies are sparse and do not identify a superior agent for all indications. The cyanide anion release concurrent with nitroprusside administration is associated with potential cyanide accumulation and severe toxicity. Agents to ameliorate the untoward effects of cyanide are limited by various problems in their practicality and effectiveness. A new orally bioavailable antidote is sodium sulfanegen, which shows promise in reversing this toxicity. The unique effectiveness of nitroprusside as a titratable agent capable of rapid blood pressure control will likely maintain its utilization in clinical practice for the foreseeable future. Additional research will refine and perhaps expand indications for nitroprusside, while parallel investigation continues to develop effective antidotes for cyanide poisoning.


How to cite this article:
Hottinger DG, Beebe DS, Kozhimannil T, Prielipp RC, Belani KG. Sodium nitroprusside in 2014: A clinical concepts review .J Anaesthesiol Clin Pharmacol 2014;30:462-471


How to cite this URL:
Hottinger DG, Beebe DS, Kozhimannil T, Prielipp RC, Belani KG. Sodium nitroprusside in 2014: A clinical concepts review . J Anaesthesiol Clin Pharmacol [serial online] 2014 [cited 2021 Feb 26 ];30:462-471
Available from: https://www.joacp.org/article.asp?issn=0970-9185;year=2014;volume=30;issue=4;spage=462;epage=471;aulast=Hottinger;type=0