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Nitroprusside- and nitroglycerin-induced hypotension: Effects on hemodynamics and on the microcirculation

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Abstract

After a short summary of the effects and metabolism of sodium nitroprusside (SNP) and nitroglycerin (NTG), the influence of induced hypotension on hemodynamics and on the microcirculation is investigated. The continuous registration of the local tissue pO2 in skeletal muscle, myocardium, and liver with the multiwire surface electrode provides the opportunity to recognize immediately a change in the microcirculatory bed. This new method shows in animal experiments that the local oxygen supply during SNP-induced hypotension is dramatically reduced, while the arterial pO2 remains in a normal range. These changes are not found during NTG-induced hypotension. Electron microscopic examination of various organs, and especially of the myocardium, shows that the alterations of the oxygen supply found after application of SNP were connected with changes in the ultrastructure.

Résumé

Après un bref résumé sur les effets et le métabolisme du sodium-nitroprusside (SNP) et de la nitroglycérine (NTG), l'influence de l'hypotension provoquée sur les hemodynamiques et sur la microcirculation est examinée en détail. L'enregis-trement continu du PO2 du tissu local dans les muscles squelettiques, le myocarde et le foie au moyen de l'électrode de surface à multiples fils métalliques donne l'occasion de reconnaître immédiatement un changement dans la couche microcirculaire. Cette nouvelle méthode montre que, dans les expériences pratiquées sur les animaux, l'approvisionnement local en oxygène pendant l'hypotension provoquée par le SNP est considérablement réduit tandis que le PO2 artériel demeure dans une zone normale. Ces changements ne sont pas présents dans l'hypotension provoquée par la nitroglycerine. L'examen de divers organes (et particulièrement du myocarde) à l'électron microscopique révèle que la modification de l'approvisionnement en oxygène constaté après l'application du SNP était liée à des changements dans l'ultrastructure.

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References

  1. Kohlstaedt, K.G., Page, I.H.: Hemorrhagic hypotension and its treatment by intraarterial and intravenous infusion of blood. Arch. Surg.47:178, 1943

    Google Scholar 

  2. Bilsland, W.L.: Controlled hypotension by arteriotomy in intracranial surgery. Anaesthesia6:20, 1951

    Google Scholar 

  3. Griffiths, H.W.C., Gillies, J.: Thoraco-lumbar splanchniectomy and sympathectomy. Anaesthesia3:134, 1948

    Google Scholar 

  4. Murtagh, G.P.: Controlled hypotension with Halothan. Anaesthesia15:235, 1960

    Google Scholar 

  5. Hess, W., Tarnow, J., Patschke, D., Passian, J., Brückner, J.B.: Hämodynamik und Sauerstoffversorgung des Herzens bei kontrollierter Hypotension mit Natriumnitroprussid und Trimethaphan. Anaesthetist25:27, 1976

    Google Scholar 

  6. Johnson, C.C.: The action and toxicity of sodium nitroprusside. Arch. Intern. Pharmacodyn.35:480, 1929

    Google Scholar 

  7. Gifford, R.W.: Hypertensive emergencies and their treatment. Med. Clin. North Am.45:411, 1961

    Google Scholar 

  8. Page, J.H., Corcoran, A.C., Dustan, H.P., Koppany, T.: Cardiovascular actions of sodium nitroprusside in animals and hypotensive patients. Circulation11: 188, 1955

    Google Scholar 

  9. Moraca, P.P., Bitte, E.M., Hale, D.E., Wasmuth, C.E., Pontasse, E.G.: Clinical evaluation of sodium nitroprusside as a hypotensive agent. Anesthesiology23: 193, 1962

    Google Scholar 

  10. Höbel, M., Kreye, V.A.W., Phill, J.: Effect of sodium nitroprusside alone and in combination with sodium thiosulfate on the acid-base balance, and on thiocyanate and iron plasma levels in the rabbit. Klin. Wochenschr.56 (Suppl.I):147, 1978

    Google Scholar 

  11. Barker, M.H.: The blood cyanates in the treatment of hypertension. J.A.M.A.106:762, 1936

    Google Scholar 

  12. Bhatia, S.K., Fröhlich, E.D.: Hemodynamic comparison of agents useful in hypertensive emergencies. Am. Heart J.85:367, 1973

    Google Scholar 

  13. Brunton, T.L.: On the use of nitrite of amyl in angina pectoris. Lancet2:97, 1867

    Google Scholar 

  14. Murrel, W.: Nitroglycerin as a remedy for angina pectoris. Lancet1:80, 1879

    Google Scholar 

  15. Boyer, N.H., Green, H.D.: The effects of nitrites and xanthines on coronary inflow and blood pressure in anesthetized dogs. Am. Heart J.21: 199, 1941

    Google Scholar 

  16. Brandt, J.L., Caccese, A., Dock, W.: Slit-kymographic evidence that nitroglycerine decreases heart volume and stroke volume, while increasing amplitude of ballistocardiographic waves. Am. J. Med.12:650, 1952

    Google Scholar 

  17. Charlier, R.: Antianginal drugs. In Handbuch der experimentellen Pharmakologie, Vol. 31, Berlin-Heidelberg-New York, Springer-Verlag, 1971

    Google Scholar 

  18. Christensson, B., Korlefors, T., Westling, H.: Hemodynamic effects of nitroglycerin in patients with coronary heart disease. Br. Heart J.27:511, 1965

    Google Scholar 

  19. Coleman, H.N., Sonnenblick, E.H., Braunwald, E.: Myocardial oxygen consumption associated with external work: The Feen effect. Am. J. Physiol.217:291, 1969

    Google Scholar 

  20. Cameron, P.D.: Physiological and pharmacological studies on cardiac tonicity in mammals. Johns Hopkins Hosp. Rep.16:549, 1911

    Google Scholar 

  21. Essex, H.E., Wegria, G.E., Herrick, J.F., Mann, F.C.: The effect of certain drugs on the coronary blood flow of the trained dog. Am. Heart J.19:554, 1940

    Google Scholar 

  22. Müller, O., Rovik, K.: Hemodynamic consequences of coronary heart disease: With observations during anginal pain and on the effect of nitroglycerin. Br. Heart J.20:302, 1958

    Google Scholar 

  23. Wayne, E.J., Laplace, L.B.: Observations on angina on effort. Clin. Sci.1:103, 1933

    Google Scholar 

  24. Wegria, R., Nickerson, J.L., Case, R.B., Holland, J.F.: Effect of nitroglycerin on the cardiovascular system of normal persons. Am. J. Med.10:414, 1951

    Google Scholar 

  25. Strauer, B.E.: Der Mechanismus der Nitroglycerinwirkung vom Aspekt der Myokardkontraktilität. Z. Kardiol.62:97, 1973

    Google Scholar 

  26. Winbury, M.M., Howe, B.B., Hefner, M.A.: Effects of nitrates and other coronary dilators on large and small coronary vessels: An hypothesis for the mechanism of action of nitrates. J. Pharmacol. Exp. Ther.168:70, 1963

    Google Scholar 

  27. Eldridge, F.L., Hultgren, H.N., Stewart, P., Proctor, D.: Effect of nitroglycerin upon the cardiovascular system. Stanford Med. Bull.13:273, 1955

    Google Scholar 

  28. Ferrer, M.I., Bradley, S.E., Wheeler, H.O., Euxon, Y., Preisig, R., Brickner, P.W., Conroy, R.J., Harvey, R.M.: Some effects of nitroglycerin upon the splanchnic, pulmonary and systemic circulation. Circulation33:357, 1966

    Google Scholar 

  29. Lochner, W., Raff, W.K., Kosche, F., Holtermann, W.: On the mechanism of action of nitroglycerin: Experimental studies on anesthetized dogs. In Coronary Heart Disease, M. Kaltenbach, P. Lichlen, G.C. Friesinger, editors, Stuttgart, Thieme, 1973

    Google Scholar 

  30. Mason, D.T., Braunwald, E.: The effects of nitroglycerin and amyl nitrite on arteriolar and venous tone in the human forearm. Circulation32:755, 1965

    Google Scholar 

  31. Hagemann, K., Niehues, B., Arnold, G., Lochner, W.: Intravasales Volumen und Strömungswiderstand des groβen und kleinen Kreislaufes unter der Wirkung von Nitroglycerin. Verh. Dtsch. Ges. Kreisl.-Forsch.39:243, 1973

    Google Scholar 

  32. Hauss, J., Schönleben, K., Spiegel, U.: Die kontrollierte Hypotension mit Natriumnitroprussid. Herz/ Kreisl.8:379, 1978

    Google Scholar 

  33. Kessler, M., Bruley, D.F., Clark, L.L., Lübbers, D.W., Silver, I.A., Strauss, J.: Oxygen Supply. München, Urban & Schwarzenberg, 1973

    Google Scholar 

  34. Kessler, M., Höper, J., Krumme, B.A.: Monitoring of tissue perfusion and cellular function. Anesthesiology45:184, 1976

    Google Scholar 

  35. Kessler, M., Höper, J., Schäfer, D., Starlinger, H.: Sauerstofftransport im Gewebe. Schriftenreihe Anaesthesiologie und Intensivtherapie, Vol. V, Mikrozirkulation, F.W. Ahnefeld, L. Burri, W. Dick, M. Halmagyi, editors, Springer, 1974

  36. Lübbers, D.W., Luft, V.C., Thews, G., Witzleb, E.: Oxygen Transport in Blood and Tissue. Stuttgart, Thieme, 1968

    Google Scholar 

  37. Lübbers, D.W.: Exchange processes in the microcirculatory bed. Hdb. allg. Path.III/7:411, 1977

    Google Scholar 

  38. Schönleben, K., Krumme, B.A., Bölling, B., Kessler, M.: Microcirculation and oxygen supply in skeletal muscle under physiological and pathological conditions. Pflügers Arch.359:67, 1975

    Google Scholar 

  39. Kessler, M., Lübbers, D.W.: Aufbau und Anwendungsmöglichkeiten verschiedener pO2-Elektroden. Pflügers Arch. Ges. Physiol.291:32, 1966

    Google Scholar 

  40. Kunze, K.: Das Sauerstoffdruckfeld im normalen und pathologisch veränderten Muskel. Berlin, Springer-Verlag, 1969

    Google Scholar 

  41. Schönleben, K., Krumme, B.A., Bünte, H., Kessler, M.: Kontrolle der Intensivbehandlung durch Messung von Mikrozirkulation und O2-Versorgung. Langenbecks Arch. Suppl. Chir. Forum72: 1976

  42. Zimmermann, G., Hess, W., Johannsen, H., Patschke, D.: The cardiovascular effects of the inspiratory N2O-concentration during piritramide anaesthesia in dogs. Anaesthetist26:257, 1977

    Google Scholar 

  43. Messmer, K., Sunder-Plassmann, L., Jesch, F., Görnandt, L., Sinagowitz, E., Kessler, M.: Oxygen supply to the tissue during limited normovolemic hemodilution. Res. Exp. Med.159:152, 1973

    Google Scholar 

  44. Messmer, K., Görnandt, L., Sinagowitz, E., Sunder-Plassmann, L., Jesch, F., Kessler, M.: Local oxygen tension in tissue of different organs during limited normovolemic hemodilution. Bibl. Anat.12:327, 1973

    Google Scholar 

  45. Huch, R., Lübbers, D.W., Huch, A.: Quantitative continuous measurement of partial oxygen pressure on the skin of adults and newborn babies. Pflügers Arch. Ges. Physiol.337:185, 1974

    Google Scholar 

  46. Mann, T., Cohn, P.F., Holmann, L., Green, L.H., Markis, J.E., Philips, D.A.: Effect of nitroprusside on regional myocardial blood flow in coronary artery disease. Results in 25 patients and comparison with nitroglycerin. Circulation57:732, 1978

    Google Scholar 

  47. Michenfelder, J.D.: Cyanide release from sodium nitroprusside in the dog. Anesthesiology46:196, 1977

    Google Scholar 

  48. Nakamura, S., Skin, T., Horokata, Y., Shigematsu, A.: Inhibition of mitochondrial respiration by sodium nitroprusside and the mechanism of cyanide liberation. Br. J. Anaesth.49:1239, 1977

    Google Scholar 

  49. Zweifach, B.W.: Functional Behavior of the Microcirculation. Springfield, Ill., Charles C Thomas, 1961

    Google Scholar 

  50. Tountas, C.J., Georgropolos, A.I., Kiyriakon, K.V., Marxos, A.A.: The effect of sodium nitroprusside on coronary circulation. J. Cardiovasc. Surg.6:100, 1965

    Google Scholar 

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Authors and Affiliations

  1. Chirurgische Universitäts-Klinik Münster, Allgemeinchirurgie, and Lehrstuhl für Medizinische Cytobiologie der Universität Münster, Münster, West Germany

    Jan Hauss M.D., Klaus Schönleben M.D., Hans Ullrich Spiegel & Hermann Themann M.D.

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  1. Jan Hauss M.D.
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  2. Klaus Schönleben M.D.
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  3. Hans Ullrich Spiegel
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  4. Hermann Themann M.D.
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Supported by a grant from the Ministerium für Wissenschaft und Forschung des Landes Nordrhein-Westfalen.

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Hauss, J., Schönleben, K., Spiegel, H.U. et al. Nitroprusside- and nitroglycerin-induced hypotension: Effects on hemodynamics and on the microcirculation. World J. Surg. 6, 241–250 (1982). https://doi.org/10.1007/BF01654701

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