Simultaneous infusion of nitroglycerin and nitroprusside to offset adverse effects of vasopressin during portosystemic shunting.
In the present study, 52 patients with cirrhosis, portal hypertension, and variceal hemorrhage underwent either an elective or an emergency side-to-side portacaval shunt operation. Vasopressin was infused intravenously at 60 units/hour from just prior to abdominal incision until completion of the anastomosis. Eight of 35 patients who received vasopressin alone (23 percent) tolerated increased doses of 75 to 90 units/hour to obtain hemostasis. Four of 52 patients required simultaneous infusion of sodium nitroprusside to correct systemic hypertension. An additional 15 percent reduction in portal venous pressure occurred in these patients. Eleven of 13 patients with vasopressin-induced myocardial ischemia responded to simultaneous infusion of nitroglycerin. Further prospective studies are indicated to adequately delineate the dose and duration of therapy with either nitroprusside or nitroglycerin for simultaneous administration with intravenous vasopressin.
Sirinek
K R
KR
Department of Surgery, University of Texas Health Science Center, San Antonio 78284-7842.
Adcock
D K
DK
Levine
B A
BA
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000139:chemically induced / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D005292:Ferricyanides / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use*; D009599:Nitroprusside / Q000627:therapeutic use*; D011167:Portacaval Shunt, Surgical; D012189:Retrospective Studies; D014667:Vasopressins / Q000009:adverse effects* / Q000037:antagonists & inhibitors
D005292:Ferricyanides; D014667:Vasopressins; D009599:Nitroprusside; D005996:Nitroglycerin