title: Cyanide toxicity during cardiopulmonary bypass with small dose of nitroprusside: a case report.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Kum-Hee
authors.initials: KH
authors.lastname: Chung
authors.affiliation: Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Seo Min
authors.initials: SM
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: In Chan
authors.initials: IC
authors.lastname: Baek
authors.affiliation: Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Junheum
authors.initials: J
authors.lastname: Jang
authors.affiliation: Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Yong-Woo
authors.initials: YW
authors.lastname: Hong
authors.affiliation: Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: SoWoon
authors.identifier: 0000-0002-2990-528X
authors.initials: S
authors.lastname: Ahn
keywords: Cardiopulmonary bypass; Cyanides; Sodium nitroprusside; Toxicity