Summary
A death from cyanide poisoning during operation was attributable to the use of approximately 400 mg (10 mg per Kg) sodium nitroprusside as an hypotensive agent. Autopsy cyanide levels of 0.5 mg per cent in blood and 0.3 mg per cent in urine and thiocyanate levels too low to measure in either, suggest an abnormality of cyanide metabolism. The lethal dose of sodium nitroprusside appears to be 7 mg per Kg. A safe regimen would be 3.5 mg per Kg as the anticipated total dose for the period of hypotension. Patients resistant to the full hypotensive effects of sodium nitroprusside, or unable to maintain the level of hypotension, or requiring more than 3.5 mg per Kg to achieve the required effect for the anticipated time, may accumulate toxic levels of cyanide in the blood.
Patients with Leber’s optic atrophy, tobacco amblyopia and possibly those with other nerve atrophies should not receive sodium nitroprusside or any other cyanide precursor.
Résumé
Les auteurs rapportent un décès per-opératoire par empoisonnement au cyanure chez un malade ayant reçu une dose totale de 400 mg de Nitroprussiate de sodium (10 mg/kg). La détermination du taux sanguin et du taux urinaire de cyanure à l’autopsie a montré des taux respectifs de 0.5 et 0.3 mg%. Des taux de thiocyanates trop bas pour être déterminés suggèrent un métabolisme anormal du thiocyanate.
La dose léthale de Nitroprussiate semble se situer autour de 7 mg/kg. L’établissement anticipé d’une dose totale plus petite que 3.5 mg/kg pour toute la durée de l’intervention nous semble recommandable.
Chez des patients qui présentent une résistance anormale aux doses habituelles de Nitroprussiate ou incapables de maintenir leur niveau d’hypotension avec une dose constante de Nitroprussiate ou qui requièrent une dose totale anticipée supérieure à 3.5 mg/kg, le taux de cyanure sanguin peut atteindre des seuils toxiques.
Les malades présentant le syndrome d’atrophie optique de Leber, une amblyopie tabagique et possiblement ceux souffrant d’autres atrophies nerveuses ne devraient pas recevoir de Nitroprussiate.
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Davies, D.W., Kadar, D., Steward, D.J. et al. A Sudden death associated with the use of sodium nitroprusside for induction of hypotension during anaesthesia. Canad. Anaesth. Soc. J. 22, 547–552 (1975). https://doi.org/10.1007/BF03013407
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DOI: https://doi.org/10.1007/BF03013407