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Ann Thorac Surg 1982;34:307-312
© 1982 The Society of Thoracic Surgeons

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Articles

Effect of Sodium Nitroprusside during the Payback Period of Cardiopulmonary Bypass on the Incidence of Postoperative Arrhythmias

From the Minneapolis Heart Institute, Minneapolis, MN, and United Hospitals, St. Paul, MN

^* Address reprint requests to Dr. Arom, Minneapolis Heart Institute, 2545 Chicago Ave S, Minneapolis, MN 55404

This study was designed to determine whether a sodium nitroprusside infusion during the reperfusion (payback) period of cardiopulmonary bypass would minimize arrhythmias during the early postoperative period of coronary artery bypass surgery. A double-blind randomized study was carried out in 38 patients with no previous history of ventricular arrhythmias. Seventeen received 5% dextrose in water (D5W) and 21 received sodium nitroprusside at the rate of 2 µg per kilogram per minute during the payback period. The pump flow was kept constant at 2.2 liters per square meter per minute, and mean pressure was maintained at > 50 mm Hg.

There was a statistically significant difference between the two groups in the number of patients who developed ventricular arrhythmias (13 of 17, or 76%, in the D5W group versus 6 of 21, or 29%, in the sodium nitroprusside group; p < 0.005). Twelve of the 13 patients in the D5W group experienced arrhythmias (6 ventricular tachycardia and 6 ventricular premature depolarization) within the first 24 hours, compared to 5 of 12 patients in the nitroprusside group (3 ventricular tachycardia and 2 ventricular premature depolarization). Only 1 patient in each group developed ventricular arrhythmia after the first postoperative day. One patient in each group experienced atrial arrhythmia during the first 24 hours. After 24 hours, atrial arrhythmias developed in 5 patients in the D5W group (35%) and 3 patients in the sodium nitroprusside group (17%) (p > 0.05). The arterial pH ranged from 7.35 to 7.55, with a Po₂ greater than 70 torr and a serum potassium of 3.7 ± 0.36 mEq per liter in the D5W group and 3.4 ± 0.34 mEq per liter in the nitroprusside group during the period of arrhythmias. Sodium nitroprusside given during the payback period of cardiopulmonary bypass appears to minimize ventricular arrhythmias in the early postoperative period of coronary artery bypass surgery.

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