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Ann Thorac Surg 1989;47:678-683
© 1989 The Society of Thoracic Surgeons

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Articles

Automated control of postoperative hypertension: A prospective, randomized multicenter study

^a Departments of Thoracic and Cardiovascular Surgery and Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
^b Department of Anesthesia, Emory Clinic, Atlanta, Georgia, USA
^c Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA

^_* Address reprint requests to Dr Cosgrove, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, One Clinic Circle, 9500 Euclid Ave, Cleveland, OH 44195-5066.

Hypertension after a cardiac operation is a frequent phenomenon. Complications resulting from this include bleeding, disruption of vascular suture lines, subendocardial ischemia, and possible cerebrovascular accidents. Treatment with sodium nitroprusside has become accepted practice to prevent these complications. To improve control of arterial blood pressure, a closed-loop system for sodium nitroprusside administration was developed. A prospective, randomized multicenter study was carried out postoperatively in 180 cardiac surgical patients to evaluate the performance of this system compared with manual control of infusion. Adherence of mean arterial blood pressure to ±10% of the target blood pressure occurred 85% of the time with the automatic system and 61% of the time with manual regulation (p < 0.0001). With the automatic system, there was less hypertension (9% versus 22%; p < 0.0001) and hypotension (6% versus 22%; p < 0.0001). The superior control of hypertension was achieved more rapidly with less requirement for nurse regulation of infusion rate. The superior control of blood pressure resulted in less chest tube drainage in the automatic mode (720 mL versus 840 mL; p < 0.05).

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