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European Heart Journal 1984 5(2):140-145;
Copyright © 1984 by the European Society of Cardiology.
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© 1984 The European Society of Cardiology

Nifedipine versus nitroprusside for controlling hypertensive episodes during coronary artery bypass surgery

W. HESS, U. SCHULTE-SASSE and J. TARNOW

Department ofAnaesthesiology, Free University of Berlin Charlottenburg Clinic, 1000 Berlin 19, F.R.G

Received 29 March 1983; revised 29 June 1983; .

Reprint requests to: Dr med. w. Hess.

Abstract

Intraoperative hypertensive episodes are a common problem in patients undergoing coronary artery bypass grafting. Twenty patients who developed acute hypertension (mean arterial pressure increase to 110 mmHg) were studied. Ten patients received nifedipine (about 3 fig µg–1 min–1) and ten patients nitroprusside (about 0-75 fig/kg–1 min–1) to return arterial blood pressure to control levels. All patients were anaesthetized with Jlunitrazepam, fentanyl, pancuronium and N20/V2. The study compares the effects of nifedipine and nitroprusside on systemic and pulmonary haemodynamics. Both nifedipine and nitroprusside decreased arterial pressure to baseline values within about 3 min by reducing the elevated systemic vascular resistance. Cardiac filling pressures and pulmonary artery pressure decreased significantly only with nitroprusside. Following nitroprusside cardiac output remained unchanged whereas nifedipine increased cardiac output and stroke volume when blood pressure was lowered by a comparable degree.

The data suggest that nifedipine primarily affects resistance vessels in the systemic circulation without significantly changing venous tone as opposed to the effect of nitroprusside. Thus, nifedipine appears to be an appropriate vasodilator for controlling arterial hypertensive episodes in patients with coronary artery disease and normal left ventricular function.

Key Words: Nifedipine • nitroprusside • hypertension • coronary artery disease


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