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British Journal of Anaesthesia, 1985, Vol. 57, No. 2 148-155
© 1985 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

BLOOD CYANIDE AND THIOCYANATE CONCENTRATIONS PRODUCED BY LONG-TERM THERAPY WITH SODIUM NITROPRUSSIDE

C. J. VESEY, M.D. and P. V. COLE, M.D.

Anaesthetics Research Laboratory, St Bartholomew's Hospital London EC1A 7BE

Blood cyanide (HCN) or plasma thiocyanate (SCN) concentrations, or both, were measured in 30 patients (ages 11 months-72 yr) receiving sodium nitroprusside (SNP) for 12–314 h. Sequential measurements in three of these patients (infused 5, 12 and 13 days) showed that HCN concentrations varied with dose rate, while SCN concentrations increased linearly with increasing SNP dose. The accumulated data confirmed that the rate of administration (0.3–6.5 µg kg–1 min–1) determined the plasma HCN concentrations (0–3.8 µmol litre–1; y = 0.267 x - 0.0733; r = 0.64; n = 51; P< 0.001). Thus, if prolonged exposure to plasma HCN concentrations greater than 1 µmol litre–1 is to be avoided, the maximum safe sustained dose rate of SNP will lie near to 4 µg kg–1 min–1. Likewise, the SCN results (30—880 iimol litre–1) confirmed the close relationship between plasma concentrations and the total SNP dose (0.44–32.9 mg kg–1; y = 24.6x + 74.9; r = 0.95, n = 51, P < 0.001). Therefore, we suggest that, to avoid SCN toxicity (plasma SCN > 1.75 µmol litre–1), in the absence of SCN monitoring, the total SNP dose should be less than 70 mg kg–1 in patients with normal renal function.


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