Sodium nitroprusside is a potent and fast-acting peripheral vasodilator with the full name of sodium nitrosocyanide, which can directly relax small arteries, veins and vascular smooth muscle, increase cardiac output and reduce myocardial ischemia, and is clinically effective in the treatment of heart failure and hypertensive emergencies. However, in the actual application process, due to the lack of care and observation, it can bring serious consequences to patients. The usual application is described below. Feng Baolin, Department of Cardiovascular Medicine, No.2 People’s Hospital, Neihuang, Henan Province, China
1 – Dosing method
The dose of sodium nitroprusside is mostly 25mg to 50mg added to 250 or 500ml of liquid and slowly administered by IV. It can be started from 30ug/minute, and after 10 minutes the dose is gradually increased according to the patient’s blood pressure, usually not more than 200ug/minute. It can be used once a day or can be continued until the symptoms are relieved.
2 – Drug combination
(1) Many reports with dobutamine, dobutamine can increase the efficacy, but if the patient combined with atrial fibrillation should strictly control the dose to prevent increasing the patient’s ventricular rate. In addition, it should not be mixed with sodium nitroprusside in the same bottle.
(2) Clinical can be combined with cardiac stimulants and diuretics.
3 – Care
1) Necessary preparation before medication: firstly, clarify the purpose of medication to the patient as well as family members to obtain cooperation. It is strictly forbidden to change the drip rate without authorization. Avoid light with light-proof paper before drip, and use up the prepared liquid in 4 to 6 hours. Do not continue to use if the liquid turns blue, green or red. Measure blood pressure, heart rate and pulse before administration. Connect monitoring equipment.
(2) Strictly control the speed of administration: applying too fast can cause the patient’s blood pressure to drop excessively, resulting in nausea, headache, profuse sweating, palpitations and other symptoms, and even lead to brain infarction. If this happens, the symptoms can mostly be relieved by timely speed adjustment. At the same time, the drip rate should not be too slow, the drug concentration in the blood does not reach the requirements and affect the efficacy.
(3) Patient’s position: Patients with heart failure can adopt a semi-recumbent or sitting position, which is favorable for symptom relief. Patients in the use of sodium nitroprusside drip longer, often need to change the position, different positions will directly affect the speed of drip, thus affecting the efficacy.
(4) Closely observe the heart rate (Transport Transport State Angsu Χ just we frighten the cupboard cut Mu left trespass gnawing ∈ coin Huaiwei dangerous basal bone salvage project scalping buzzing Minamata caries繁Q Gon 3衷谡7段В∪擞帜苣褪埽佣忱瓿烧龉檀锏街瘟相当康摹
(5) Observe the symptoms and signs of heart failure: weigh the patient several times before and after admission, observe the patient’s range of motion and tolerance after activity, observe the patient’s posture, heart rate and respiratory changes to understand the drug effect and cardiac function, especially strengthen the observation at night. After treatment most patients can sleep flat and their respiratory distress is reduced.
(6) Observation of urine volume, weight and sweating: daily weight measurement in the early morning on an empty stomach can reflect the change of water load in the body, while accurately recording the urine volume and paying attention to the presence of sweating and the amount of sweating. Pay attention to the changes in water and electrolytes, normal conditions will be weight loss and increased urine output.
(7) Monitor the side effects: the general reactions are nausea, headache and loss of appetite, which can be relieved by symptomatic treatment. Sometimes liver and kidney ocarina injury may occur, which needs to be treated separately.
4 – Precautions for drug administration
(1) The medication should be administered slowly, starting with a small amount and adjusted according to the condition and vital signs.
(2) Use with caution in children, patients with severe coronary artery or cerebrovascular insufficiency, and patients with hepatic, renal and thyroid insufficiency.
(3) Patients with heart failure should gradually discontinue the drug and should not stop it suddenly to avoid aggravation.
(4) It is better to monitor the plasma cyanide concentration during the drug administration to minimize the toxic side effects.