Nitroprusside and Epinephrine for Treatment of Low Output in Children after Open-Heart Surgery

We evaluated the acute hemodynamic effects of treatment of the low output state with sodium nitroprusside and epinephrine in 13 children after intracardiac operation. The 13 patients were selected from a consecutive series of 106 children undergoing cardiopulmonary bypass. They had a cardiac index less than 2.0 L/min/m 2, even after an increase in left ventricular filling pressure and during infusion of nitroprusside. Although the nitroprusside brought about a significant increase in cardiac output and decrease in systemic vascular resistance, the cardiac index remained critically low (less than 2 L/min/m 2). Epinephrine resulted in a further significant increase in the cardiac index, without a significant change in systemic resistance. This study suggests that in selected patients the simultaneous use of both a vasodilator drug (sodium nitroprusside) and a positive inotropic agent (epinephrine) is advantageous in the short-term treatment of the low cardiac output state after intracardiac operation.