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Volume 349:811-813 August 21, 2003 Number 8
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Nitroprusside in Critically Ill Patients with Aortic Stenosis

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by Khot, U. N.
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To the Editor: The study by Khot et al. (May 1 issue)1 regarding the use of nitroprusside in patients with severe aortic stenosis and severe left ventricular systolic dysfunction is encouraging. However, we do not agree with the authors that nitroprusside is a safe drug. It has a very narrow therapeutic window and requires close monitoring. Nitroprusside-induced cyanide intoxication may be fatal.2 The addition of thiosulfate to nitroprusside infusion may decrease the risk of cyanide intoxication.3 Thiocyanate toxicity is another potential problem. Patients receiving a high-dose infusion (>2 to 3 µg per kilogram of body weight per minute) or patients . . . [Full Text of this Article]



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