The action of sodium nitroprusside on the pial vessels

Sodium nitroprusside dilates cerebral vessels and enhances internal carotid artery flow in young men

KEY POINTS

Sodium nitroprusside lowers blood pressure by vasodilatation but is reported to reduce cerebral blood flow. In healthy young men sodium nitroprusside reduced blood pressure, total peripheral resistance, and arterial CO₂ tension and yet cerebral blood flow was maintained, with an increase in internal carotid artery blood flow and cerebrovascular conductance. Sodium nitroprusside induces both systemic and cerebral vasodilatation affecting internal carotid artery more than vertebral artery flow.

ABSTRACT

Cerebral autoregulation maintains cerebral blood flow (CBF) despite marked changes in mean arterial pressure (MAP). Sodium nitroprusside (SNP) reduces blood pressure by vasodilatation but is reported to lower CBF, probably by a reduction in its perfusion pressure. We evaluated the influence of SNP on CBF and aimed for a 20% and then 40% reduction in MAP, while keeping MAP ≥ 50 mmHg, to challenge cerebral autoregulation. In 19 healthy men (age 24 ± 4 years; mean ± SD) duplex ultrasound determined right internal carotid (ICA) and vertebral artery (VA) blood flow. The SNP reduced MAP (from 83 ± 8 to 69 ± 8 and 58 ± 4 mmHg; both P < 0.0001), total peripheral resistance, and arterial CO₂ tension (P aC O2; 41 ± 3 vs. 39 ± 3 and 37 ± 4 mmHg; both P < 0.01). Yet ICA flow increased with the moderate reduction in MAP but returned to the baseline value with the large reduction in MAP (336 ± 66 vs. 365 ± 69; P = 0.013 and 349 ± 82 ml min^-1 ; n.s.), while VA flow (114 ± 34 vs. 112 ± 38 and 110 ± 42 ml min^-1 ; both n.s.) and CBF ((ICA + VA flow) × 2; 899 ± 135 vs. 962 ± 127 and 918 ± 197 ml min^-1 ; both n.s.) were maintained with increased cerebrovascular conductance. In conclusion, CBF is maintained during SNP-induced reduction in MAP despite reduced P aC O2 and the results indicate that SNP dilates cerebral vessels and increases ICA flow.

The effect of sodium nitroprusside on cerebral hemodynamics and headache in healthy subjects

Investigation

Sodium nitroprusside (SNP) is a powerful vasodilatory agent that, similarly to glyceryl trinitrate (GTN), releases nitric oxide (NO) but in contrast does not pass the blood-brain barrier. Nevertheless, it has already been used in animal models without any knowledge of its headache-inducing potential. We hypothesized that SNP would induce headache and vasodilation of cephalic and radial but not cerebral arteries.

Methods

Five healthy volunteers received intravenous infusions of SNP in a non-randomized dose-titration (1–5 µg/kg/min) study. We recorded headache intensity (verbal rating scale from 0 to 10), velocity in the middle cerebral artery (VMCA), and diameters of the superficial temporal artery (STA) and radial artery (RA).

Results

All participants reported a dose-related headache (median peak = 2.5, range 0–3). SNP dilated the STA and RA, caused a marked increase of heart rate and a decrease of mean arterial pressure (MAP) and partial pressure of end-tidal carbon dioxide (PetCO2). We found that SNP decreased the velocity of the VMCA, but this was canceled by a decrease of cerebral blood flow (CBF) due to hypocapnia.

Conclusion

The present study shows that SNP is a headache-inducing agent with close similarities to headaches induced by GTN and probably without effect on intracerebral arteries.

Image-based vessel-by-vessel analysis for red blood cell and plasma dynamics with automatic segmentation

The aim of the present study was to test the hypothesis that vascular tones of cortical surface and parenchymal blood flow can be dissociated depending on the perturbation. To this end, a novel image-based analytical method for quantitatively measuring vessel diameters and flow dynamics was developed. The algorithm relies on the spatiotemporal coherence of the pixel intensity changes induced by the transit of the fluorescent signals measured using confocal laser scanning fluorescent microscopy in the rat cerebral cortex. A cocktail of fluorescently labeled red blood cell (RBC) and plasma agents was administered to simultaneously compare RBC and plasma dynamics in the same vascular networks. The time to fluorescent signal appearance and the width of the fluorescent signal were measured in each segment and compared between sodium nitroprusside-induced global and sensory stimulation-induced local perturbation conditions. We observed that infusion of sodium nitroprusside induced significant vasodilation in the surface artery, particularly in the small arteries (1.8-fold increase). Vasodilation induced by sensory stimulation was observed to depend on vessel size, but significant changes were only detected for the small arteries and veins. Measurements of the time to venous appearance revealed that appearance time was extended by sodium nitroprusside, but shortened during forepaw stimulation, relative to the control condition. Both perturbations provoked the largest changes between the small artery and vein segments, indicating that the changes in the appearance time originate from blood passage through parenchymal microcirculation. These findings support the hypothesis that cortical surface vascular tone and parenchymal blood flow are individually coordinated.

Trial-by-trial relationship between neural activity, oxygen consumption, and blood flow responses

Trial-by-trial variability in local field potential (LFP), tissue partial pressure of oxygen (PO2), cerebral blood flow (CBF), and deoxyhemoglobin-weighted optical imaging of intrinsic signals (OIS) were tested in the rat somatosensory cortex while fixed electrical forepaw stimulation (1.0-ms pulses with amplitude of 1.2 mA at a frequency of 6 Hz) was repeatedly applied. The changes in the cerebral metabolic rate of oxygen (CMRO2) were also evaluated using a hypotension condition established by our group based on the administration of a vasodilator. Under normal conditions, CBF, PO2, and OIS showed positive signal changes (48%, 32%, and 0.42%, respectively) following stimulation. Over multiple trials, the CBF responses were well correlated with the integral of the LFP amplitudes (sigmaLFP) (Rmean=0.78), whereas a lower correlation was found between PO2 and sigmaLFP (Rmean=0.60) and between OIS and sigmaLFP (Rmean=0.54). Under the hypotension condition the LFP responses were preserved, but the CBF responses were suppressed and the PO2 and OIS changes were negative (-12% and -0.28%, respectively). In this condition, the trial-by-trial variations in PO2 and OIS were well correlated with the variability in sigmaLFPs (Rmean= -0.77 and -0.76, respectively), indicating a single trial coupling between CMRO2 changes and sigmaLFP. These findings show that CBF and CMRO2 signals are more directly correlated with neural activity compared to blood oxygen-sensitive methods such as OIS and BOLD fMRI.

Cerebrovascular effects of sodium nitroprusside in the anaesthetized baboon: a positron emission tomographic study

The effects of sodium nitroprusside (SNP), a potent hypotensive agent, on cerebral blood flow (CBF) have been extensively studied in clinical and experimental situations but the results remain controversial. Whereas its properties would predict a dilatation of cerebral blood vessels, most studies report either no change or a decrease in CBF. The aim of this study was to investigate the effects of SNP on CBF, cerebral blood volume (CBV), and cerebral oxygen metabolism (CMRO2), by means of positron emission tomography in the anaesthetized baboon. Measurements were performed during normotension (mean arterial pressure (MABP): 97+/-16 mm Hg) and repeated following SNP-induced hypotension (MABP: 44+/-9 mm Hg). Sodium nitroprusside led to an increase in CBF and CBV (+30% and +37%, respectively, P<0.05), whereas no change in CMRO2 was noted. Linear regression analysis of CBF values as a function of MABP confirmed that CBF increases when MABP is reduced by SNP. The comparison between these cerebrovascular changes and those found during trimetaphan-induced hypotension in our previously published studies further argues for a direct dilatatory effect of SNP on cerebral blood vessels.

Intra-arterial nitrovasodilators do not increase cerebral blood flow in angiographically normal territories of arteriovenous malformation patients

BACKGROUND AND PURPOSE

The mechanism of adaptation to chronic cerebral hypotension in normal brain adjacent to cerebral arteriovenous malformations (AVMs) is unknown. To clarify these mechanisms, we performed cerebral blood flow (CBF) studies in structurally and functionally normal vascular territories during 53 distal cerebral angiographic procedures in 37 patients with AVMs.

METHODS

CBF was measured using the superselective intra-arterial 133Xe method before and after a 3-minute infusion of either verapamil (1 mg.min-1, n = 23), acetylcholine (1.33 micrograms.kg-1.min-1, n = 7), nitroprusside (0.5 microgram.kg-1.min-1, n = 16) or nitroglycerin (0.5 microgram.kg-1.min-1, n = 7).

RESULTS

Mean +/- SD systemic (76 +/- 13 mm Hg) and distal cerebral arterial (55 +/- 16 mm Hg; range, 20 to 97 mm Hg) pressures were not different among groups. Verapamil increased CBF (45 +/- 12 to 65 +/- 21 mL.100 g-1.min-1, P < .001). There was no effect of acetylcholine (no change [46 +/- 9 to 46 +/- 9 mL.100 g-1.min-1], NS) or nitroglycerin (36 +/- 14 to 36 +/- 13 mL.100 g-1.min-1, NS). Nitroprusside decreased CBF (40 +/- 12 to 31 +/- 11 mL.100 g-1.min-1, P < .001). The percent change in CBF after drug administration was proportional to cerebral arterial pressure for verapamil only (r = .57, P = .0051).

CONCLUSIONS

When infused intra-arterially in clinically relevant doses in both hypotensive and normotensive normal vascular territories remote from an AVM nidus, calcium channel blockade caused vasodilation, but there was an absence of response to nitric oxide-mediated vasodilators. These data suggest that (1) the nitric oxide pathway probably is not involved in the adaptation to chronic cerebral hypotension in AVM patients and (2) if our findings in vessels remote from or contralateral to the AVM are applicable to vessels of patients with other forms of cerebrovascular disease, clinically relevant doses of intra-arterial nitrovasodilators may not be useful in the manipulation of cerebrovascular resistance.

Controlled hypotension with sodium nitroprusside: effects on cerebral blood flow and cerebral venous blood gases in patients operated for cerebral aneurysms

The effect on cerebral haemodynamics of arterial hypotension induced by sodium nitroprusside infusion was studied in nine patients at the end of operations for intracranial aneurysms under N2O-O2-halothane anaesthesia. Cerebral blood flow (CBF), using the intraarterial 133Xe injection method, and cerebral jugular venous blood gases were monitored before, during and after the induced hypotension. CBF and jugular venous oxygen tension (PvO2) remained constant during the hypotensive period. Following its termination, a 13% increase in CBF occurred (P less than 0.05) and PvO2 showed the same trend, a 5% increase (P less than 0.30). Regional CBF recordings (rCBF) in 16 small areas within the cerebral hemisphere were obtained at each measurement. In four of the patients, rCBF abnormalities were present in the form of hyperaemic regions, probably induced by the operation or the disease itself. The focal abnormalities were not accentuated during hypotension nor were ischaemic regions disclosed. It is concluded that sodium nitroprusside has only a minor influence on cerebral haemodynamics in the anaesthetized state.

The effects of sodium nitroprusside on cerebral blood flow and cerebral venous blood gases. II. Observations in awake man during successive blood pressure reduction

Cerebral blood flow (CBF) and cerebral venous blood gases were investigated in seven awake patients during hypotension induced with sodium nitroprusside. Infusion of the drug into the internal carotid artery produced no changes in cerebral haemodynamics. Intravenous nitroprusside infusion resulted in a decrease in both CBF and jugular venous PO2 (P less than 0.01, respectively). Reducing mean arterial blood pressure by 18% and 43% produced a mean CBF fall of 6% and 27% respectively. Arteriovenous oxygen difference increased in consonance with the CBF decrease (P less than 0.01). Arterial PCO2 fell during the infusion (P less than 0.01). At 18% blood pressure reduction, the observed PCO2 decrease of 0.25 kPa could account for the 6% CBF decrease. At 43% blood pressure reduction, PCO2 fell by 0.53 kPa, a decrease which could not explain the observed CBF fall of 27%. Dizziness and incipient fainting occurred in the patients at this point. It is concluded that sodium nitroprusside has a minor but significant effect on cerebral haemodynamics in normal awake man.