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Benjamin A. Lampert, MD
Springfield, Mo

JAMA. 1985;254(13):1721.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Chen et al¹ found that patients undergoing total hip arthroplasty under general anesthesia had a high incidence of adynamic ileus following nitroprusside-induced hypotension. The authors speculate that diminished mesenteric arterial blood flow was the cause of ileus in this group of patients.

While this may be possible, other considerations should be addressed. Intestinal ischemia may have resulted from increased cyanide levels or methemoglobinemia, secondary to nitroprusside infusion. Hypoxemia may have resulted from nitroprusside-induced inhibition of hypoxic pulmonary vasoconstriction. More importantly, Ebert et al² recently reported that cortisol and glucose concentrations rise to significantly higher levels in patients undergoing total hip anthroplasty if sodium nitroprusside is used to induce hypotension. This stress response was greater than in patients under similar anesthetic levels without induced hypotension. Since the sympatho-adrenal axis is thought to mediate adynamic ileus,³ this would be a more likely cause than mesenteric ischemia . . . [Full Text PDF of this Article]

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