
OpenAnesthesia and the APSF: Achieving Safe and Quality Anesthesia Care with Education Innovation
New! APSF's Podcast
Medical Safety Principles
New PAINTS episode with Drs. Morrissey and Nash
Psychological Safety
New PAINTS episode with Dr. Joseph Sisk
Check out the latest OpenAnesthesia Summaries!
More than 450 mini-reviews on high-yield topics in anesthesiology, critical care, and perioperative medicine.
Question of the Day
An 80-year-old man has been in the ICU for 12 hours following an aortic valve replacement and has been on nitroprusside for control of hypertension. Which of the following is MOST responsible for the toxicity caused by nitroprusside?
Explanation
After nitroprusside enters red blood cells, electron transfer occurs and the compound dissolves into 5 cyanide ions and a nitroso group. The cyanide ions can undergo 3 different reactions: forming cyanmethemoglobin; binding with thiosulfate; or interacting directly with cytochrome oxidase. The inactivation of cytochrome oxidase is responsible for the uncoupling of mitochondrial oxidative phosphorylation and shift from aerobic to anaerobic metabolism. This causes production of lactic acid and the symptoms of cyanide toxicity including metabolic acidosis, arrhythmias, tachycardia, hypertension, neurologic dysfunction (confusion) and increased mixed venous oxygen content. One other key sign of cyanide toxicity is tachyphylaxis or the resistance to the effects of nitroprusside to reduce blood pressure.
References:
Sodium NitroprussideOA Series: July 2025
29:34
APSF Podcast
OpenAnesthesia and the APSF: Achieving Safe and Quality Anesthesia Care with Education InnovationAllison Bechtel, MD, University of Virginia, Charlottesville, VA
Copy link
14:43
PAINTS
Medical Safety PrinciplesMegan Nash, DO, Children’s Hospital Colorado, Aurora, CO, Tyler P. Morrissey, MD, University of Colorado, Aurora, CO
Copy link
14:02
PAINTS
Psychological Safety at WorkJoseph M. Sisk, MD, FAAP, University of North Carolina, Chapel Hill, NC
Copy link