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Systemic Hypotension Following Intravenous Administration of Nonionic Contrast Medium During Computed Tomography: Iopromide Versus Iodixanol

Widmann, Gerlig, MD*; Bale, Reto, MD*; Ulmer, Hanno, PhD; Putzer, Daniel, MD*; Schullian, Peter, MD*; Wiedermann, Franz-Josef, MD; Lederer, Wolfgang, MD

doi: 10.1213/ANE.0000000000002346
Hemostasis: Original Clinical Research Report

BACKGROUND: In light of the increasing number of radiologic interventions performed under general anesthesia, the effects of contrast media (CM) on circulation and organ perfusion are of paramount importance. The objectives of this study were to systematically quantify effects on blood pressure, heart rate, and kidney function following intravenous administration of nonionic CM with normal and low osmolality.

METHODS: In this controlled, double-blinded phase IV clinical trial, 40 consecutive patients were randomly assigned to receive repeated measures of either low-osmolar iopromide or iso-osmolar iodixanol. Normal saline solution (NSS) served as control. Blood pressure and heart rate were measured continuously from 1 minute before until 3 minutes after administration of CM and NSS. Urine output was recorded hourly.

RESULTS: Administration of iopromide resulted in systemic hypotension lasting up to 300 seconds (105 ± 61 seconds) with the lowest mean arterial pressure of 39 mm Hg (56.7 ± 12.2 mm Hg). Iopromide caused a systolic/diastolic decrease of 31/26 mm Hg (P < .001), significant increase in heart rate (P = .042), and significant diuresis with a 2-fold higher per-hour urine output (P = .010). Administration of iodixanol and NSS had no significant influence on blood pressure (P > .640).

CONCLUSIONS: Administration of low-osmolar iopromide was followed by a significant transient decrease in blood pressure and a rise in heart rate. Anesthetists and radiologists should be aware of these effects in patients in whom short episodes of disturbed tissue microcirculation may pose a clinical risk.

From the Departments of *Radiology

Medical Statistics, Informatics and Health Economy

Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.

Published ahead of print August 10, 2017.

Accepted for publication June 8, 2017.

Funding: GE Healthcare sponsored the investigational medicinal product iodixanol. GE Healthcare had no role in study design, data collection, data analysis, data interpretation, or the writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Gerlig Widmann, MD, Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Address e-mail to gerlig.widmann@i-med.ac.at.

© 2018 International Anesthesia Research Society
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