The Utility of Nitric Oxide in the Postoperative Period

Abstract

Inhaled nitric oxide (iNO) is a pulmonary-selective vaso dilator with minimal bronchodilator activity in humans. NO also inhibits platelet and neutrophil activation and adhesion and inhibits ischemia-reperfusion injury. The pulmonary vasodilatory property of iNO causes a reduc tion in pulmonary vascular resistance and improvement in arterial oxygenation in a wide spectrum of diseases characterized by pulmonary hypertension and hypox emia. Promising examples of diseases for which NO may provide beneficial physiologic effects are primary and secondary pulmonary hypertension, right ventricu lar failure, cardiac transplantation, pulmonary embo lism, protamine reactions, acute respiratory distress syndrome, lung transplantation and, perhaps, chronic obstructive airways disease. The usefulness of iNO may be improved by concomitant therapy with pulmonary- selective intravenous vasoconstrictors (eg, Almitrine; Vectarian, Neuilly, France) and cGMP phosphodiester ase V inhibitors (eg, Zaprinast; Research Biochemicals International, Natick, MA). Almitrine improves oxygen ation, synergistically with iNO, and may be useful in disease states characterized primarily by hypoxemia. Zaprinast may be useful for weaning iNO and avoidance of rebound pulmonary hypertension.