Nicardipine Infusion for Blood Pressure Control in Patients with Subarachnoid Hemorrhage

Varelas, Panayiotis N.; Abdelhak, Tamer; Wellwood, Jody; Shah, Irem; Hacein‐Bey, Lotfi; Schultz, Lonni; Mitsias, Panayiotis

doi:10.1007/s12028-010-9393-7

Cited by 8 publications

(4 citation statements)

References 26 publications

(41 reference statements)

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“…[17] Systolic blood pressures were controlled below 180 mmHg by administering calcium antagonists nicardipine. [31] Nimodipine was not used (this drug is unavailable in Japan). Fasudil hydrochloride was administered three times a day, with a dose of 30 mg at each administration.…”

Section: Methodsmentioning

confidence: 99%

Performance of Third-generation FloTrac/Vigileo system during hyperdynamic therapy for delayed cerebral ischemia after subarachnoid hemorrhage

Mutoh

Ishikawa²,

Kobayashi³

et al. 2012

Surg Neurol Int

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Background:Monitoring of cardiac output (CO) is important for promising safe approach to goal-directed hemodynamic therapy for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH), but is often precluded by the invasiveness and complexity of ongoing monitoring modalities. We examined the clinical utility of less-invasive management using an uncalibrated arterial pressure waveform-derived cardiac output (APCO) monitor with refined algorithm (Third-generation FloTrac/Vigileo, Edwards, Irvine, CA, USA) during hyperdynamic therapy for post-SAH DCI, compared with transpulmonary thermodilution (PiCCO, Pulsion, Munich, Germany) as a reference technique.Methods:Forty-five patients who underwent surgical clipping within 24 h of SAH onset and subsequently developed clinical deterioration attributable to DCI were investigated. Validation of the APCO-derived cardiac index (CI) during dobutamine-induced hyperdynamic therapy was compared with a reference CI analyzed by transpulmonary thermodilution in 20 patients. In a subsequent trial of 48 cases, the overall clinical results from patients managed with each device were compared.Results:The APCO underestimated CI with an overall bias ± SD of 0.33 ± 0.26 L/min/m2 compared with transpulmonary thermodilution, resulting in an error of 14.9%. The trends of CI for both techniques at each dobutamine dose were similar (r2= 0.77; P < 0.0001). No statistically significant differences were observed between the device groups for frequencies of neurological improvement, cerebral infarction, cardiopulmonary complications, or functional outcomes at 3 months.Conclusions:These data suggest that the refined APCO tends to underestimate CI compared with reference transpulmonary thermodilution during hyperdynamic therapy with dobutamine for reversing DCI, but may be acceptable in this select category of patients to obtain comparable clinical results.

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Section: Methodsmentioning

confidence: 99%

Performance of Third-generation FloTrac/Vigileo system during hyperdynamic therapy for delayed cerebral ischemia after subarachnoid hemorrhage

Mutoh

Ishikawa²,

Kobayashi³

et al. 2012

Surg Neurol Int

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“…Recently, Varelas et al22) reported effectiveness and safety of nicardipine infusion in reducing SBP and DBP to pre-specified goal. Nicardipine achieved SBP control in 59.9% of hourly infusion measurements.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study, Qureshi et al19) reported the feasibility and safety of nicardipine use in treatment of acute hypertension with ICH, and Varelas et al22) demonstrated nicardipine infusion for controlling elevated blood pressure after SAH. However, the study showing controlling acute hypertension after SAH is limited.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Nicardipine for Blood Pressure Control in Patients with Subarachnoid Hemorrhage

Kim

Park

et al. 2012

J Cerebrovasc Endovasc Neurosurg

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ObjectiveThe purpose of the study is to determine the effectiveness and safety of nicardipine infusion for controlling blood pressure in patients with subarachnoid hemorrhage (SAH).MethodsWe prospectively evaluated 52 patients with SAH and treated with nicardipine infusion for blood pressure control in a 29 months period. The mean blood pressure of pre-injection, bolus injection and continuous injection period were compared. This study evaluated the effectiveness of nicardipine for each Fisher grade, for different dose of continuous nicardipine infusion, and for the subgroups of systolic blood pressure.ResultsThe blood pressure measurement showed that the mean systolic blood pressure / diastolic blood pressure (SBP/DBP) in continuous injection period (120.9/63.0 mmHg) was significantly lower than pre-injection period (145.6/80.3 mmHg) and bolus injection period (134.2/71.3 mmHg), and these were statistically significant (p < 0.001). In each subgroups of Fisher grade and different dose, SBP/DBP also decreased after the use of nicardipine. These were statistically significant (p < 0.05), but there was no significant difference in effectiveness between subgroups (p > 0.05). Furthermore, controlling blood pressure was more effective when injecting higher dose of nicardipine in higher SBP group rather than injecting lower dose in lower SBP group, and it also was statistically significant (p < 0.05). During the infusion, hypotension and cardiogenic problems were transiently combined in five cases. However, patients recovered without any complications.ConclusionNicardipine is an effective and safe agent for controlling acutely elevated blood pressure after SAH. A more systemic study with larger patients population will provide significant results and will bring solid evidence on effectiveness of nicardipine in SAH.

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“…The superior parallel randomized trial was powered to demonstrate the outcome of SBP during the first hour of spontaneous ICH. According to data from previous studies, nicardipine infusion reduced the SBP to 25.1 ± 11.2 mmHg in SAH [ 21 ]. The mean ± standard deviation (SD) of SBP in patients who received nicardipine intravenous bolus followed by continuous infusion was 34 ± 8.5 mmHg [ 22 ] The hypothesis test was two-tailed with criteria for significance (α) of 0.05.…”

Section: Methodsmentioning

confidence: 99%

A randomized controlled trial: Comparing blood pressure reduction in hyperacute phase of spontaneous intracerebral hemorrhage by continuous nicardipine infusion with or without a preceding nicardipine bolus dose

Nithimathachoke,

Tiensawang,

Deechot

et al. 2023

Heliyon

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Nicardipine Infusion for Blood Pressure Control in Patients with Subarachnoid Hemorrhage

Cited by 8 publications

References 26 publications

Performance of Third-generation FloTrac/Vigileo system during hyperdynamic therapy for delayed cerebral ischemia after subarachnoid hemorrhage

Performance of Third-generation FloTrac/Vigileo system during hyperdynamic therapy for delayed cerebral ischemia after subarachnoid hemorrhage

Effectiveness of Nicardipine for Blood Pressure Control in Patients with Subarachnoid Hemorrhage

A randomized controlled trial: Comparing blood pressure reduction in hyperacute phase of spontaneous intracerebral hemorrhage by continuous nicardipine infusion with or without a preceding nicardipine bolus dose

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