Nicardipine versus nitroprusside for deliberate hypotension during idiopathic scoliosis repair

Lustik, Stewart J.; Papadakos, Peter J.; Jackman, Kenneth V.; Rubery, Paul T.; Kaplan, Karen L.; Chhibber, Ashwani K.

doi:10.1016/j.jclinane.2003.05.002

Cited by 20 publications

(19 citation statements)

References 29 publications

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“…Prior studies of SNP have primarily examined: 1) clinical outcomes secondary to BP changes, such as amount of blood loss, recovery time, etc. ; 3,8,9 or 2) physiologic features such as cerebral oxygenation, mixed venous oxygen saturation, or rebound tachycardia. [15][16][17][18] There are no data describing how the practice of deliberate hypotension varies with respect to time spent in satisfactory BP control and the frequency and magnitude of dose titrations necessary to achieve said control.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Arterial Blood Pressure Control During Deliberate Hypotension With Sodium Nitroprusside in Children

Spielberg

Barrett

Hammer

et al. 2015

Survey of Anesthesiology

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Background-Sodium nitroprusside (SNP) is used to decrease arterial blood pressure (BP) during certain surgical procedures. There are limited data regarding efficacy of BP control with SNP. There are no data on patient and clinician factors that affect BP control. We evaluated the dose-response relationship of SNP in infants and children undergoing major surgery and performed a quantitative assessment of BP control.

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Section: Discussionmentioning

confidence: 99%

“…In comparison to other BP-decreasing drugs, SNP has both faster onset and offset of effect. 8,9 These properties allow for rapid adjustment of drug dosing in response to BP changes from various clinical factors. Neither hepatic nor renal dysfunction are contraindications for SNP use.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Arterial Blood Pressure Control During Deliberate Hypotension With Sodium Nitroprusside in Children

Spielberg

Barrett

Hammer

et al. 2015

Survey of Anesthesiology

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show abstract

Section: Introductionmentioning

confidence: 99%

Predictors of Arterial Blood Pressure Control During Deliberate Hypotension with Sodium Nitroprusside in Children

Spielberg

Barrett

Hammer

et al. 2014

Anesthesia &Amp; Analgesia

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Background Sodium nitroprusside (SNP) is used to decrease arterial blood pressure (BP) during certain surgical procedures. There are limited data regarding efficacy of BP control with SNP. There are no data on patient and clinician factors that affect BP control. We evaluated the dose-response relationship of SNP in infants and children undergoing major surgery and performed a quantitative assessment of BP control. Methods One hundred fifty-three subjects at 7 sites received a blinded infusion followed by open-label SNP during operative procedures requiring controlled hypotension. SNP was administered by continuous infusion and titrated to maintain BP control (mean arterial BP [MAP] within ±10% of clinician-defined target). BP was recorded using an arterial catheter. Statistical Process Control methodology was used to quantify BP control. A multivariable model assessed the effects of patient and procedural factors. Results BP was controlled an average 45.4% (SD 23.9%, 95% CI 41.5%-49.18%) of the time. Larger changes in infusion rate were associated with worse BP control (7.99% less control for 1 mcg•kg−•min− increase in average titration size, p=0.0009). A larger difference between a patient's baseline and target MAP predicted worse BP control (0.93% worse control per 1 mmHg increase in MAP difference, p=0.0013). Both effects persisted in multivariable models. Conclusions : SNP was effective in reducing BP. However, BP was within the target range less than half of the time. No clinician or patient factors were predictive of BP control, although two inverse relationships were identified. These relationships require additional study and may be best coupled with exposure-response modeling to propose improved dosing strategies when using SNP for controlled hypotension in the pediatric population.

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“…Esmolol is an ultrashort-acting β-adrenoceptor blocker, which can reduce the heart rate, prolong coronary perfusion, and increase subendocardial blood flow [26][27][28][29][30] . Vasoactive therapeutic agents such as combinations of esmolol with nicardipine or nitroglycerin are often used to maintain hemodynamic stability and associated with a decrease in stress responses in the perioperative period [24][25][26][27][28][29][30] . However, it remains unclear whether the combined use of esmolol with either nicardipine or nitroglycerin to maintain hemodynamic stability affects the incidence of POCD in elderly patients after surgery.…”

mentioning

confidence: 99%

Effects of vasodilator and esmolol-induced hemodynamic stability on early post-operative cognitive dysfunction in elderly patients: a randomized trial

Sun¹,

Yang²,

Sun³

et al. 2017

Afr H. Sci.

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Objective: To investigate the effect of continuous intravenous injection of nicardipine and/or nitroglycerin with or without esmolol on the occurrence of early post-operative cognitive dysfunction (POCD) in elderly patients. Methods: Elderly patients (n=340) who underwent radiofrequency ablation for atrial fibrillation were randomized into five groups: A, nicardipine; B nicardipine+esmolol; C, (nitroglycerin) group; D nitroglycerin+esmolol; E (control) groups. The hemodynamic parameters were recorded, and Mini Mental State Examination was used to assess cognitive function. Results: At 30 min and 60 minutes after anesthesia and at the conclusion of surgery, the rate pressure product value was significantly lower in Groups B (10621.1±321.7, 10544.2±321.8, and 10701.3±325.5, respectively) and D (10807.4±351.1, 10784.3±360.3, and 10771.7±345.7, respectively) than in Group E (13217.1±377.6, 13203.5±357.3, and 13119.2±379.5, respectively). The heart rate was significantly higher in Groups A (104.1±10.3, 104.9±11.1, and 103.9±11.8, respectively) and C (103.7±11.3, 105.5±10.5, and 107.7±11.7, respectively) than in Group E (89.3±12.0, 88.5±11.5, and 85.5±11.6, respectively). The incidence of POCD was significantly lower in Groups A and B than in Groups C, D, and E. Univariate regression analysis showed that regimens in Groups A, B, and E and doses of propofol and fentanyl were risk factors for POCD. Multivariate logistic regression analysis revealed significant associations between the incidence of POCD and interventions in Groups A and B. Conclusion: Maintenance of stable intraoperative hemodynamics using nicardipine and nitroglycerin or their combinations with esmolol, especially nicardipine with esmolol, reduced the incidence of POCD in the elderly with potential cardiovascular diseases. Afri Health Sci2016;16(4): 1056-1066

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Nicardipine versus nitroprusside for deliberate hypotension during idiopathic scoliosis repair

Cited by 20 publications

References 29 publications

Predictors of Arterial Blood Pressure Control During Deliberate Hypotension With Sodium Nitroprusside in Children

Predictors of Arterial Blood Pressure Control During Deliberate Hypotension With Sodium Nitroprusside in Children

Predictors of Arterial Blood Pressure Control During Deliberate Hypotension with Sodium Nitroprusside in Children

Effects of vasodilator and esmolol-induced hemodynamic stability on early post-operative cognitive dysfunction in elderly patients: a randomized trial

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