Perioperative Use of Clevidipine: A Systematic Review and Meta-Analysis

Abstract

BackgroundClevidipine is an ultrashort-acting drug for rapid reduction of blood pressure by selectively acting on the L-type Ca2+ channels on arteriolar smooth muscle. The drug’s ultrashort action in reducing the blood pressure is due to its rapid hydrolysis by blood and extravascular tissue esterases, which does not depend on hepato-renal metabolism and excretion. An analysis of the perioperative management of blood pressure should be considered to compare with other intravenous antihypertensive agents.MethodsAnalyses of the available evidence in randomized clinical trials following the PRISMA methodology as well as clinical significance according to the GRADE system were conducted. Placebo versus other antihypertensive drugs studies were included. Statistical assessments were done using the X2 and I2 tests.ResultsClevidipine was more effective in maintaining the blood pressure within pre-specified ranges compared with other antihypertensive drugs (MD, -17.87 CI 95%: -29.02 to -6.72; p = 0.02). The use of Clevidipine versus placebo and rescue antihypertensive intravenous drug showed a clear reduction in rates of treatment failure (RR 0.10; IC 95%; 0.05–0.18; p <0.0001). There was no difference in the incidence of adverse events compared with placebo (RR 1.47; 95% CI 0.89 to 2.43, p = 0.14) and with other antihypertensive drugs (RR 0.78, 95% CI 0.45 to 1.35; p = 0.37). In addition, there was no difference in the incidence of atrial fibrillation (AF) between clevidipine and control groups (RR 1.09, IC del 95%: 0.65 a 1.83; p = 0.73).ConclusionsClevidipine is an ultrafast-acting drug that is highly effective for management of perioperative arterial hypertension. It is devoid of adverse effects associated with the use of other IV antihypertensives. Its favorable pharmacodynamic and pharmacokinetic properties make clevidipine the drug of choice for the management of acute perioperative hypertension. It is important to emphasize the need for further studies with a larger number of patients to confirm these findings and increase the degree of evidence.

Efficiency of proxodolol in treatment of arterial hypertension in cardiac surgery cases

“…Наиболее частыми причинами интраоперационной АГ являются: интубация трахеи, хирургическая стимуляция, гипоксемия или гиперкапния, гиперволемия, синдром отмены гипотензивных препаратов, перерастяжение мочевого пузыря, повышение внутричерепного давления, абстинентный синдром и пр. [2,8].…”

Management of hypertension in patients undergoing surgery

“…Commonly used drugs for management of postoperative surgical hypertension include administration of intravenous nitroglycerin, sodium nitroprusside, beta blockers, hydralazine, and calcium channel blockers including clevidipine (26,27). Clevidipine is a rapid-acting, dihydropyridine L-type calcium channel blocker with a half-life of about 1 minute that reduces arterial pressure by direct arterial vasodilation with selective action on arteriolar resistance vessels and does not cause reflex tachycardia and tachyphylaxis (27).…”

“…Clevidipine is a rapid-acting, dihydropyridine L-type calcium channel blocker with a half-life of about 1 minute that reduces arterial pressure by direct arterial vasodilation with selective action on arteriolar resistance vessels and does not cause reflex tachycardia and tachyphylaxis (27). Its favorable pharmacodynamic and pharmacokinetic properties cause clevidipine to be an effective and safe drug for treating acute perioperative hypertension (26,27). A systematic review and meta-analysis concluded that clevidipine was the drug of choice for the management of acute postoperative hypertension (26).…”

“…Its favorable pharmacodynamic and pharmacokinetic properties cause clevidipine to be an effective and safe drug for treating acute perioperative hypertension (26,27). A systematic review and meta-analysis concluded that clevidipine was the drug of choice for the management of acute postoperative hypertension (26). Three prospective, randomized, open-label, parallel comparison studies compared use of clevidipine to nitroglycerin or sodium nitroprusside perioperatively or to nicardipine postoperatively for acute hypertension treatment in 1,512 cardiac surgery patients (27).…”

Treatment of hypertensive emergencies

“…Drugs of choice used for treating postoperative surgical hypertension include administration of intravenous clevidipine, esmolol, nitroglycerin, and nicardipine (10,11). A systematic review and meta-analysis reported that clevidipine was the drug of choice for treating acute postoperative hypertension (10).…”