Safety and Efficacy of Intravenous Clevidipine for the Perioperative Control of Acute Hypertension in Neurosurgical Patients: A Dose Update

Abstract

Clevidipine is a third-generation dihydropyridine calcium channel blocker approved in 2008 by the Food and Drug Administration for parenteral therapy of arterial hypertension. The high degree of lipophilicity of clevidipine provides a rapid onset of action and ease of titration to reach the desired clinical effect. Since its introduction into clinical practice, clevidipine has been shown to be safe and effective for perioperative use in patients undergoing procedures in which rapid and effective blood pressure control is essential. In 2011, clevidipine received institutional approval for intraoperative use during neurosurgical procedures and for postoperative blood pressure control in the Post-Anesthesia Care Unit and Surgical Intensive Care Unit during the first 24 hours after surgery. This review describes the efficacy and safety of intravenous clevidipine in intraoperative blood pressure management during neurosurgical procedures in 11 patients over a period of 3 months. The evaluation revealed that lower rates of clevidipine infusion than previously documented in the literature achieved blood pressure control within the desired limits during surgery while avoiding dose-related adverse reactions.

Management of Blood Pressure During and After Recanalization Therapy for Acute Ischemic Stroke

“…Similar to nicardipine, clevidipine generally does not decrease heart rate and in retrospective analysis has similar efficacy in lowering BP though requires less volume to be administered which may be optimal in patients with volume overload (104, 105). Since clevidipine is formulated in a lipid emulsion, there is an inherent risk of hypertriglyceridemia and pancreatitis for which there is a recommended a daily maximum of 1,000 mL (or about 21 mg/h per day) (106).…”

“…Glyceryl trinitrate, or nitroglycerin, is a nitric oxide donor that primarily causes venodilation, as well as arterial dilation at high doses, thereby effectively reducing preload and BP (106). Glyceryl trinitrate is most commonly used for acute myocardial infarction and unstable angina due to its ability to reduce cardiac oxygen demand, but there is recent literature evaluating its use in AIS.…”