Deliberate Hypotension With Nicardipine or Nitroprusside During Total Hip Arthroplasty

Abstract

To induce deliberate hypotension during anesthesia, nicardipine was administered to patients undergoing total hip arthroplasty and was randomly compared with nitroprusside. Hemodynamic measurements were performed before and 10, 20, 30, and 60 min after starting to administer either nicardipine (n = 12) or nitroprusside (n = 12) (B, T1, T2, T3, and T4, respectively); at the end of drug infusion (T5); and 10, 20, and 60 min later (T6, T7, and T8, respectively). Plasma renin activity and catecholamine levels were measured at B, T1, T5, T6, and T7. In addition, plasma nicardipine concentration was measured in five patients at T1, T2, T5, T7, and T8. As with nitroprusside, nicardipine administration (1-3 micrograms.kg-1.min-1, after a titration dose of 4.7 +/- 1.5 mg) resulted in hypotension (up to -34% +/- 3%), a decrease in systemic vascular resistances (up to -49% +/- 4%), and increases in heart rate (up to +17% +/- 6%), cardiac index (up to +37% +/- 8%), plasma norepinephrine (up to +63% +/- 17%) and epinephrine (up to +232% +/- 68%) levels, and plasma renin activity (up to +336% +/- 207%). Ten and 20 minutes after discontinuation of the hypotensive drug, nicardipine led to persistent vasodilation and hypotension, which differed significantly from the hypertensive rebound observed after nitroprusside discontinuation, despite a similar increase in plasma renin activity and catecholamine levels. Our results indicate that after the infusion was terminated, the nicardipine-induced vasodilation was opposed to the vasoconstrictive effects of angiotensin II and catecholamines, thus avoiding hypertensive rebound.(ABSTRACT TRUNCATED AT 250 WORDS)

Risks and benefits of deliberate hypotension in anaesthesia: a systematic review

“…Seventy articles were found relevant to this topic: 16 were randomized clinical trials [17][18][19]46 166,170,172,174,195,196 , 2 retrospective case Inadequate size per group 3 Patient selection was not consecutive and complete Did not describe method of randomization Did not mention duration of anaesthesia and induced hypotension * 1 = low risk of bias; 2 = moderate risk of bias; 3 = high risk of bias. Inadequate size per group 3 Patient selection was not consecutive and complete Did not describe method of randomization Did not mention duration of anaesthesia and induced hypotension * 1 = low risk of bias; 2 = moderate risk of bias; 3 = high risk of bias.…”

Effects of KRN2391-induced hypotension on the endocrine system and carbohydrate metabolism in halothane-anesthetized dogs

“…With the use of various vasodilating agents, such as nitroprusside [13][14][15][16][17], nitroglycerin [16], and nicardipine [13,17], to induce hypotension, these results also have suggested a role for renin-angiotensin system in blood pressure maintenance. Multiple factors are known to be involved in renin release [18,19].…”

Effect of nicardipine on vascular capacitance: Comparison with sodium nitroprusside during induced hypotension

“…In contrast, SNP has been shown to exert a powerful dilating effect on both resistance vessels and veins [16]. In addition, in patients receiving induced hypotension with nicardipine or SNP during total hip arthroplasty, Bernard et al [3] have shown that the intravenous fluid volume required to maintain pulmonary capillary wedge pressure at 5mmHg was larger in the SNP group than in the nicardipine group, which indirectly indicates that nicardipine has less of a dilatory effect on the venous system than SNP. However, there have been no studies examining the direct effect of nicardipine on MCFP in comparison with SNP at comparable hypotensive levels.…”

“…On the other hand, nicardipine, a dihydropyridine calcium channel blocking agent, is widely used for the treatment of hypertension. It has recently been reported that nicardipine can be used for induced hypotension under anesthesia in patients undergoing orthopedic surgery [2,3]. These human studies have compared hemodynamic changes during hypotension induced by SNP and nicardipine [2,3].…”

“…It has recently been reported that nicardipine can be used for induced hypotension under anesthesia in patients undergoing orthopedic surgery [2,3]. These human studies have compared hemodynamic changes during hypotension induced by SNP and nicardipine [2,3]. However, there have been few studies concerning the effects of nicardipine on the venous system during induced hypotension.…”