Prospective Randomized Comparison of Safety and Efficacy of Nicardipine and Nitroprusside Drip for Control of Hypertension in the Neurosurgical Intensive Care Unit

Roitberg, Ben; Hardman, Julian; Urbaniak, Klaudia; Merchant, Amina; Mangubat, Erwin Zeta; Alaraj, Ali; Mlinarevich, Nada; Watson, Karriem S.; Ruland, Sean

doi:10.1227/01.neu.0000335078.62599.14

Cited by 30 publications

(19 citation statements)

References 12 publications

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“…This medication, however, was deemed inadequate for BP control and had to be changed to SN in only one infusion (2%). Our results mirror those by Roitberg et al, who found BP to be outside the pre-specified goal in 38% of the nicardipine infusion time [18] and Liu-Deryke et al, who found that 40% of nicardipine-treated patients with ICH failed to meet the BP goal within 24 h [19]. There are several potential contributors to this suboptimal BP response.…”

Section: Discussionsupporting

confidence: 86%

“…No rebleeding occurred in these patients, which may be due to a combination of BP control and early treatment of the culprit lesion. Vasospasm occurred in 50% of patients, identical to that found in the study, which compared nicardipine to SN [18]. The three deaths that occurred in our patient population were temporally unrelated to nicardipine.…”

Section: Discussionsupporting

confidence: 85%

“…Only recently Roitberg et al examined the safety and efficacy of nicardipine versus SN in patients with either SAH or ICH. Although it is not clear how many treated patients belonged to each subgroup of hemorrhagic stroke, the goal of this study, similar to ours, was utilization of these infusions for BP control below pre-specified levels [18]. In another recent study, Liu-Deryke et al compared the use of nicardipine or labetalol in patients with stroke.…”

Section: Discussionmentioning

confidence: 84%

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Nicardipine Infusion for Blood Pressure Control in Patients with Subarachnoid Hemorrhage

et al. 2010

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 84%

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Nicardipine Infusion for Blood Pressure Control in Patients with Subarachnoid Hemorrhage

et al. 2010

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“…ICP decreased during the infusion and serial computerized tomographic (CT) scans did not demonstrate any evidence of rebleeding or exacerbation of edema. A recent clinical trial comparing nicardipine and nitroprusside in 163 neurosurgical intensive care patients noted no clinically serious elevated ICP in either group [18]. However, this study reported only serious adverse events secondary to raised ICP and prospective recording of ICP was not included.…”

Section: Discussionmentioning

confidence: 95%

A Multicenter Comparison of Outcomes Associated with Intravenous Nitroprusside and Nicardipine Treatment Among Patients with Intracerebral Hemorrhage

et al. 2009

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Introduction No clinical data exist to compare outcomes between patients with intracerebral hemorrhage (ICH) treated with different intravenous antihypertensive agents. This study was performed to compare outcomes among patients with ICH who were treated with intravenous infusion of different antihypertensive medications during the first 24 hours after admission. Methods We analyzed one-year data (2005–2006) from the Premier database which is a nationally representative hospital discharge database containing data pertaining to admissions in the United States. We compared discharge outcomes, length of stay, and cost of hospitalization between groups of patients who were treated using either intravenous nicardipine or nitroprusside infusion. Chi-square and ANOVA were used for univariate analysis. Logistic and linear regression analyses were performed to adjust for baseline risk of mortality between the two groups. Results A total of 12,767 admissions with primary diagnosis of ICH were identified. Nicardipine was administered in 926 patients (7.3%) and nitroprusside was administered in 530 (4.3%) patients. There was no difference in baseline disease severity or risk of mortality among patients who were administered nicardipine or nitroprusside. After adjustment for baseline risk of mortality, the risk of in-hospital mortality (odds ratio [OR] 1.7, 95% confidence interval [95% CI] 1.3–2.2) was higher among patients treated with nitroprusside compared with nicardipine. The risk of in-hospital mortality was also higher after adjustment for baseline risk of mortality and hospital characteristics in patients treated with nitroprusside (OR 1.6, 95% CI 1.2–2.1). After exclusion of patients who died during hospitalization, there was no difference in length of stay and total hospital cost in the multivariate analysis. Conclusion Use of nicardipine compared with nitroprus-side infusion during the first 24 h after ICH may be associated with reduced risk of in-hospital mortality without any increase in the hospitalization cost or length of stay.

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“…A variety of titratable medications are available. Nicardipine may give smoother blood pressure control than labetalol 135 and sodium nitroprusside, 136 although data showing different clinical outcomes are lacking. Although lowering cerebral perfusion pressure may lead to cerebral ischemia, a cohort study of neurologically critically ill patients did not find an association between use of nicardipine and reduced brain oxygen tension.…”

Section: Medical Measures To Prevent Rebleeding After Asahmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,957

1,375

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Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods— A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Results— Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. Conclusions— aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.

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Prospective Randomized Comparison of Safety and Efficacy of Nicardipine and Nitroprusside Drip for Control of Hypertension in the Neurosurgical Intensive Care Unit

Abstract: When used for control of hypertension in patients with subarachnoid or intracerebral hemorrhage, NC and SNP were both safe and effective, but patients on an NC drip required fewer dose adjustments and fewer additional medications.

Cited by 30 publications

References 12 publications

Nicardipine Infusion for Blood Pressure Control in Patients with Subarachnoid Hemorrhage

Nicardipine Infusion for Blood Pressure Control in Patients with Subarachnoid Hemorrhage

A Multicenter Comparison of Outcomes Associated with Intravenous Nitroprusside and Nicardipine Treatment Among Patients with Intracerebral Hemorrhage

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

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