The Effect of Clevidipine on Cerebral Blood Flow Velocity and Carbon Dioxide Reactivity in Human Volunteers

Lemkuil, Brian P.; Gierl, B; Patel, Piyush M.; Pearn, Matthew L.; Nguyen, Liem; Minokadeh, Anushirvan; Drummond, John C.

doi:10.1097/ana.0000000000000236

Cited by 7 publications

(2 citation statements)

References 18 publications

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“…This is a shortacting CCB administered as a continuous infusion for rapid control of hypertension. One study has evaluated the cerebrovascular effects of clevidipine and it was not found to significantly increase cerebral blood flow velocity (CBFV) or CO 2 responsiveness [15]. The key to reducing adverse effects from CCB agents is to avoid abrupt changes in dosage and maintaining euvolemia throughout the duration of treatment.…”

Section: Nicardipinementioning

confidence: 99%

Neuropharmacology in the ICU: Monitoring the Therapeutic Response and Neurological Hemodynamic Impact of Our Therapeutic Decisions in Real Time

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Brophy

2021

Neurosonology in Critical Care

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Vasoactive drugs impact both systemic and cerebral hemodynamic parameters. 2. Impaired cerebral autoregulation (CA) may cause an unwanted effect of a drug on central nervous system (CNS) vasculature. 3. Avoid abrupt hemodynamic changes that may lead to unwanted increases in intracranial pressure. 4. Optimization of mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) needs to be considered when selecting certain drugs due to their potential side effects. 5. Comorbid disease states, organ dysfunction, and temperature must be considered when administering medications that may alter cerebrovascular hemodynamics. 6. The use of noninvasive techniques, such as transcranial Doppler (TCD/TCCS), can serve as a tool for determining the therapeutic response of pharmacological treatments in neurocritical care patients.

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Section: Nicardipinementioning

confidence: 99%

Neuropharmacology in the ICU: Monitoring the Therapeutic Response and Neurological Hemodynamic Impact of Our Therapeutic Decisions in Real Time

Fillmore

Brophy

2021

Neurosonology in Critical Care

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“…It showed effectiveness and safety for acute HBP control in patients with ICH [10,13,17,18], aIS [7,13,14,15,18], aSAH [13,18] and after neurosurgical procedures [15,16,19], but little evidence exists regarding its effectiveness and safety in perioperative management of HBP after mechanical thrombectomy, embolization of aneurysm causing aSAH, ICH requiring surgical treatment and interventional neuroradiology procedures. Clevidipine has been shown not increase brain blood ow velocity or decrease brain reactivity to C0 2 in healthy human volunteers according to evidence [20], but the real signi cance of this nding is unknown in damaged brain of neurocritical patients.…”

Section: Introductionmentioning

confidence: 98%

Perioperative Control Of Acute High Blood Pressure In Neurosurgical Patients Admitted To Intensive Care Unit Using Clevidipine (Neuro-Clev)

Rodríguez

Arana-Arri

Boedo

et al. 2022

Preprint

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Background: Effective treatment of acute high blood pressure in neurocritical diseases is a current recommendation of guidelines to reduce mortality and severe disability. Clevidipine is a calcium channel blocker that showed effectiveness and safety for acute high blood pressure control in neurocritical patients. Materials and methods: Retrospective, observational and cross-sectional study in adult patients admitted to Intensive Care Unit for neurocritical disease requiring surgical or interventional treatment and presenting acute high blood pressure requiring urgent treatment with clevidipine as first line or rescue therapy after failure of different intravenous antihypertensive drugs. Primary endpoint was effectiveness of clevidipine treatment. Secondary endpoint was safety of clevidipine treatment. Analysis of subgroups described patient and treatment variables on effectiveness and safety of clevidipine, mortality, functional situation and major neurologic complications. Hematoma expansion, rebleeding and vasospasm were specific neurological complications described. Comparisons was made using Fisher, chi-square, t or Mann Whitney U test. Significance was set at the 5% level. Analysis was made using IBM SPSS Statistics 23.0 Results: thirty-three patients admitted to Intensive Care Unit fulfilled inclusion criteria and were included. Clevidipine showed a higher effectiveness and safety for acute high blood pressure control in our patients. Effectiveness was higher in patients with larger brain hematomas and severe aneurysmal subarachnoid hemorrhages treated with first line and early began of clevidipine within 24 hours of admission. Adverse events were mild, transient and more frequent in patients with first line treatment. Early and effective treatment were safe with lower major neurological complications. Mortality was lower in patients with first line and effective treatment. Hematoma expansion was seen in a higher number of patients. Rebleeding and vasospasm were less frequent. Conclusion: Clevidipine was effective and safe treatment of acute high blood pressure in neurocritical patients. Severity of neurocritical disease is a key factor but early and effective treatment could contribute to reduce mortality and major neurological complications. Nevertheless, our results need to take with caution because little size and design of our study. Trial registration: NCT05168059

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Clevidipine Versus Nicardipine for Acute Blood Pressure Reduction in a Neuroscience Intensive Care Population

2016

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The Effect of Clevidipine on Cerebral Blood Flow Velocity and Carbon Dioxide Reactivity in Human Volunteers

Abstract: Clevidipine infusion did not significantly increase CBFV nor was cerebral CO2 reactivity reduced during maximal-dose clevidipine infusion. Further systematic investigation of clevidipine in patients with central nervous system pathology seems justified.

Cited by 7 publications

References 18 publications

Neuropharmacology in the ICU: Monitoring the Therapeutic Response and Neurological Hemodynamic Impact of Our Therapeutic Decisions in Real Time

Neuropharmacology in the ICU: Monitoring the Therapeutic Response and Neurological Hemodynamic Impact of Our Therapeutic Decisions in Real Time

Perioperative Control Of Acute High Blood Pressure In Neurosurgical Patients Admitted To Intensive Care Unit Using Clevidipine (Neuro-Clev)

Clevidipine Versus Nicardipine for Acute Blood Pressure Reduction in a Neuroscience Intensive Care Population

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