The efficacy of nicardipine and nitroprusside in preventing poststernotomy hypertension

Wezel, Harry B. van; Koolen, Jacques; Visser, Cees A.; Vergroesen, Isabelle; Leyssius, A. T. Rheineck; Dijkhuis, Job P.; Meyne, Nico G.; Deen, L

doi:10.1016/s0888-6296(89)94578-x

Cited by 23 publications

(15 citation statements)

References 32 publications

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“…In patients with adequate circulating blood volume, nitroprusside has a predictable dose-response relationship, making it easy to titrate, and its efficacy has been widely documented in the perioperative setting (Kaplan and Jones 1979; Domenighetti and Perret 1982; van Wezel et al 1989; Halpern et al 1992; Leslie et al 1994). …”

Section: Pharmacotherapymentioning

confidence: 99%

Perioperative hypertension management

Varon¹

2008

VHRM

159

117

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Perioperative hypertension is commonly encountered in patients that undergo surgery. While attempts have been made to standardize the method to characterize the intraoperative hemodynamics, these methods still vary widely. In addition, there is a lack of consensus concerning treatment thresholds and appropriate therapeutic targets, making absolute recommendations about treatment diffi cult. Nevertheless, perioperative hypertension requires careful management. When treatment is necessary, therapy should be individualized for the patient. This paper reviews the pharmacologic agents and strategies commonly used in the management of perioperative hypertension.

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Section: Pharmacotherapymentioning

confidence: 99%

Perioperative hypertension management

Varon¹

2008

VHRM

159

117

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“…A total of five studies was included in the pooled analyses 2,4,6‐8 . These five studies had a total of 571 patients, with 282 in the sodium nitroprusside group and 289 in the nicardipine group.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have compared the efficacy of sodium nitroprusside and nicardipine in decreasing blood pressure at different postoperative states 2‐8 . There is no general consensus about which agent is more effective in regard to blood pressure control and no single study has characterized the multitude of hemodynamic changes induced by these agents.…”

Section: Introductionmentioning

confidence: 99%

Sodium nitroprusside versus nicardipine for hypertension management after surgery: A systematic review and meta‐analysis

et al. 2020

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Background: Vasoactive medications are commonly administered for afterload reduction and arterial hypertension treatment in patients after cardiac surgery. A systematic review and meta-analysis were conducted to determine the effects of sodium nitroprusside and nicardipine on hemodynamics and cardiac performance in this population.Methods: A systematic review of published manuscripts was performed to identify studies of patients who received sodium nitroprusside and nicardipine as part of the treatment for arterial hypertension or afterload reduction after cardiac surgery. A meta-analysis was then conducted to determine the effects of sodium nitroprusside and nicardipine on hemodynamics and cardiac performance. The following parameters were captured: blood pressure, heart rate, right atrial pressure, systemic vascular resistance, and stroke volume.Results: In total, five studies with 571 patients were pooled for these analyses.Systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were similar in both groups. The cardiac index was greater with nicardipine while mean pulmonary artery pressure was lower with sodium nitroprusside.Conclusion: Nicardipine and sodium nitroprusside have similar abilities in reducing afterload in the postoperative cardiac population. Statistically significant differences were found in pulmonary artery pressure and cardiac index. It may be beneficial to consider nicardipine for afterload reduction in patients with a low cardiac index. K E Y W O R D Sblood pressure, congenital heart surgery, nicardipine, sodium nitroprusside

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“…Intravenous NIC is considered an effective alternative to SNP. 18–28 Unlike SNP, NIC is not associated with excessive venous dilation or toxic metabolites and is less frequently associated with reflex tachycardia. 18–28 Compared to SNP, NIC is associated with a more rapid time to goal blood pressure.…”

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confidence: 99%

Nicardipine versus Sodium Nitroprusside for Postcardiac Surgery Hypertension: An Evaluation of Effectiveness and Postoperative Costs

et al. 2012

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Background: Postoperative hypertension after cardiac surgery is associated with substantial morbidity. Both sodium nitroprusside (SNP) and nicardipine (NIC) are effective in its management. Outcomes data for NIC and SNP in persons undergoing cardiac surgery are limited, and there are no data characterizing the influence of drug choice on postoperative costs. Objective: Our aim was to compare the effectiveness of NIC versus SNP in the management of hypertension after cardiac surgery and evaluate the influence of drug choice on postoperative costs. Methods: We conducted a retrospective, cohort study using our hospital's financial and electronic medical records. Adults admitted to a cardiothoracic surgical intensive care unit after coronary artery bypass grafting (CABG) and/or valve surgery who developed hypertension requiring >30 minutes of NIC or SNP were included. We evaluated drug effectiveness by assessing infusion rate stability, blood pressure and heart rate, and concomitant antihypertensive agent use. Activity-based postoperative costs were compared between study groups. Results: One hundred twelve subjects were included (NIC = 72, SNP = 40). Hypertension-related demographics were balanced between the groups. NIC was associated with improved infusion rate stability that required fewer dose changes per hour (1.2 ± 1.6) versus SNP (1.7 ± 1.8) (P = .004). Heart rates and blood pressures did not differ significantly. The number of antihypertensive medications used before and during the NIC or SNP infusions was the same. However, persons who were prescribed SNP required significantly more medications to manage blood pressure after infusions were discontinued (P = .001). NIC use did not significantly increase postoperative cost. NIC use may be associated with cost increases in isolated CABG but with cost savings in isolated valve or combined CABG/valve surgeries; however, these differences were not statistically significant. Conclusions: Blood pressure was equally controlled using NIC or SNP. NIC was associated with improved infusion rate stability. Despite a higher acquisition cost, NIC did not significantly influence postoperative costs. Larger, prospective cost-effective analyses in surgical subgroups are needed.

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The efficacy of nicardipine and nitroprusside in preventing poststernotomy hypertension

Cited by 23 publications

References 32 publications

Perioperative hypertension management

Perioperative hypertension management

Sodium nitroprusside versus nicardipine for hypertension management after surgery: A systematic review and meta‐analysis

Nicardipine versus Sodium Nitroprusside for Postcardiac Surgery Hypertension: An Evaluation of Effectiveness and Postoperative Costs

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