Optimal dose of nicardipine for maintenance of hemodynamic stability after tracheal intubation and skin incision

Dajun Song, Harbhej Singh, Paul F. White, Moffadal Gadhiali, James D. Griffin, Kevin W. Klein

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

To determine the optimal dose of nicardipine (N) for maintenance of hemodynamic stability during the postinduction period, we designed a randomized, double-blind, placebo-controlled, dose-ranging study using four different doses of N administered after a standardized anesthetic induction sequence. A total of 106 patients were assigned to one of the following treatment groups: saline (control), N 0.5 mg (N0.5), N 1 mg (N1), N 2 mg (N2), and N 4 mg (N4). The study medication was administered intravenously (IV) in 2.5 mL of saline over 30 s 2 min before laryngoscopy. Mean arterial pressure (MAP) and heart rate (HR) were recorded at 1-min intervals for 15 min after tracheal intubation and for 5 min after skin incision. After intubation, the peak MAP values differed from the preinduction baseline MAP values by 21% ± 20%, 9% ± 12%, 1% ± 13%, -10% ± 12%, and -15% ± 13% (mean ± SD) in the control, N0.5, N1, N2, and N4 groups, respectively. However, the percent change in the pre- to postintubation MAP values (37% to 47%) was similar in all five groups. The highest postintubation HR values were recorded in the N4 group (P < 0.05 versus the other groups). However, the increases in MAP values after skin incision were the least in the N4 group. In conclusion, N1 IV, administered 2 min before laryngoscopy provides optimal control of arterial blood pressure during the postinduction period. Implications: Acute increases in blood pressure during anesthesia are undesirable in patients with preexisting cardiovascular diseases. This double-blind study found that the calcium-channel blocker, nicardipine, 1 mg intravenously 2 rain before tracheal intubation maintained hemodynamic stability during the intraoperative period.

Original languageEnglish (US)
Pages (from-to)1247-1251
Number of pages5
JournalAnesthesia and Analgesia
Volume85
Issue number6
DOIs
StatePublished - 1997

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Nicardipine
Intubation
Arterial Pressure
Hemodynamics
Maintenance
Skin
Laryngoscopy
Heart Rate
Intraoperative Period
Preexisting Condition Coverage
Rain
Calcium Channel Blockers
Double-Blind Method
Anesthetics
Cardiovascular Diseases
Anesthesia
Placebos
Blood Pressure
Control Groups

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Optimal dose of nicardipine for maintenance of hemodynamic stability after tracheal intubation and skin incision. / Song, Dajun; Singh, Harbhej; White, Paul F.; Gadhiali, Moffadal; Griffin, James D.; Klein, Kevin W.

In: Anesthesia and Analgesia, Vol. 85, No. 6, 1997, p. 1247-1251.

Research output: Contribution to journalArticle

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abstract = "To determine the optimal dose of nicardipine (N) for maintenance of hemodynamic stability during the postinduction period, we designed a randomized, double-blind, placebo-controlled, dose-ranging study using four different doses of N administered after a standardized anesthetic induction sequence. A total of 106 patients were assigned to one of the following treatment groups: saline (control), N 0.5 mg (N0.5), N 1 mg (N1), N 2 mg (N2), and N 4 mg (N4). The study medication was administered intravenously (IV) in 2.5 mL of saline over 30 s 2 min before laryngoscopy. Mean arterial pressure (MAP) and heart rate (HR) were recorded at 1-min intervals for 15 min after tracheal intubation and for 5 min after skin incision. After intubation, the peak MAP values differed from the preinduction baseline MAP values by 21{\%} ± 20{\%}, 9{\%} ± 12{\%}, 1{\%} ± 13{\%}, -10{\%} ± 12{\%}, and -15{\%} ± 13{\%} (mean ± SD) in the control, N0.5, N1, N2, and N4 groups, respectively. However, the percent change in the pre- to postintubation MAP values (37{\%} to 47{\%}) was similar in all five groups. The highest postintubation HR values were recorded in the N4 group (P < 0.05 versus the other groups). However, the increases in MAP values after skin incision were the least in the N4 group. In conclusion, N1 IV, administered 2 min before laryngoscopy provides optimal control of arterial blood pressure during the postinduction period. Implications: Acute increases in blood pressure during anesthesia are undesirable in patients with preexisting cardiovascular diseases. This double-blind study found that the calcium-channel blocker, nicardipine, 1 mg intravenously 2 rain before tracheal intubation maintained hemodynamic stability during the intraoperative period.",
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