Abstract
Previous studies have reported haemodynamic interactions between dihydropyridine calcium antagonists and general anaesthesia. During anaesthesia for intracranial aneurysm surgery, we prospectively compared haemodynamic values obtained from 13 patients being treated with nicardipine HCl (0.15 mg · kg-1 · hr-1 IV) for cerebral vasospasm against values obtained from 11 untreated controls. Prior to induction of anaesthesia, nicardipine-treated patients had significantly elevated mean ± SD cardiac index (5.67 ± 1.30 vs 3.99 ± 0.73 L · min-1 · m-1) while MAP (86 ± 10 vs 99 ± 14 mmHg) and systemic vascular resistance (647 ± 227 vs 1141 ± 404 dynes · sec-1 · cm-1) were reduced. Heart rate, CVP, and PACWP were similar between groups. Anaesthesia induction and tracheal intubation resulted in similar haemodynamic values between groups with the exception of CVP (10 ± 5 vs 5 ± 2 mmHg) and PACWP (15 ± 5 vs 8 ± 3 mmHg) which were elevated in the nicardipine group (P < 0.01). Mannitol infusion and deliberate hypotension resulted in nearly identical haemodynamic responses in both groups. Nicardipine-treated patients required more intravenous fluids during the operative procedure (2.4 ± 0.3 L vs l.5 ± 0.4 L, P < 0.05) and were less likely to require isofturane supplementation to morphine sulphatel nitrous oxide anaesthesia (P < 0.01). In summary, our experience with nicardipine HCl revealed no major untoward
Résumé
Des études antérieures ont rapporté des intéractions hémodynamiques entre les antagonistes du calcium dihydropyridine et ľanesthésie générale. Durant ľanesthésie pour résection ďun anéurysme intracrânien, on a comparé ďune façon prospective les valeurs hémodynamiques obtenues chez treize patients ayant été traités avec la nicardipine HCl (0.15mg·kg-1hre-1 IV) pour vasospasme cérébral avec des valeurs obtenues chez onze patients contrôle non traités. Avant ľinduction, les patients traités à la nicardipine avaient une élévation significative de la valeur moyenne ± SD de ľindex cardiaque (5.67 ± 1.30 vs 3.99 ±0.73 L·min·-1m-1) alors que la pression artérielle moyenne (86 ± 10 vs 99 ± 14 mmHg) et la résistance vasculaire systémique (647 ± 227 vs 1141 ± 404 dynes·sec-1 ·cm-1) étaient diminuées. La fréquence cardiaque, la pression veineuse centrale et la pression bloquée de ľartère pulmonaire étaient similaires dans les deux groupes. Ľinduction de ľanesthésie et ľintubation ont produit des valeurs hémodynamiques similaires entre les groupes à ľexception de la pression veineuse centrale (10 ± 5 vs 4 ± 2 mmHg) et la pression bloquée de ľartère pulmonaire (15 ± 5 vs 8 ± 3 mmHg) qui étaient élevées dans le groupe nicardipine (P < 0.01). La perfusion de mannitol et ľhypotension contrôlée ont amené des réponses hémodynamiques quasi identiques dans les deux groupes. Les patients traités à la nicardipine ont requis plus de liquide lors de la procédure chirurgicale (2.4 ± 0.3 Lvs 1.5 ± 0.4 L, P < 0.05) et avaient tendance à recevoir moins ďisoflurane supplémentaire lors ďune anesthésie au sulfate de morphinelprotoxyde ďazote (P < 0.01). En résumé, notre expérience avec HCl nicardipine n’a pas démontré ďeffets secondaires sur la stabilité hémodynamique peropératoire malgré la continuation de la thérapie antispasmodique avec ce vasodilatateur.
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Warner, D.S., Sokoll, M.D., Maktabi, M. et al. Nicardipine HCL: clinical experience in patients undergoing anaesthesia for intracranial aneurysm clipping. Can J Anaesth 36, 219–223 (1989). https://doi.org/10.1007/BF03011449
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DOI: https://doi.org/10.1007/BF03011449