Document Detail


Efficacy of clevidipine in controlling perioperative hypertension in neurosurgical patients: initial single-center experience.
MedLine Citation:
PMID:  20622687     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Acute blood pressure (BP) elevations in neurosurgical patients are associated with serious neurologic, cardiovascular, or surgical site complications. Clevidipine, an ultra-short-acting dihydropyridine calcium antagonist, has been shown to be efficacious and safe for acute hypertension in cardiac surgery. This study assessed the efficacy and safety of clevidipine in controlling perioperative hypertension in the neurosurgical setting.
METHODS: Patients scheduled for intracranial surgery were prospectively enrolled after giving consent. Clevidipine (0.5 mg/mL in 20% lipid solution, which was to be initiated at 10 mg/h and titrated to effect) was administered as the primary antihypertensive agent for perioperative hypertension, with target BPs of less than 130 mm Hg. Other vasoactive drugs were administered as needed for treating systolic BP (SBP) less than 90 mm Hg or greater than 130 mm Hg. The primary study endpoint was the proportion of patients not requiring rescue antihypertensives to maintain target SBP (<130 mm Hg).
RESULTS: Twenty-two patients were enrolled. One patient did not require antihypertensive therapy. Seventeen patients (17 of 21, 81%) were treated with clevidipine alone; one received clevidipine in the postanesthesia care unit only. Twenty-eight hypertensive episodes (defined as any new acute BP elevation requiring clevidipine initiation) were documented. SBP was reduced to target level within 15 minutes in 22 of 28 episodes (78.6%). Two mild hypotensive episodes occurred after the initiation of clevidipine infusion; these transient decreases in BP were treated with vasoactive drugs and resolved within 5 minutes.
CONCLUSIONS: Clevidipine is effective and safe for perioperative hypertension in patients undergoing intracranial procedures. Rapid control of BP is possible with higher starting doses. Drug effects resolved rapidly after drug discontinuation.
Authors:
Alex Bekker; Sorosch Didehvar; Sunmi Kim; John G Golfinos; Erik Parker; Andrew Sapson; Michael Haile; Richard Kline; Mitchell Lee
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgical anesthesiology     Volume:  22     ISSN:  1537-1921     ISO Abbreviation:  J Neurosurg Anesthesiol     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-16     Completed Date:  2011-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8910749     Medline TA:  J Neurosurg Anesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  330-5     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, New York University Medical Center, New York, NY 10016, USA. alex.bekker@nyumc.org
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, General
Blood Pressure / physiology
Calcium Channel Blockers / pharmacokinetics,  therapeutic use*
Female
Heart Rate / physiology
Humans
Hypertension / drug therapy*
Intensive Care
Length of Stay
Male
Middle Aged
Neurosurgical Procedures*
Perioperative Period
Pyridines / pharmacokinetics,  therapeutic use*
Treatment Outcome
Vasodilation / drug effects
Chemical
Reg. No./Substance:
0/Calcium Channel Blockers; 0/Pyridines; 0/clevidipine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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