Document Detail

Management of hypertensive emergencies in acute brain disease: evaluation of the treatment effects of intravenous nicardipine on cerebral oxygenation.
MedLine Citation:
PMID:  19035721     Owner:  NLM     Status:  MEDLINE    
OBJECT: Inappropriate sudden blood pressure (BP) reductions may adversely affect cerebral perfusion. This study explores the effect of nicardipine on regional brain tissue O(2) (PbtO(2)) during treatment of acute hypertensive emergencies. METHODS: A prospective case-control study was performed in 30 patients with neurological conditions and clinically elevated BP. All patients had a parenchymal PbtO(2) and intracranial pressure bolt inserted following resuscitation. Using a critical care guide, PbtO(2) was optimized. Intravenous nicardipine (5-15 mg/hour) was titrated to systolic BP < 160 mm Hg, diastolic BP < 90 mm Hg, mean arterial BP (MABP) 90-110 mm Hg, and PbtO(2) > 20 mm Hg. Physiological parameters-intracranial pressure, PbtO(2), central venous pressure, systolic BP, diastolic BP, MABP, fraction of inspired O(2), and cerebral perfusion pressure (CPP)-were compared before infusion, at 4 hours, and at 8 hours using a t-test. RESULTS: Sixty episodes of hypertension were reported in 30 patients (traumatic brain injury in 13 patients; aneurysmal subarachnoid hemorrhage in 11; intracerebral and intraventricular hemorrhage in 3 and 1, respectively; arteriovenous malformation in 1; and hypoxic brain injury in 1). Nicardipine was effective in 87% of the patients (with intravenous beta blockers in 4 patients), with a 19.7% reduction in mean 4-hour MABP (115.3 +/- 13.1 mm Hg preinfusion vs 92.9 +/- 11.40 mm Hg after 4 hours of therapy, p < 0.001). No deleterious effect on mean PbtO(2) was recorded (26.74 +/- 15.42 mm Hg preinfusion vs 27.68 +/- 12.51 mm Hg after 4 hours of therapy, p = 0.883) despite significant reduction in CPP. Less dependence on normobaric hyperoxia was achieved at 8 hours (0.72 +/- 0.289 mm Hg preinfusion vs 0.626 +/- 0.286 mm Hg after 8 hours of therapy, p < 0.01). Subgroup analysis revealed that 12 patients had low pretreatment PbtO(2) (10.30 +/- 6.49 mm Hg), with higher CPP (p < 0.001) requiring hyperoxia (p = 0.02). In this group, intravenous nicardipine resulted in an 83% improvement in 4- and 8-hour PbtO(2) levels (18.1 +/- 11.33 and 19.59 +/- 23.68 mm Hg, respectively; p < 0.01) despite significant reductions in both mean MABP (120.6 +/- 16.65 vs 95.8 +/- 8.3 mm Hg, p < 0.001) and CPP (105.00 +/- 20.7 vs 81.2 +/- 15.4 mm Hg, p < 0.001). CONCLUSIONS: Intravenous nicardipine is effective for the treatment of hypertensive neurological emergencies and has no adverse effect on PbtO(2).
Pradeep K Narotam; Varun Puri; John M Roberts; Charles Taylon; Yashail Vora; Narendra Nathoo
Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  109     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-27     Completed Date:  2009-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1065-74     Citation Subset:  AIM; IM    
Division of Neurosurgery, Creighton University Medical Center, Omaha, Nebraska, USA.
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MeSH Terms
Acute Disease
Antihypertensive Agents / administration & dosage,  adverse effects,  therapeutic use*
Blood Pressure / drug effects,  physiology
Brain / metabolism
Brain Injuries / physiopathology*
Cerebral Hemorrhage / physiopathology*
Hypertension / drug therapy*,  physiopathology
Hypoxia, Brain / physiopathology
Infusions, Intravenous
Intracranial Arteriovenous Malformations / physiopathology*
Middle Aged
Nicardipine / administration & dosage,  adverse effects,  therapeutic use*
Oxygen / metabolism
Prospective Studies
Subarachnoid Hemorrhage / physiopathology*
Reg. No./Substance:
0/Antihypertensive Agents; 55985-32-5/Nicardipine; 7782-44-7/Oxygen

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

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