Anticonvulsant activity of nicardipine in experimentally induced seizures in wistar albino rats.

Background: The objective of the study was to evaluate the anticonvulsant activity of nicardipine in wistar albino rats.Methods: Anticonvulsant activity of nicardipine in a dose 10 mg/kg, and its effect with the standard drug lamotrigine (5 mg/kg) was studied in a maximal electroshock seizures (MES) experimental animal model.Results: Nicardipine in dose of 10 mg/kg showed significant anticonvulsant effect (p<0.001) and combination with standard drug lamotrigine (p<0.001) also showed more significant anticonvulsant effect in MES model.Conclusions: Nicardipine is having anticonvulsant activity and it also potentiates the anticonvulsant effect of lamotrigine in MES model.

Development of cerebral anoxia during controlled hypotension with nicardipine or urapidil after ca-rotid endarterectomy / 中华麻醉学杂志

Objective To evaluate the development of cerebral anoxia during controlled hypoten-sion with nicardipine or urapidil after carotid endarterectomy in patients. Methods Forty-four patients of either sex, aged 48-64 yr, scheduled for elective carotid endarterectomy under general anesthesia, requi-ring controlled hypotension after operation, were divided into nicardipine group ( group N ) and urapidil group ( group U) using a random number table method, with 22 patients in each group. Nicardipine at 2. 5μg·kg-1 ·min-1 was intravenously infused in group N, and urapidil 2μg·kg-1 ·min-1 was intravenously infused in group U. After systolic blood pressure was decreased to 130-140 mmHg, the consumption of nicardipine was adjusted to 0. 2 - 0. 5 μg·kg-1 ·min-1 and the consumption of urapidil to 1-2μg·kg-1 ·min-1 in group N and group U, respectively, to maintain systolic pressure at 130-140 mmHg. Heart rate ( HR) , cardiac index ( CI) , bispectral index ( BIS) value, regional cerebral oxygen saturation (rSO2) and end-tidal pressure of carbon dioxide (PETCO2) were recorded after entering the operating room ( baseline) , at the beginning of controlled hypotension ( T1 ) , and at 5, 10, 20, 30, 60 and 120 min af-ter systolic blood pressure was decreased to the target hypotension ( T2-7 ) . Development of cerebral anoxia( the relative decrease in rSO2>12％ of the baseline value) was recorded in controlled hypotension period. Results Compared with the value at T1 , the HR at T2,3 and CI at T3-7 were significantly increased ( P<0. 05), and no significant change was found in rSO2, PETCO2 or BIS value at the other time points in group N (P>0. 05), and rSO2 was significantly decreased at T3-7 (P<0. 05), and no significant change was found in HR, CI, PETCO2 or BIS value at the other time points in group U (P>0. 05). Compared with group N, the HR at T2,3, CI at T3-7 and rSO2 at T3-7 were significantly decreased in group U (P<0. 05). The incidence of cerebral anoxia was significantly higher in group U than in group N ( P<0. 05) . Conclu-sion Controlled hypotension with nicardipine is recommended after carotid endarterectomy in order to avoid the development of cerebral anoxia in the patients.

Effect of self-made traditional Chinese medicine decoction on pregnancy outcome in patients with hypertensive disorder complicating pregnancy / 中国中西医结合急救杂志

Objective To investigate the effect of self-made traditional Chinese medicine(TCM) decoction on pregnancy outcome in patients with hypertensive disorder complicating pregnancy. Methods A total of 124 pregnant hypertensive patients admitted to the Department of Critical Care of Guizhou Provincial People's Hospital from October 2016 to October 2018 were enrolled. The 62 patients who were treated with western medicine conventional method;62 patients who were treated with self-made TCM decoction on the basis of western medicine conventional method. The western medicine conventional treatment group was given magnesium sulfate combined with nicardipine; the self-made TCM treatment group was supplemented with TCM decoction on the basis of conventional western medicine treatment (composition: uncaria, raw oyster 20 g, gastrodia elata, eucommia, salvia miltiorrhiza, medlar rehmannia glutinosa each 15 g, rhizoma, mulberry parasitic, astragalus, ophiopogonis each 10 g. Severe headache and dizziness plus tortoise shell, gentian grass 15 g, anemarrhenae 10 g; severe edema plus cassia twig, aristolochiae 15 g, astragali, ginger skin 10 g), be decocted in water for oral dose, morning and evening oral, one dose a day, 1 week for a course of treatment, the two groups were continued for 4 weeks after the evaluation of clinical efficacy. The changes of blood pressure and blood coagulation parameters, placental bed arterial hemodynamics, pregnancy outcome index were observed before and after treatment; antihypertensive effects and adverse reactions after treatment were recorded. Results After treatment, the systolic blood pressure (SBP), diastolic blood pressure (DBP), Fibrinogen (Fib), placental bed arterial pulsation index (PI), end-systolic blood flow velocity and end-diastolic blood flow velocity ratio (S/D) and resistance index (RI) in both groups were lower than those before treatment, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly longer than before treatment, and the time-averaged flow rate (TAV) increased than that before treatment; SBP, DBP, Fib, PI, S/D and RI were significantly lower in self-made TCM treatment group than those in western medicine conventional treatment group [SBP (mmHg, 1 mmHg = 0.133 kPa): 114.26±17.07 vs. 132.72±17.64, DBP (mmHg): 82.98±6.24 vs. 90.09±6.48, Fib (g/L): 3.21±0.45 vs. 3.64±0.31, PI: 0.59±0.14 vs. 0.75±0.15, S/D: 1.70±0.21 vs. 1.93±0.25, RI: 0.43±0.08 vs. 0.54±0.12, all P < 0.05], PT, APTT, TAV in self-made TCM treatment group were significantly higher than western medicine conventional treatment group [PT (s): 12.26±0.57 vs. 11.72±0.44, APTT (s): 27.11±1.34 vs. 25.69±1.48, TAV (cm/s): 15.64±2.88 vs. 12.49±2.76, all P < 0.05]. The rate of cesarean section, postpartum hemorrhage, fetal heart abnormality and neonatal asphyxia in self-made TCM treatment group were significantly lower than those in western medicine conventional treatment group [cesarean section rate: 9.84% (6/61) vs. 27.78% (15/54), postpartum hemorrhage rate: 1.64% (1/61) to 14.81% (8/54), fetal heart abnormal rate: 3.28% (2/61) vs. 16.67% (9/54), the incidence of neonatal asphyxia: 1.64% (1/61) vs. 12.96% (7/54), all P < 0.05]. The total effective rate of the self-made TCM treatment group was significantly higher than that of western medicine conventional treatment group [98.39% (61/62) vs. 87.10% (54/62), P < 0.05]. However, there was no significant difference in the incidence of adverse reactions between the self-made TCM treatment group and western medicine conventional treatment group [16.39% (10/61) vs. 16.67% (9/54), P > 0.05]. Conclusion Self-made TCM decoction can improve the maternal and infant outcomes by improving the hypercoagulable state and placental hemodynamics in hypertensive patients with hyperthyroidism, the antihypertensive effect is remarkable and the safety is good.

The relaxant effect of nicardipine on the isolated uterine smooth muscle of the pregnant rat

BACKGROUND: Nicardipine, a calcium channel blocker, is used to treat hypertension in pregnancy or preterm labor. The current study was conducted to investigate the relaxant effects of nicardipine on the isolated uterine smooth muscle of the pregnant rat.METHODS: We obtained uterine smooth muscle strips from pregnant female SD rats. After uterine contraction with oxytocin 10 mU/ml, we added nicardipine (10⁻¹² to 10⁻⁸ M) accumulatively every 20 min. We recorded active tension and frequency of contraction, and calculated EC₅ (effective concentration of 5% reduction), EC₂₅, EC₅₀, EC₇₅, and EC₉₅ of active tension and frequency of contraction using a probit model.RESULTS: Nicardipine (10⁻¹² to 10⁻⁸ M) decreased active tension and frequency of contraction in a concentration-dependent manner. The EC₅₀ and EC₉₅ of nicardipine in the inhibition of active tension of the uterine smooth muscle were 2.41 × 10⁻¹⁰ M and 3.06 × 10⁻⁷ M, respectively. The EC₅₀ and EC₉₅ of nicardipine in the inhibition of frequency of contraction of the uterine smooth muscle were 9.04 × 10⁻¹¹ and 4.18 × 10⁻⁷ M, respectively.CONCLUSIONS: Nicardipine relaxed and decreased the frequency of contraction of the uterine smooth muscle in a concentration-dependent pattern. It might be possible to adjust the clinical dosage of nicardipine in the obstetric field based on our results, but further clinical studies are needed to confirm them.

Use of methylene blue in vasoplegic syndrome that developed during non-cardiac surgery: A case report

BACKGROUND: Vasoplegic syndrome is an increasingly recognized disease in perioperative medicine and is characterized by severe hypotension, normal or elevated cardiac output, and decreased systemic vascular resistance. It occurs commonly after cardiopulmonary bypass but may also occur after other types of surgery.CASE: Vasoplegic syndrome developed in our patient during posterior lumbar interbody fusion because of administering nicardipine after phenylephrine. However, the blood pressure did not increase as expected despite simultaneous use of norepinephrine and vasopressin to increase the reduced systemic vascular resistance.CONCLUSIONS: We present a case of vasoplegic syndrome that developed during posterior lumbar interbody fusion and was treated successfully with methylene blue.

A comparison between nicardipine and urapidil used for management of intracerebral hemorrhage / 中华急诊医学杂志

Objective To compare the efficacy and safety of nicardipine versus urapidil in blood pressure (BP) management during the acute phase of intracerebral hemorrhage (ICH).Methods ICH patients admitted in Emergency Intensive Care Unit of Shenzhen People's Hospital from March,2013 through March,2016 were retrospectively studied.Patients were enrolled as nicardipine group or urapidil group depending on the initial antihypertensive drug given at admission.The differences in rate of patients reached the goal BP within the first 24 h,time required for getting goal BP,blood pressure variability (BPV),rebleeding or hematoma expansion during the first 24 h,cerebral state index (CSI) within 7 days and 28-day mortality were compared between the two groups.The differences in adverse events including bradycardia,tachycardia and hypotension were also compared between two groups.An independent t test and x2 test were performed to compare different variables.An analysis of variance of repeated measurement was performed to compare CSI within 7 days between two groups.Results Seventy-seven patients were included with 42 in nicardipine group and 55 in urapidil group.Rate of patients getting goal BP in nicardipine group was (94±5)％ and (86±11)％ in urapidil group (P＜0.01).Time required to get goal BP was (35 ± 28) min in nicardipine group and (52 ± 37) min in urapidil group (P =0.02).BPV was (11.23 ± 2.38) in nicardipine group and (13.16 ± 3.15) in urapidil group (P =0.003).Rebleeding or hematoma expansion rate during the first 24 h and 28-day mortality rate were comparable between the two groups (P ＞ 0.05).Through analysis of variance of repeated measurement,CSI in nicardipine group improves more rapidly than that in urapidil group (F =1 581.115,P =0.000).Hypotension,bradycardia and tachycardia were also comparable between groups (P ＞ 0.05).Conclusion Compared with urapidil,nicardipine produces effect more rapidly with more stable BP and higher rate of patients with ICH getting goal BP.Moreover,the application of nicardipine may be better to improve the CSI of ICH patients.

The effects of nicardipine induced controlled hypotension in patients underwent orthognathic surgery: A systematic review and meta-analysis / 实用口腔医学杂志

Objective:To evaluate the clinical effects of nicardipine for induced controlled hypotension in patients underwent orthognathic surgery.Methods:The related trails were searched from English and Chinese literature databases.The quality of the RCTs was evaluated by 2 indepandent reviewers.The data were statistical analyzed using the Rev Man 5.3.3 software.Results:5 RCTs with 248 patients were included.Meta-analysis and descriptive analysis indicated that blood loss of nicardipine group was more than that of remifentanil group [WMD =43.85,95％ CI(20.52,67.18)].There was no significant difference in blood loss between nicardipine group and dexmedetomidine group and nitroglycerin group.There was no significant difference in transfusion between nicardipine group and the control group.Nicardipine increased the heart rate during controlled hypotension and caused QT prolongation (P ＜ 0.001).Nicardipine had no adverse effects on cerebral oxygen saturation and neurophysiological function.Urinary N-acetyl-1-b-D-glucosaminidase was lower in nicardipine group than that in remifentanil group (P ＜ 0.05).Conclusion:Nicaridpine is effective in the induced controlled hypotension during orthognathic surgery,with potential renal protective effect.However,it is not better than the remifentanil on reducing the blood loss.Nicardipine can increase the heart rate and prolong the QT interval during the controlled hypotension.

Nicardipine′s Influence on Post Operation Cognitive Dysfunction in Senior Patient after Hip Joint Replacement Operation / 现代医院

Objective To discuss nicardipin′s influence on post operation cognitive dysfunction (POCD) in senior patient after hip joint replacement operation.Methods 180 senior patient, who received selective unilateral hip joint replacement operation between October 2015 and October 2016 under the condition of combined spinal-epidural anesthesia (CSEA) were randomly divided into Group A (with nicardipine) and Group B (without nicardipine).Nicardipine was only appropriately pumped into vein in time in Group A.MAP was observed and recorded 30 minutes after starting the operation and at the end of the operation.Mini-mental state examination (MMSE) was applied to score the patient one day before, one day, three days and five days after operation, and the number of POCD was recorded.Results Compared with Group B, Group A was obviously lower in MAP level (P<0.05) after 30 minutes.MMSE score of Group A was obviously higher (P<0.01) one day after operation.The number of POCD in Group A was 8 (8.89%) significantly lower than than that of Group B (19, 21.11%).Conclusion Nicardipine could maintain hemodynamic stability of senior patients receiving selective unilateral hip joint replacement operation under the CSEA and prevent POCD to a certain extent.

Comparison of urapidil and nicardipine in the treatment of chronic renal failure patients with hypertensive emergencies / 药学实践杂志

Objective To study the efficacies and adverse reactions of urapidil and nicardipine in the treatment of the chronic renal failure patients with hypertensive emergencies .Methods 59 chronic renal failure patients with hypertensive emer-gencies were randomly divided into nicardipine treatment group and urapidil treatment group .The patients in the nicardipine group were given a 1 mg nicardipine intravenous injection ,and 30-100 μg/min intravenous transfusion was given continuously . The patients in the urapidil group were given a 12 .5 mg urapidil intravenous injection ,and 150-500μg/min intravenous trans-fusion was given continuously .The dosage were changed according to the patients′blood pressure in both of the groups .The patients′blood pressure ,heart rate and adverse reactions were recorded .Results The patients′blood pressure in both of the groups were significantly lower after treatment (P<0 .05) .The SBP in nicardipine treatment group was significant lower than SBP in urapidil treatment group in the first hour after treatment (P<0 .05) .There was no significant difference in SBP be-tween the two groups 2 hours after treatment (P>0 .05) .There was no significant difference in DBP between the two groups after treatment (P>0 .05) .In the nicardipine group ,the heart rate rose after the treatment ,the difference was statistically significant (P<0 .05) .While in the urapidil group ,the heart rate went down after the treatment ,and the difference was statis-tically significant (P<0 .05) .There was no significant difference in adverse reactions between the two groups (P>0 .05) . Conclusion Both of nicardipine and urapidil were effective in the treatment of chronic renal failure patients with emergency hy-pertensive .Nicardipine was more effective in reducing the SBP in the first stage of treatment .

Effect of nicardipine on hepatic blood flow in patients undergoing cardiac valve replacement with cardiopulmonary bypass / 中华麻醉学杂志

Objective To investigate the effect of nicardipine on the hepatic blood flow in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Twenty-six patients of both sexes,aged 30-64 yr,weighing 50-90 kg,with New York Heart Association Ⅱ or Ⅲ,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective mitral or aortic valve replacement,were randomly divided into either nicardipine group (group P,n =13) or control group (group C,n =13) using a random number table.Transesophageal echocardiography was used to measure the indexes of blood flow in the hepatic vein.Nicardipine 0.2-0.5 μg · kg-1 · min-1 was infused intravenously starting from beginning of CPB,and the infusion was stopped at termination of CPB in group P.After induction of general anesthesia,at 30 min after beginning of CPB,at 10 min before termination of CPB,and at 30 min after termination of CPB,the diameter of the right and middle hepatic veins (DR and DM),blood flow index in the right hepatic vein (QIR),blood flow index in the middle hepatic vein (QIM),and total blood flow index in the hepatic vein (QIR+M) were recorded,and the percentage of QIR+M in cardiac index (CI) (QIR+M/CI) or in QICPB (QIR+M/QICPB) was calculated.Before operation,and at 1 and 2 days after operation,blood samples were obtained from the median cubital vein for determination of total bilirubin,alanine aminotransferase,and aspartate aminotransferase (AST) levels in serum.Results Compared with group C,the serum levels of AST at 1 day after operation and serum levels of AST at 1 day after operation were significantly decreased (P＜0.05),and no significant change was found in DR,DM,QIR,QIM,QIR+M,QIR+M/CI and QIR+M/QICPB at each time point in group P (P＞0.05).Conclusion Nicardipine (0.2-0.5 μg · kg-1 · min-1) infused intravenously during CPB exerts no effect on the hepatic blood flow,and it is not related to the improvement in hepatic function in the patients undergoing cardiac valve replacement.

A comparative study of dexmedetomidine and nicardipine in the induction of controlled hypotension in the patients during orthognathic surgery / 实用口腔医学杂志

Objective:To compare the effects of dexmedetomidine and nicardipine in the induction of controlled hypotension in the pa-tients during orthognathic surgery.Methods:60 patients were randomly divided into 2 groups(n =30).The patients in group D were intravenously pumped with 1 μg/kg dexmedetomidine for 10 min followed by 0.2 ~0.7 μg/(kg·h).Those in group N were pumped with nicardipine for an initial dose of 0.75 μg/(kg·min)followed by 0.2 ~0.5 μg/(kg·min).HR,MAP were recorded before in-duction (T0 ),start of hypotension(T1 ),10 min(T2 ),20 min (T3 ),30 min(T4 )and 60 min(T5 )after hypotension,10 min(T6 ), 30 min(T7 )after stop of hypotension,and at the end of surgery(T8 ).The remifentanil dosage was recorded.Riker sedation-agitation score (RSAS)before extubation and Ramsay score 5 min after extubation were observed.Results:Comparing with T0 ,MAP at T2 -T7 in the 2 groups were significantly decreased(P <0.05).The intraoperative remifentanil consumption in group D was significantly lower than that in group N (P <0.05).The Ramsay score in group D was significantly higher than that in group N(P <0.05).The RSAS in group D was significantly lower than that in group N(P <0.05).Conclusion:Both dexmedetomidine and nicardipine are safe for con-trolled hypotension in providing ideal surgical field during orthognathic surgery.Dexmedetomidine can produce more stable hemdynamic indexes and offer more advantage in postoperative sedation.

Effects of Nicardipine on Apoptosis in Ischemia Reperfusion Myocardium of Rabbits / 中国医科大学学报

Objective To investigate the effects of nicardipine on apoptosis in ischemia?reperfusion myocardium of rabbits. Methods Forty New Zealand rabbit were randomly divided into 4 groups:control group(group A),ischemia group(group B),ischemia?reperfusion group(group C),ni?cardipine treatment group(group D). Ischemia?reperfusion model was established by left circumflex branch coronary artery ligation for 40 min,fol?lowed by 120 min reperfusion. Apoptotic cardiomyocyte was detected using the analysis for the exposure of phosphatidyl?serine ( Annexin V)meth?od. Results Myocardial cell damage was lower in D group than that in group B and group C from pathology(P0.05). Conclusion Nicardipine horizon can reduce the myocardial cell apoptosis in rabbits with myocardial ischemic reperfusion injury.

Effect of nicardipine on lung injury in a fast floating escape induced decompression sickness animals / 军事医学

Objective To study the effect of nicardipine on fast floating escape induced lung injury in animal models with decompression sickness .Methods Sixty male SD rats were randomly and evenly divided into three groups:blank control, control and nicardipine groups .The nicardipine group was given nicardipine 50 mg/kg orally 0.5 h before entrance.In the control group, rats were given an equal volume of saline 0.5 h before entrance.The blank control group only stayed in the vehicle without any pressurized procedure .The air was pressurized at the 2t/7 exponential rate to 1.5 Mpa which was maintained for 4 min, and then uniformly decompressed to atmospheric pressure .The extravehicular survival and lung pathology were observed in rats after 0.5 h, IL1-βand TNF-αexpression levels were detected by ELISA , and the Caspase 3 expression in lung tissue was detected by Western blot .Results The incidence and mortality rate were 80%and 50%respectively in control group ,and 100%and 80%in the experimental group .The surviving animals in the two groups suffered from alveolar and interstitial lung hemorrhage , with widened interstitial lung .IL1-βin the experimental group was significantly higher than in the normal control group , while TNF-αhad no significant change .After nicardipine treatment pro-caspase 3 did not change significantly , but cleaved-caspase 3 increased significantly .Conclusion Nicardipine can aggravate lung injury caused by fast floating escape-induced decompression sickness if used before decompression.

Spectrophotometric determination of amlodipineand nicardipine in pharmaceutical formulations viabinary complex formation with eosin Y.

A validated simple and selective spectrophotometric method was developed for the selective determination of amlodipine and nicardipine in bulk powders and pharmaceutical formulation. The proposed method was based on the formulation of a binary complex between either of the studied drugs and eosin Y in aqueous buffered medium. The surfactant, methylcellulose, was added to enhance the solubility of the formed complex. The binary complexes showed absorption maxima at 549 nm. The different experimental parameters affecting the development of stability of the colors were studied and optimized. Under the optimum reaction conditions, linear relationship with good correlation coefficients (0.9981 and 0.9995) were found between the absorbances and the concentrations of amlodipine and nicardipine respectively in the range of 5-60 g/ml for both drugs. The limits of detection were 1.8 and 1.2 g/ml while the limits of quantitation were 6.0 and 3.6 g/ml for both drugs respectively. The analytical parameters were fully validated and results were satisfactory. No interference was observed from the excipients that are commonly present in pharmaceutical formulations. The proposed method was successfully applied to the analysis of the cited drugs in some pharmaceutical formulations. The mean percentage recoveries were 100.04 ± 0.83 and 99.98 ± 0.80. The results obtained are reproducible with a coefficient of variation less than 2% and were in good agreement with those obtained using the reference methods.

Effectiveness of Nicardipine for Blood Pressure Control in Patients with Subarachnoid Hemorrhage

OBJECTIVE: The purpose of the study is to determine the effectiveness and safety of nicardipine infusion for controlling blood pressure in patients with subarachnoid hemorrhage (SAH). METHODS: We prospectively evaluated 52 patients with SAH and treated with nicardipine infusion for blood pressure control in a 29 months period. The mean blood pressure of pre-injection, bolus injection and continuous injection period were compared. This study evaluated the effectiveness of nicardipine for each Fisher grade, for different dose of continuous nicardipine infusion, and for the subgroups of systolic blood pressure. RESULTS: The blood pressure measurement showed that the mean systolic blood pressure / diastolic blood pressure (SBP/DBP) in continuous injection period (120.9/63.0 mmHg) was significantly lower than pre-injection period (145.6/80.3 mmHg) and bolus injection period (134.2/71.3 mmHg), and these were statistically significant (p 0.05). Furthermore, controlling blood pressure was more effective when injecting higher dose of nicardipine in higher SBP group rather than injecting lower dose in lower SBP group, and it also was statistically significant (p < 0.05). During the infusion, hypotension and cardiogenic problems were transiently combined in five cases. However, patients recovered without any complications. CONCLUSION: Nicardipine is an effective and safe agent for controlling acutely elevated blood pressure after SAH. A more systemic study with larger patients population will provide significant results and will bring solid evidence on effectiveness of nicardipine in SAH.

Antihypertensive Treatment of Acute Intracerebral Hemorrhage by Intravenous Nicardipine Hydrochloride: Prospective Multi-Center Study

The authors performed a multicenter prospective study to evaluate the feasibility and safety of intravenous nicardipine hydrochloride for acute hypertension in patients with intracerebral hemorrhage (ICH). This study included 88 patients (mean age: 58.3 yr, range 26-87 yr) with ICH and acute hypertension in 5 medical centers between August 2008 and November 2010, who were treated using intravenous nicardipine. Administration of nicardipine resulted in a decrease from mean systolic blood pressure (BP) (175.4 +/- 33.7 mmHg) and diastolic BP (100.8 +/- 22 mmHg) at admission to mean systolic BP (127.4 +/- 16.7 mmHg) and diastolic BP (67.2 +/- 12.9 mmHg) in 6 hr after infusion (P or = 2) was observed in 2 (2.2%) of 88 patients during the treatment. Aggressive nicardipine treatment of acute hypertension in patients with ICH can be safe and effective with a low rate of neurological deterioration and hematoma expansion.

Efficacy of dexmedetomidine combined with nicardipine for controlled hypotension in patients undergoing orthopedic surgery / 中华麻醉学杂志

Objective To evaluate the efficacy of dexmedetomidine combined with nicardipine for controlled hypotension in patients undergoing orthopedic surgery.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 32-64 yr,weighing 45-76 kg,scheduled for orthopedic surgery under general anesthesia,were randomly allocated into 2 groups (n =30 each):nicardipine group (group N) and dexmedetomidine + nicardipine group (group DN).A loading dose of dexmedetomidine 1 μg/kg was injected intravenously 10 min before induction of anesthesia,followed by infusion at 0.5.μg ·kg-1 ·h-1 until 30 min before the end of operation in group DN.While the equal volume of normal saline was given in group N.BIS value was maintained at 40-49 during operation.Controlled hypotension was performed with iv infusion of nicardipine at a rate of 2.5 μg· kg-1 · min-1,MAP was reduced to 60-65 mm Hg,then the infusion rate was adjusted to maintain MAP at this level,and nicardipine infusion was stopped while closing the skin.The amount of anesthetics and nicardipine consumed,blood loss,volume of fluid infused,and allogeneic blood transfusion during operation and the operation time,emergence time and extubation time were recorded.Results No patient received allogeneic blood transfusion in both groups.Compared with group N,the amount of anesthetics and nicardipine consumed was significantly decreased,the emergence time and extubation time were significantly shortened (P ＜ 0.05),and no significant change in the volume of fluid infused and blood loss was found in group DN (P ＞ 0.05).Conclusion Dexmedetomidine combined with nicardipine can reduce the requirements for nicardipine and anesthetics during operation,shorten the time for recovery from anesthesia and improve the efficacy of nicardipine for controlled hypotension when used for controlled hypotension in patients undergoing orthopedic surgery.

The Effect of Intra-Arterial Low-Dose Nicardipine for the Treatment of Aneurysmal Subarachnoid Hemorrhage-associated Vasospasm / 대한뇌혈관외과학회지

OBJECTIVE: Delayed cerebral ischemia due to vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is a leading cause of morbidity and mortality. Recent reports have confirmed that intra-arterial infusion of calcium-channel blockers, which are widely used to counteract vasospasm, is effective for treating SAH with a low risk of complications. Here we report on our experience with intra-arterial nicardipine angioplasty in a consecutive series of 32 patients with SAH. METHODS: This retrospective review evaluated a series of 32 consecutive patients with symptomatic vasospasm that was treated with intra-arterial nicardipine. The patients included in the study were diagnosed with aneurysmal SAH between January 2007 and February 2011. All the patients underwent microsurgical clipping or endovascular coiling. Angioplasty using intra-arterial nicardipine was performed in those patients who were refractory to medical therapy such as triple H therapy. RESULTS: The 32 patients underwent a total of 55 procedures. The total amount of nicardipine used in each angioplasty procedure did not exceed 12 mg, with a maximum dose of 3 mg for each vessel. The Glasgow Coma Scale (GCS) score improved in all patients with an average improvement of 2.4 (range : 1~5). During angioplasty, there were no complications such as thromboembolic events and/or acute transitory spasm. The clinical results were evaluated using the modified Rankin Scale (mRS). Good outcomes (mRS 0~2) were determined in 19 (63.3%) of the 30 patients. The 11 patients (36.7%) with poor outcomes initially had a high Hunt and Hess grade (III or IV) or they had intra-operative complications (mRS: 3~6). CONCLUSION: Our study results support the effectiveness and safety of low-dose nicardipine when performing intra-arterial angioplasty for the treatment of vasospasm after aneurysmal SAH.

Optimal dose of esmolol in combination with nicardipine to stabilize cardiovascular response during anesthetic induction in ambulatory patients

BACKGROUND: We conducted this study to determine the optimal dose of esmolol in combination with nicardipine to block undesirable cardiovascular responses effectively during endotracheal intubation in patients undergoing ambulatory surgery. METHODS: One-hundred and twenty patients were randomly allocated into one of the following 4 groups: the E0 group (no esmolol, control), the E0.25 group (esmolol 0.25 mg/kg), the E0.5 group (esmolol 0.5 mg/kg) and the E1.0 group (esmolol 1.0 mg/kg). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.9mg/kg. All the patients received 20 microgram/kg of nicardipine, and esmolol was subsequently administered according to the group. Endotracheal intubation was performed 150 seconds after inhalation of 6 vol% of desflurane. The systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure and the heart rate (HR) were measured before and immediately after intubation, and at 1, 3, 5, and 10 minutes after intubation. The rate changes were calculated using the baseline values as the standard (change rate [%] = measured value/baseline value x 100). RESULTS: There were no significant differences in SBP, DBP and MBP after intubation between the control and the experimental groups. The rate changes of HR in the experimental groups were significantly lower than those in the control group throughout the study period (P < 0.05). However, there was no difference in therate changes of HR among the experimental groups. CONCLUSIONS: The combination of nicardipine 20 microgram/kg and esmolol 0.25 mg/kg can most effectively and safely attenuate thecardiovascular responses during anesthetic induction in ambulatory patients.

Prolonged effect of nicardipine used for deliberate hypotension in scoliosis surgery: A case report

Postoperative respiratory complications following scoliosis surgery are high incidence. In this case, fifty year-old male patient was admitted for thoracolumbar screw fixations and developed postoperative pulmonary edema. This was most likely due to prolonged administration of nicardipine, which over time may inadvertently cause hypotension. As a result of volume overload, interstitial pulmonary edema and pleural effusion occurred. Moreover, pulmonary edema and pleural effusion appeared on the right side first and spread to the left. This phenomenon could be explained by the positioning of scoliosis patient. The cause of pulmonary edema was volume overload initiated by prolonged effect of nicardipine.