Long-Term Hypotensive Technique With Nicardipine and Nitroprusside During Isoflurane Anesthesia for Spinal Surgery

Abstract

Short-term infusion of nicardipine can be used to induce deliberate hypotension but may result in plasma drug accumulation. To assess long-term nicardipine administration for deliberate hypotension in 10 patients in a moderately hemodiluted state who were undergoing spinal surgery, hemodynamics and plasma nicardipine concentrations were concomitantly measured before and 20, 80, and 140 min after starting nicardipine, at drug discontinuation, and 20 and 80 min later. A dose of 6.2 ± 0.9 mg (mean ± SEM) of nicardipine was initially required to obtain mean arterial blood pressures at 55--60 mm Hg. Maintenance doses of nicardipine were 3--5 mg/h. The duration of nicardipine administration was 270 ± 20 mins (mean ± SEM). Hypotension was associated with decreased systemic and pulmonary vascular resistances, increased cardiac index, and decreased arteriovenous difference in O2 contents. Only two patients required homologous blood transfusion. Plasma nicardipine concentrations peaked at 110 ± 21 ng/mL (mean ± SEM) and then decreased to 38 ± 11 ng/mL (mean ± SEM) without changes in arterial blood pressure. After vasodilator discontinuation, hypotension was observed during a mean time of 43 min (range 27--88 min) despite plasma concentrations