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Comparison of clevidipine with sodium nitroprusside in the control of blood pressure after coronary artery surgery

Published online by Cambridge University Press:  11 July 2005

A. V. V. Powroznyk ,
A. Vuylsteke ,
C. Naughton ,
S. L. Misso ,
J. Holloway ,
Å. Jolin-Mellgård ,
R. D. Latimer ,
M. Nordlander  and
R. O. Feneck
A. V. V. Powroznyk
Affiliation:
Papworth Hospital, Department of Anaesthesia, Papworth Everard, Cambridge, UK
A. Vuylsteke
Affiliation:
Papworth Hospital, Department of Anaesthesia, Papworth Everard, Cambridge, UK
C. Naughton
Affiliation:
St Thomas' Hospital, Department of Anaesthetics, London, UK
S. L. Misso
Affiliation:
Papworth Hospital, Department of Anaesthesia, Papworth Everard, Cambridge, UK
J. Holloway
Affiliation:
St Thomas' Hospital, Department of Anaesthetics, London, UK
Å. Jolin-Mellgård
Affiliation:
AstraZeneca R & D Mölndal, Mölndal, Sweden
R. D. Latimer
Affiliation:
Papworth Hospital, Department of Anaesthesia, Papworth Everard, Cambridge, UK
M. Nordlander
Affiliation:
AstraZeneca R & D Mölndal, Mölndal, Sweden
R. O. Feneck
Affiliation:
St Thomas' Hospital, Department of Anaesthetics, London, UK
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Extract

Summary

Background and objective: We set out to compare the efficacy of clevidipine and sodium nitroprusside infusions in the control of blood pressure and the haemodynamic changes they produce in hypertensive patients after operation for elective coronary bypass grafting.

Methods: Thirty patients were randomly allocated to receive either clevidipine or sodium nitroprusside after their mean arterial pressure (MAP) had reached >90 mmHg for at least 10 min in the postoperative period. The MAP was continuously measured and related to time. Thus, the efficacy of the drugs in controlling arterial pressure could be inversely related to the total area under the MAP–time curve outside a target MAP range of 70–80 mmHg normalized per hour (AUCMAP mmHg min h−1). Haemodynamic variables and the number of dose-rate adjustments required to maintain MAP were also studied.

Results: There was no statistically significant difference in the efficacy (AUCMAP mmHg min h−1) of clevidipine (106 ± 25 mmHg min h−1) compared with sodium nitroprusside (101 ± 28 mmHg min h−1). Nor was any significant difference found in the total number of dose adjustments required to control MAP within the target range. The heart rate in patients receiving clevidipine increased less than in those given sodium nitroprusside. Stroke volume, central venous pressure and pulmonary artery pressure were significantly reduced upon administration of sodium nitroprusside but not of clevidipine.

Conclusions: There was no significant difference between clevidipine and sodium nitroprusside in their efficacy in controlling MAP. The haemodynamic changes, including tachycardia, were less pronounced with clevidipine than with sodium nitroprusside.

Keywords

CARDIOVASCULAR AGENTS, vasodilator agents, clevidipine, nitroprussideHAEMODYNAMICS, blood pressureMYOCARDIAL REVASCULARISATION, coronary artery bypass
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 9 , September 2003 , pp. 697 - 703
Copyright
© 2003 European Society of Anaesthesiology

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References

Vuylsteke A, Feneck RO, Jolin-Mellgård Å, et al. Perioperative blood pressure control: a prospective survey of patient management in cardiac surgery. J Cardiothorac Vasc Anesth 2000; 14: 269–273.Google Scholar
Mora CT, Dudek C, Torjman MC, White PF. The effects of anesthetic technique on the hemodynamic response and recovery profile in coronary revascularization patients. Anesth Analg 1995; 81: 900–910.Google Scholar
Estafanous FG, Tarazi RC, Viljoen JF, el-Tawil MY. Systemic hypertension following myocardial revascularization. Am Heart J 1973; 85: 732–738.Google Scholar
Mangano DT, Siliciano D, Hollenberg M, et al. Postoperative myocardial ischemia. Therapeutic trials using intensive analgesia following surgery. Anesthesiology 1992; 76: 342–353.Google Scholar
Viljoen JF, Estafanous FG, Tarazi RC. Acute hypertension immediately after coronary artery surgery. J Thorac Cardiovasc Surg 1976; 71: 548–550.Google Scholar
Roberts AJ, Niarchos AP, Subramanian VA, et al. Systemic hypertension associated with coronary artery bypass surgery. Predisposing factors, hemodynamic characteristics, humoral profile, and treatment. J Thorac Cardiovasc Surg 1977; 74: 846–859.Google Scholar
Gray RJ. Postcardiac surgical hypertension. J Cardiothoracic Anesth 1988; 2: 678–682.Google Scholar
Tinker JH, Michenfelder JD. Sodium nitroprusside: pharmacology, toxicology and therapeutics. Anesthesiology 1976; 45: 340–354.Google Scholar
Kaplan JA, Finlayson DC, Woodward S. Vasodilator therapy after cardiac surgery: a review of the efficacy and toxicity of nitroglycerin and nitroprusside. Can Anaesth Soc J 1980; 27: 254–259.Google Scholar
Amaranath L, Kellermeyer WF Jr. Tachyphylaxis to sodium nitroprusside. Anesthesiology 1976; 44: 345–348.Google Scholar
Khambatta HJ, Stone GJ, Khan E. Hypertension during anesthesia on discontinuation of sodium nitroprusside-induced hypotension. Anesthesiology 1979; 51: 127–130.Google Scholar
Benumof JL. Hypoxic pulmonary vasoconstriction and infusion of sodium nitroprusside. Anesthesiology 1979; 50: 481–483.Google Scholar
Van Zwieten PA, van Wezel HB. Antihypertensive drug treatment in the perioperative period. J Cardiothorac Vasc Anesth 1993; 7: 213–226.Google Scholar
Van Wezel HB, Koolen JJ, Visser CA, et al. The efficacy of nicardipine and nitroprusside in preventing poststernotomy hypertension. J Cardiothorac Anesth 1989; 3: 700–706.Google Scholar
Nathan HJ, Laganière S, Dubé L, et al. Intravenous nifedipine to treat hypertension after coronary artery revascularization surgery. A comparison with sodium nitroprusside. Anesth Analg 1992; 74: 809–817.Google Scholar
Fitton A, Benfield P. Isradipine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in cardiovascular disease. Drugs 1990; 40: 31–74.Google Scholar
Levy JH, Huraux C, Nordlander M. Treatment of perioperative hypertension. In: Epstein M, ed. Calcium Antagonists in Clinical Medicine. Philadelphia, USA: Hanley & Belfus, 1997: 345–358.
Ericsson H, Fakt C, Hoglund L, et al. Pharmacokinetics and pharmacodynamics of clevidipine in healthy volunteers after intravenous infusion. Eur J Clin Pharmacol 1999; 55: 61–67.Google Scholar
Kieler-Jensen N, Jolin-Mellgård Å, Nordlander M, Ricksten S-E. Coronary and systemic hemodynamic effects of clevidipine, an ultra-short-acting calcium antagonist, for treatment of hypertension after coronary artery surgery. Acta Anaesthesiol Scand 2000; 44: 186–193.Google Scholar
FDA Guidance for Industry: Computerized Systems Used in Clinical Trials. Washington, DC, USA: Department of Health and Human Services, Food and Drug Administration, April 1999.
Ericsson H. The pharmacokinetics and pharmacodynamics of clevidipine, a new ultra-short-acting calcium antagonist, in different animal species and man. Dissertation, Uppsala University, Sweden, 1999.
Bailey JM, Lu W, Levy JH, et al. Clevidipine in adult cardiac surgical patients. A dose finding study. Anesthesiology 2002; 96: 1086–1094.Google Scholar
Estafanous FG, Tarazi RC. Systemic arterial hypertension associated with cardiac surgery. Am J Cardiol 1980; 46: 685–694.Google Scholar
Epstein M, Loutzenhiser R. Calcium Antagonists and the Kidney. Philadelphia, USA: Hanley & Belfus, 1990.
Schwieler JH, Ericsson H, Löfdahl P, Thulin T, Kahan T. Circulatory effects and human pharmacology of clevidipine, a novel ultra short acting and vascular selective calcium antagonist, in hypertensive humans. J Cardiovasc Pharmacol 1999; 34: 268–274.Google Scholar
Wagenknecht LE, Furberg CD, Hammon JW, Legault C, Troost BT. Surgical bleeding: unexpected effect of a calcium antagonist. BMJ 1995; 310: 776–777.Google Scholar