title: Antihypertensive and anti-ischemic effects of nicardipine and nitroprusside in patients undergoing coronary artery bypass grafting.
abstract: The efficacy of nicardipine vs nitroprusside in controlling hypertension after sternotomy was compared in 120 patients undergoing coronary artery bypass grafting and anesthetized with fentanyl (100 micrograms/kg). All had good left ventricular function and had been receiving long term oral beta-blocking therapy. Patients were randomly allocated to 1 of 3 groups: group C, the control (n = 40), received no vasodilator; group N (n = 40) received intravenous nicardipine at an initial rate of 3 micrograms/kg/min; and group S (n = 40) received intravenous nitroprusside at an initial rate of 1 microgram/kg/min. Vasodilator infusion was begun before surgery and infusion rates were adjusted to maintain systolic blood pressure between 80 and 120% of postintubation (baseline) values. Additional measurements were obtained before incision and after sternotomy. In groups N and S, arterial blood pressure was effectively controlled in all patients. Before the incision, pulmonary artery pressure decreased in group S and systemic vascular resistance decreased in groups N and S. After sternotomy, mean arterial pressure, heart rate, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index and rate-pressure product increased in group C. At this time, pulmonary artery pressure returned to baseline values in group S. In groups N and S, heart rate, cardiac index and rate-pressure product increased, but, compared with baseline values, systemic vascular resistance remained low after sternotomy. Ischemic changes were seen in the electrocardiogram in 11 patients (28%) in group C, 10 patients (25%) in group S and 4 patients (10%) in group N. The concentration of creatine phosphokinase MB was not significantly different in the first 24 postoperative hours in any group.
authors.affiliation: Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: H B
authors.initials: HB
authors.lastname: van Wezel
authors.forename: J J
authors.initials: JJ
authors.lastname: Koolen
authors.forename: C A
authors.initials: CA
authors.lastname: Visser
authors.forename: J P
authors.initials: JP
authors.lastname: Dijkhuis
authors.forename: I
authors.initials: I
authors.lastname: Vergroesen
authors.forename: A C
authors.initials: AC
authors.lastname: Moulijn
authors.forename: L
authors.initials: L
authors.lastname: Deen
mesh_terms: D000368:Aged; D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000517:prevention & control; D004562:Electrocardiography; D005283:Fentanyl; D005292:Ferricyanides / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D007262:Infusions, Intravenous; D008875:Middle Aged; D009529:Nicardipine / Q000627:therapeutic use*; D009599:Nitroprusside / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication; D011897:Random Allocation
chemical_list: D005292:Ferricyanides; D009599:Nitroprusside; D009529:Nicardipine; D005283:Fentanyl